follow-up which is at odds with these clinical guidelines. This should not be a concern where the trial has been through the appropriate ethical approval. Appendix 1- Primary care referral guidelines for skin cancer Premalignant lesions May be treated by any GP in the community Includes actinic keratoses, Bowens disease (SCC in situ) High Risk BCC Refer to core member of Local MDT Suspected BCCs should usually be referred as High risk of incomplete excision and recurrence, defined as: routine. Consider 2 week referral if there is particular recurrent BCCs concern that delay may have an impact BCCs on the head (face and scalp) because of site or size of lesion. large BCCs > 2cm diameter (unless they are superficial BCCs see below) lesions that have a clinical appearance of morphoeic, infiltrative or basosquamous lesions with poorly defined margins BCCs in patients who are immunosuppressed or have Gorlin‟s syndrome BCCs located over important underlying anatomical structures (for example, major vessels or nerves) or where primary surgical closure may be difficult (for example, digits or front of shin). Extended Low Risk BCC Refer to either There is no diagnostic uncertainty that the Core member of local lesion is a primary nodular low-risk BCC and it MDT Or meets the following criteria: Group 3 GPwSI in dermatology and skin surgery The patient with BCC is not: Or aged 24 years or younger (that is, a Group 3a GPwSI in skin lesions child or young adult) and skin surgery immunosuppressed or has Gorlin‟s Suspected BCCs should usually be referred as routine. Consider 2 week referral if there is particular The lesion: concern that delay may have an impact Is not on the nose and lips (including because of site or size of lesion. nasofacial sulci and nasolabial folds), or around the eyes (periorbital) or ears Is less than 2 cm in diameter if below the clavicle (unless they are superficial BCCs see below). Is less than 1 cm in diameter if above the clavicle (unless they are superficial BCCs see below). Is not morphoeic, infiltrative or basosquamous in appearance Does not have poorly defined margins
follow-up which is at odds with these clinical guidelines. This should not be a concern where the trial has been through the appropriate ethical approval. Appendix 1- Primary care referral guidelines for skin cancer Premalignant lesions Includes actinic keratoses, Bowens disease (SCC in situ) May be treated by any GP in the community High Risk BCC High risk of incomplete excision and recurrence, defined as: recurrent BCCs BCCs on the head (face and scalp) large BCCs > 2cm diameter (unless they are superficial BCCs see below) lesions that have a clinical appearance of morphoeic, infiltrative or basosquamous lesions with poorly defined margins BCCs in patients who are immunosuppressed or have Gorlin‟s syndrome BCCs located over important underlying anatomical structures (for example, major vessels or nerves) or where primary surgical closure may be difficult (for example, digits or front of shin). Refer to core member of Local MDT Suspected BCCs should usually be referred as routine. Consider 2 week referral if there is particular concern that delay may have an impact because of site or size of lesion. Extended Low Risk BCC There is no diagnostic uncertainty that the lesion is a primary nodular low-risk BCC and it meets the following criteria: The patient with BCC is not: aged 24 years or younger (that is, a child or young adult) immunosuppressed or has Gorlin‟s The lesion: Is not on the nose and lips (including nasofacial sulci and nasolabial folds), or around the eyes (periorbital) or ears Is less than 2 cm in diameter if below the clavicle (unless they are superficial BCCs see below). Is less than 1 cm in diameter if above the clavicle (unless they are superficial BCCs see below). Is not morphoeic, infiltrative or basosquamous in appearance Does not have poorly defined margins Refer to either Core member of local MDT Or Group 3 GPwSI in dermatology and skin surgery Or Group 3a GPwSI in skin lesions and skin surgery Suspected BCCs should usually be referred as routine. Consider 2 week referral if there is particular concern that delay may have an impact because of site or size of lesion.