What referral criteria should I follow for a patient with a suspected melanoma in primary care?

Refer patients urgently using a suspected cancer pathway (for an appointment within 2 weeks) if they have a suspicious pigmented lesion with a weighted 7-point checklist score of 3 or more ¹.

Consider an urgent referral if dermoscopy suggests melanoma ¹.

Refer urgently if there are nail changes, such as a new pigmented line in the nail (especially if associated damage) or a lesion growing under the nail ¹.

Refer if they have a new persistent skin condition, especially if growing, pigmented, or vascular in appearance and the diagnosis is unclear ¹.

Refer if there is any doubt about the lesion or a recent change in it ¹.

Refer if a biopsy has confirmed malignant melanoma ¹.

Consider referral using a suspected cancer pathway if the lesion suggests nodular melanoma or has major features in the 7-point checklist or features of the ABCDE system ¹.

For patients at greatly increased risk (e.g., giant congenital pigmented naevi, family history of melanoma), routine or specialist referral should be considered ¹.