What criteria should I use to determine whether a patient with suspected melanoma requires urgent referral to a specialist?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Patients with suspected melanoma should be urgently referred 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 .
  • Dermoscopy suggests melanoma .
  • There are nail changes, such as a new pigmented line in the nail (especially if there is associated damage to the nail), or a lesion growing under the nail .
  • They have a new persistent skin condition, especially if growing, pigmented, or vascular in appearance and the diagnosis is unclear .
  • There is any doubt about the lesion, or there is a history of recent change .
  • A biopsy has confirmed the diagnosis of malignant melanoma .

Consider referring urgently if there is a pigmented or non-pigmented skin lesion that suggests nodular melanoma .

Additionally, major features in the 7-point checklist or any features of the ABCDE system should prompt urgent referral .

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Educational content only. Always verify information and use clinical judgement.