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

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 ¹.
• Dermoscopy suggests melanoma ¹.
• 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 ¹.
• They have a new persistent skin condition, especially if growing, pigmented, or vascular in appearance and the diagnosis is unclear ¹.
• There is any doubt about the lesion, or there is a history of recent change ¹.
• A biopsy has confirmed the diagnosis of malignant melanoma ¹.

Consider referring urgently if there is a pigmented or non-pigmented skin lesion that suggests nodular melanoma ¹.

Additionally, major features in the 7-point checklist or any features of the ABCDE system should prompt urgent referral ².