When should I consider referring a patient for a skin biopsy to a specialist?

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

Posted: 22 August 2025Updated: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Consider referring a patient for a skin biopsy to a specialist when the skin lesion raises suspicion of malignancy, particularly if it meets any of the following criteria:

  • Skin lesion (pigmented and suspicious) with a weighted 7-point checklist score of 3 or more, suggestive of melanoma. Refer using a suspected cancer pathway referral.
  • Skin lesion (pigmented or non-pigmented) that suggests nodular melanoma. Consider a suspected cancer pathway referral.
  • Skin lesion that raises suspicion of squamous cell carcinoma. Consider a suspected cancer pathway referral.
  • Skin lesion that raises suspicion of basal cell carcinoma. Consider routine referral, but only consider a suspected cancer pathway referral if delay may significantly impact due to lesion site or size.

Typical features prompting referral include ulcers with raised rolled edges, prominent fine blood vessels around a lesion, or pearly/waxy nodules.

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