Should I see a melanoma specialist?

It can be very difficult for GPs to decide who may have a melanoma and who may have a non-cancerous change in a mole or area of skin. The National Institute for Health and Clinical Excellence (NICE) has produced guidelines for GPs to help them decide which patients need to be seen urgently by a specialist. The guidelines were revised in June 2005. There are particular symptoms that mean your GP should refer you to a specialist straight away.

While reading these guidelines, it is important to remember that

• The number of people in the UK being diagnosed with this type of skin cancer is going up
• It can affect adults of all ages
• Some people are at higher risk than others of melanoma
• The most common place for a melanoma to develop is on the lower leg for women and on the back for men
• The Department of Health recommends that anyone with a suspected melanoma does not have a biopsy done by a GP - you should be referred to a skin specialist (dermatologist) in your local area for further examination and tests.

If you have a mole or other area of skin that looks a little suspicious but your GP thinks it is not a melanoma, it is acceptable for your GP to monitor it for 8 weeks. The mole should be measured with a ruler or against a marker scale. It is best if the GP takes photos so that any changes are recorded. The guidelines say that GPs should use the 7 point scale (see below) to judge changes in your mole. Your GP will look for these changes over the 8 weeks.

Remember - if there is any possibility that the mole could be a melanoma, your GP should refer you to see a hospital skin specialist within 2 weeks. You should not have a suspected melanoma removed in the GP surgery.

The NICE guidelines say that all GPs should use the '7 point scale' for assessing changes in moles. The scale has 3 major features and 4 minor ones. The major features are

• Change in size
• Change in colour - such as getting darker, becoming patchy or multi-shaded
• Change in shape

The 4 minor features are

• 7mm or more across in any direction
• Inflammation
• Oozing or bleeding
• Change in sensation - itching or pain, for example

The doctor counts 2 points for any of the major features. Any of the minor features scores 1 point. If your mole scores 3 points you need urgent referral to a specialist. But the guidelines say that if there are strong concerns about any one feature, then urgent referral is reasonable.

You can use this link to pictures of some abnormal moles to give you some idea of what you should be looking for. There is also more information about the symptoms of melanoma in the about melanoma section of CancerHelp UK.

In 2006 NICE issued guidance called 'Improving Outcomes For People With Skin Tumours Including Melanoma'. This guidance recommends that all cancer networks set up two levels of multidisciplinary teams.

The multidisciplinary team (MDT) is a team of health professionals who work together to decide on the best way to manage your care. The MDT can include many different health professionals including skin specialists (dermatologists), plastic surgeons, cancer specialists, doctors who specialise in reading X-rays and scans (radiologists), specialist nurses, GPs with a special interest in skin cancer, physiotherapists, occupational therapists, cosmetic camouflage advisers, and doctors who specialise in diagnosing illness from tissue specimens (histopathologists).

The two levels of MDT are the Local Hospital Skin Cancer Multidisciplinary Team (LSMDT) and a Specialist Skin Cancer Multidisciplinary team (SSMDT). LSMDTs are usually in cancer units in district general hospitals. SSMDTs are more likely to be in larger hospitals that have cancer centres, or plastic surgery centres. All of the members of these multidisciplinary teams, for example the doctors and nurses, have a special interest in skin cancer. The teams meet regularly and have specialist training. There may be more than one of these teams if you live in an area with a large population.

Everyone with suspected skin cancer will be seen by a member of one of these teams. If you have suspected melanoma you will be referred to either the local skin cancer multidisciplinary team (LSMDT) or the specialist skin cancer multidisciplinary team (SSMDT).

Your GP, or doctor from the LSMDT, will refer you to the SSMDT if

• Your melanoma is at higher risk of coming back or has come back
• The melanoma has spread to another part of your body
• You need treatment that the LSMDT does not provide
• You are taking part in a clinical trial
• You live close to the SSMDT, in which case it will act as both your local and specialist centre
• You are under the age of 19
• You have more than one melanoma

If you are worried that you have a skin change that could be melanoma and your GP does not want to refer you urgently to a specialist, you could print this page and take it along to an appointment. Ask your GP to talk it through with you and then you may be able to decide together whether you need to see a specialist and if so, how soon.

There is information about preventing skin cancer in this section of CancerHelp UK.