Introduction
NHS Lothian Dermatology department will be implementing the updated Scottish Referral Guidelines for Suspected Cancer from 16th March 2026 (Scottish Referral Guidelines for Suspected Cancer 2025 – gov.scot). In addition to suspected melanomas, suspected SCCs and high risk BCCs should be referred through USOC pathways. RefHelp has been updated to reflect this and you will find new SCI Gateway referral proformas for USOC-Melanoma, USOC- SCC and USOC-High risk BCC.
These changes will put additional pressure on our USOC pathway. Currently, only a very small percentage of patients referred via this pathway have a high-risk skin cancer (less than 5%). From 16th March 2026, all lesion referrals should be accompanied by a good quality photograph to support the triage process.
Photographs are an essential part of Active Clinical Referral Triage (ACRT) and enables the priority of patients to be upgraded or downgraded. Photo triage enables more patients to be streamlined directly to treatment or biopsy without the need for a face-to-face review of the lesion in a clinic and allows more patients to be safely discharged from Secondary Care with advice or reassurance. This is important in managing the volume of Urgent Suspicious of Cancer (USOC) referrals.
Please see the following for more information about taking photos and attaching them to referrals :
Attaching photos to referrals – RefHelp
Using the Consultant Connect App – RefHelp
Photo Exception Pathway – RefHelp
For contact details and information about specialist clinics see Dermatology
B.C, C.L & P.O – 12-3-26
Who to refer & Who not to refer:
The following topics are covered by this referral advice. Clinicians are asked to follow the Primary Care Management guidance on RefHelp whenever possible prior to making any referral. Referrals may be declined unless there is a clearly documented valid clinical reason why this is not the case.
How to refer:
- SCI-Gateway referral protocols for lesions are now asking if a dermatoscopic image has been sent. Just tick no if this is not available.
- Adults (Aged 16 or over at the date of referral)
SCI Gateway –LB/SJH/ELCH-dermatology
- Children (Aged under 16 at the date of referral)
SCI Gateway- RHCYP-dermatology
- Note the exception for Children with acne vulgaris aged 13 or over at the date of referral should be referred to Adult dermatology
- The more detail you are able to provide with regard to the history and description of the lesion/rash in question, the better able we are to triage appropriately.
- Attaching photos to referrals – RefHelp
