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. From 16th March 2026, all lesion referrals should be accompanied by a good quality photograph to support the triage process.
Introduction
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.
Methods
We will accept any high-resolution photo for referrals.
1. The preferred option is to use the Consultant Connect App
Using the Consultant Connect App page.
2. Photographs taken via Outlook. The attached guide runs through the necessary steps for this process including how to specifically attach photos to Sci Gateway referrals. There is now also a vision template for recording patient consent for photos; guidance on how this can be installed is also provided..
General-3-DigitalDermaOutlook_SOP_v0.1-2.pdf
Contacts: For support with the process around attaching photos using outlook please contact loth.digitaldermatology@nhs.scot
3. Photos taken by patients and attached to the referral as long as they are of good quality and in focus.
4. Dermoscopic images, in addition to close up and localising photographs, are welcomed but not mandatory.
5. Photos are also helpful for inflammatory or other skin conditions but are less essential.
Image quality
Please see the guidance below on taking better photos as this enables more effective clinical triage in secondary care. This guidance can be used by clinicians and patients.
Taking-better-photos-portrait-leaflet.pdf
1. Check to ensure the photograph is clear and in focus before sending.
2. It is helpful to have at least 3 pictures with your referral – a picture of the lesion/rash to show where it is (“orientation shot”), a closer photo ideally next to a ruler, a close-up photo of the area of concern. A dermatoscopic image is helpful if this is available to you.
3. Mark the lesion in question when including a photograph that has multiple lesions on it.
BC March 2026
