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 referrals 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.
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.
Exception Pathway
Despite these multiple options, we appreciate there will be occasional technical barriers to sending a photograph. In these circumstances, please use our Medical Photography Exceptions Pathway to refer the patient to Lauriston Building for a photograph. Once the patient has attended for photography you will be notified so you can then refer the patient to Dermatology. The use of this pathway will be monitored to identify, and provide help to, practices with persistent technical barriers.
B.C, C.L & P.O – 4-3-26
Who to refer
Patients in whom it is not possible to get a photograph of the skin lesion/issue via the methods mentioned above.
How to refer
Via Sci Gateway:
Lauriston Buildings/SJH>Dermatology>LI Medical Photography
This pathway enables clinical images to be captured only and does not constitute a referral into Dermatology.
Please be very specific in your description of what lesion(s) are to be photographed (maximum 2). Consider marking lesions with a pen and/or taking a localising photograph on the patient’s mobile phone for them to bring with them.
Provide the patient with this phone number 0300 7900 624 so that they can phone to arrange an appointment. If the patient does not make contact within 2 weeks to book their photography appointment you and the patient will be notified and they will be removed from the pathway.
You will receive notification once images have been taken, in 2 to 4 weeks’ time, allowing you to initiate a Dermatology referral. We politely suggest that you simultaneously write the Sci Gateway referral to Dermatology at the same time as this referral and then ‘Save as Draft’ until you have been notified that the clinical images have been captured.
