STEP 2: Presentation, initial investigations and referral

Signs and symptoms

The following should be investigated by a GP:

  • any new or changing skin lesions or lesions that do not respond to treatment
  • a rapidly growing skin lesion that remains unresolved after a month.

SCC: Induration (thickening) or tenderness in the erythematous base of a scaling lesion.

BCC: A dome-shaped skin lesion, pink or red scaly patch, waxy or pearly hard skin-coloured lesion, a sore that will not heal or with blood vessels.

GP investigations

Some lesions will be confidently diagnosed on clinical examination and history; others will require a biopsy, particularly early lesions.

The best approach for most lesions is complete excision. If complete excision is not appropriate, small representative samples, such as by one or more punch biopsies, shave biopsy or curettage, can be useful.

Most BCCs that are clinically favourable can be satisfactorily excised under local anaesthetic with direct primary closure in an ambulatory care setting.


Most BCCs/SCCs do not require referral.

For a complicated BCC, consider referral for:

  • incompletely excised lesions where surgical expertise is required for appropriate margins or lesions with a high risk of recurrence
  • lesions involving the central face, ears, genitalia, digits, palm of the hand or lower leg
  • poorly defined lesions
  • lesions fixed to underlying structures
  • lesions involving or lying adjacent to significant nerves
  • large lesions
  • neurotropic spread
  • lymphovascular invasion.

For a complicated SCC, consider referral for:

  • an SCC of the central face, scalp, lip, ear or genitals
  • lesions larger than 20 mm in diameter or 6 mm deep
  • chronically immunosuppressed patients with multiple aggressive SCCs
  • histologically aggressive head and neck SCCs
  • locally recurrent and/or persistent SCCs.

Referral options

At the referral stage, the patient’s GP or other referring doctor should advise the patient about their options for referral, waiting periods, expertise, if there are likely to be out-of-pocket costs and the range of services available. This will enable patients to make an informed choice of specialist and health service.


The GP’s responsibilities include:

  • explaining to the patient and/or carer who they are being referred to and why
  • supporting the patient and/or carer while waiting for specialist appointments
  • informing the patient and/or carer that they can contact Cancer Council on 13 11 20.



Investigations and/or curative treatment should be performed within 4 weeks of initial presentation to a GP or as soon as practicable.

If a diagnosis is required, referral to specialist should be as soon as practicable according to clinical concern (e.g. 4 weeks for a presumed SCC and 8 weeks for a presumed BCC).