01Workflow
Lesion assessment and follow-up
In the UK, NICE recommends a suspected cancer pathway referral for a pigmented lesion that scores 3 or more on the weighted 7-point checklist, or where dermoscopy suggests melanoma.1 After treatment, NICE recommends follow-up for 1 year after stage IA melanoma and for 5 years after stages IB to IV.2
- Take the history. Change in size, shape, colour and sensation, written into the note in the patient's words.1
- Examine and score. Dermoscopy and the 7-point checklist score recorded for each lesion examined.1
- Decide the pathway. Excise, refer on a suspected cancer pathway, review or reassure, with the reason in the signed note.1
- Give direct contact details. Patients who have finished melanoma treatment leave with a direct route back to the skin cancer service.2
- Set the follow-up schedule. Clinic visits planned for the stage of the melanoma, over 1 year or 5 years.2
How wai handles it
- Scribe. The lesion history, dermoscopy findings and checklist score are written from the consultation, cited to published guidelines, for the dermatologist to sign.
- Appointments. Follow-up visits are booked into the dermatologist's own diary, with a reminder before each one and a new time offered after a missed visit.
- Follow-up. Recalls for the next skin check go out once a clinician approves them, by WhatsApp or email in the patient's language.


