UK skin cancer pathway
The end-to-end UK skin cancer journey in six discrete steps. Each step is its own reference page, linking to the relevant NICE / BAD / NHS England / RCPath guidance, the on-site clinical calculators, and the related monographs — so a single workflow covers triage, diagnosis, staging, treatment, reconstruction and follow-up.
Suspicion & referral
From primary-care suspicion to accepted specialist referral. NICE NG12 thresholds, weighted 7-point checklist, teledermatology, Cancer Waiting Times standards.
- NICE NG12 (suspected cancer)
- Faster Diagnosis Standard 28-day
- Skin-of-colour equity gap
Diagnosis & biopsy
Choosing the right biopsy: punch, incisional, shave, excisional. Anaesthetic considerations, specimen handling, dataset-driven histology reporting, ancillary testing.
- RCPath skin cancer datasets and appendices
- Never shave a suspected melanoma
- BRAF / MMR ancillary IHC
Staging
AJCC 8 for melanoma, BWH for cSCC, dedicated systems for MCC and conjunctival melanoma. Imaging thresholds, SLNB indications, MRI for perineural spread, PET-CT for MCC.
- NG14 §1.4.3–4 SLNB
- BWH outperforms AJCC 8 for cSCC
- Brain MRI in stage III/IV melanoma
Treatment
Surgical margins (BAD), Mohs / staged excision, definitive and adjuvant radiotherapy, systemic therapy by stage. Adjuvant ICI, BRAF/MEK combinations, hedgehog inhibitors, ADCs, bispecifics.
- NHS England URN 2426 (neoadjuvant)
- TA544 / TA684 / TA766 / TA837
- TA802 cemiplimab cSCC
Reconstruction
Defect-driven flap and graft selection by anatomical site. Subunit principles, three-layer reconstruction, cartilage and lining strategies, regional and free-tissue options.
- Burget & Menick subunit principle
- Nose / lip / eyelid / ear / scalp / hand
- Reconstructive ladder vs elevator
Follow-up
Stage-specific surveillance per NG14 §1.9.15, BAD 2020 / 2021. Self-examination, second-primary risk, OTR pathways, recurrence triage, late-effect surveillance, end-of-life care.
- NG14 §1.9.15 melanoma table
- BAD cSCC / BCC risk-tiered schedules
- OTR lifelong MDT-agreed surveillance
How to use the pathway
Each step page is a standalone clinical reference written from the consultant plastic-surgical perspective. Pages cross-link to the relevant monograph (e.g. melanoma, cSCC) for tumour-specific detail, to the relevant tool (staging, margin planner, follow-up scheduler, 2-week-wait checker), and to UK guidelines. If you're not sure where to start, follow the steps in order — that is the patient's natural journey through UK NHS skin oncology care.