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Skin 2WW incorporating Teledermatology


Information and referral forms for 2WW Skin incorporating Teledermatology

2WW Referral Criteria for Skin Lesions

Revised January 2024 to incorporate Teledermatology

GPs across Coventry & Warwickshire are encouraged to use the NEW Teledermatology 2WW form instead of the old form

TELEDERMATOLOGY (pilot for Rugby patients only)

In line with National mandate to implement teledermatology, patients referred on 2WW pathway who are appropriate for teledermatology will be offered image capture appointments from 15th January 2024

As part of the initial pilot, appointments will be available in Rugby at St Cross Hospital. The pilot will be expanded to South Warwickshire in March (implementation date to be confirmed)

To support audit and review, initial capacity for image capture in the pilot is limited. As such, many patients will continue to be offered a face-to-face appointment. Feedback will be sought from patients and clinicians to ensure effective upscaling of teledermatology for 2WW

From 15th January, all GPs are required to refer on the updated 2WW Skin Teledermatology referral form

Please try to ensure the referral form is completed in the presence of the patient as some of the required information would not be routinely asked

Please ensure the referral form is completed fully – including the teledermatology criteria, even for those who decline teledermatology. This will ensure system understanding of demand

Alongside the referral form, an FAQ referral document is available. Patients will be able to access further information about teledermatology online Happy Healthy Lives (page to be live 15th January)


It is recognised that lesions may be more challenging to assess and diagnose in patients with brown or black skin when assessed using images. As such, patients with skin types 5 or 6 (Fitzpatrick scale) will follow a face-to-face pathway and are excluded from the teledermatology pathway

Skin of Colour – BAD Patient Hub (skinhealthinfo.org.uk)



Clinicians may use EITHER the ABCD rules OR NICE weighted 7-point checklist:

A B C D rules apply to melanocytic lesions only. Change often occurs in 3-12 months

Melanomas are generally not keratotic (crusty), unlike Seborrhoeic Keratoses Please indicate if there has been any change in:

A. Asymmetry (change in symmetry)

B. Border (change to be irregular, blurred edges)   

C. Colour (change in colour or change to have more than one colour, even if lighter)

D. Diameter (change in diameter, especially if change to be greater than 6mm)

OR: NICE weighted 7-point checklist score of  3  or more

MAJOR features of the lesions (scoring 2 points each):

  • Change in size
  • Irregular shape
  • Irregular colour

MINOR features of the lesions (scoring 1 point each):

  • Largest diameter 7 mm or more
  • Inflammation
  • Oozing
  • Change in sensation

Additional important clinical information

  • Previous history of skin cancer
  • Family history of skin cancer
  • Immunosuppression
  • Pacemaker (or another electronic implanted device?)
  • Please include the history and location of the lesion and attach any photographs.


These are from Keratinocytes and usually have adherent keratin. Poorly differentiated SCCs can just be ulcerated. Refer Keratoacanthomas as if they are SCCs.

NB: Usually appear as a red, prominent nodule or a non-healing ulcer. In some cases, a keratin core is present (possible keratoacanthoma) which should be referred in case they are SCCs.


  • Dermal induration (nodular)
  • Expansion over weeks to months
  • Tender
  • Keratin producing (adherent)
  • Ulcerated pink lesion


Critical sites

  • Eyelid margin
  • Nostril rim
  • Vermilion border of lip
  • External auditory meatus
  • (All others are routine referral)

Document size (If <2 cm and not critical site refer to DMC)

Additional important clinical information:

  • Previous history of skin cancer
  • Family history of skin cancer
  • Immunosuppression
  • Anticoagulants
  • Pacemaker (or another electronic implanted device)

Please include the history and location of the lesion and attach any photographs to the referral.

Consider handing the patient a Cancer Research UK Information Sheet – follow link

Two Week Wait referrals should now be processed through the NHS eReferral Service (previously known as Choose & Book)






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