REFREC013
ONCOLOGY REFERRAL RECOMMENDATIONS
Diagnosis / Symptomatology
Primary Sector Referral for the
following areas:
Evaluation
Management Options
A thorough history and physical examination
is required to determine the specific
diagnosis (see below).
Specific treatments depend on the
specific diagnoses identified, as noted
below.
 Lymphoedema
 Melanoma
 New patient with previous
diagnosis from outside the
region
 Non melanoma skin cancers
 Oncologic Emergencies
 Palliative Care
 Previously diagnosed
malignancies with
complications of treatment
 Previously diagnosed
malignancies with suspected
recurrence
Diagnosis / Symptomatology
Significant Lymphoedema of the
Extremities – Benign and
Malignant causes
Referral Guidelines
Circumstances for referral are indicated
below with reference to the appropriate
specialty/specialties.
Note: Most referrals to the Oncology service
are from other specialty services.
Oncological referral to specific specialty
services may be found in those services
referral recommendations and waiting time
criteria.
Evaluation
Management Options
Standard history and examination.
Lymphoedema guideline document.
Ensure that a malignant cause is excluded
Education of patient and carers
Information and advice re: skin care,
exercise/activity, simple lymphatic
drainage massage, compression
garments.
Assessment to include, Quality of Life, risk
of infection/skin integrity, functional status
and impairment of mobility.
Referral Guidelines
Malignant causes of lymphoedema to be
referred urgently to oncology service
Monitor limb condition and volume.
Last updated February 2006
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REFREC013
Diagnosis / Symptomatology
Melanoma
Evaluation
As for Non Melanoma Skin Cancer
Also assess
1.
2.
3.
4.
Asymmetry
Border
Colour
Diameter
Management Options
Referral Guidelines
Excision biopsy with clear visual
margin of 2-5 mm. Do not undermine
the edge.
All material to be sent for histopathological assessment. Greater than
0.7mm depth requires referral for reexcision +/- skin grafting.
Referral to specialist (Dermatologist, Plastics
or General Surgeon) if above the
practitioner’s skill level for excision
(subungual, facial and large lesions etc), if
primary closure not possible, if local
recurrence (including in-transit or nodal
disease) or margins close or positive.
Category 2
FNA or excision biopsy if evidence of
recurrence or metastases. If
metastases confirmed stage with CT
scan of chest, abdomen and pelvis
(where available).
Diagnosis / Symptomatology
New patient with previous
diagnosis from outside the region
Last updated February 2006
Evaluation
Standard history and examination. Gain
access to previous management files,
reports and investigations.
Management Options
Patient presenting for routine follow-up
Vs patient presenting with problems
possibly related to history of
malignancy
Refer all melanomas to specialist with
interest in Melanoma for review-category 2.
Refer to Oncologist if evidence of metastatic
disease. Category 2.
Referral Guidelines
Refer according to the need for ongoing
specialist management (urgent or nonurgent) or review with appropriate timing as
per waiting time criteria.
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REFREC013
Diagnosis / Symptomatology
Non Melanoma Skin Cancer
Evaluation
Standard history and examination, attention
to dermatology evaluation.
Report
1.
2.
3.
4.
Symptoms
Size
Location
Lymph node status
Management Options
Referral Guidelines
Small lesions – excision biopsy
No referral if complete excision.
Large lesions – excision biopsy if
feasible and competency to perform
procedure appropriate. Ensure
adequate deep and radial margins.
Follow-up to confirm recurrence does
not occur.
If too large to excise in primary care, positive
margins or re-excision above practitioners
skill level, refer to Plastic Surgeon or
Dermatologist.
Local recurrence- may attempt reexcision.
(Consider need for radiotherapy or
plastic surgical input).
Metastatic disease – confirm with
biopsy, stage with CT scan (where
available).
If other medical problems making excision
difficult, ie local anaesthetic allergy,
anticoagulation, corticosteroid use.
Very large lesions where radiotherapy, skin
grafting or multi-disciplinary approach may
be needed.
Facial lesions where cosmetic result is
important.
Oncology referral for metastatic disease.
Category 2 for the above indications.
Last updated February 2006
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REFREC013
Diagnosis / Symptomatology
Oncologic Emergencies/Other
Acute Presentations
Evaluation
Standard history and examination
History of malignancy or substantial clinical
evidence for malignancy
Diagnosis / Symptomatology
Palliative Care
Evaluation
Standard history and examination
Management Options
Emergencies (not a comprehensive
list)
 Spinal cord/cauda equina
compression

Airway obstruction

Hypercalcemia

Brain metastasis

Superior vena cava obstruction

Marked renal or hepatic
impairment
Management Options
Evaluate origin of symptoms with
appropriate investigations.
Seek specialist Palliative care or
Oncology advice for difficult to manage
symptomatology
Diagnosis / Symptomatology
Previously diagnosed
malignancies with suspected
recurrence
Evaluation
Standard history and examination
Management Options
Image as appropriate, eg bone scan,
CT scan, X-rays.
Referral Guidelines
Category 1 referral
Referral Guidelines
Referral to treating Oncologist for ongoing
care eg. Symptomatic care, palliative
radiotherapy or palliative chemotherapy.
Category 1 for severe uncontrolled and
distressing symptoms.
Referral Guidelines
Referral to oncologist for biopsy,
symptomatic care and ongoing
management. Category 2
Biopsy if possible to confirm suspicions
of recurrence or metastatic disease.
Manage symptoms, palliative care
service and oncology service may be
contacted to advise
Last updated February 2006
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REFREC013
Diagnosis / Symptomatology
Previously diagnosed
malignancies with complications
of treatment
Evaluation
Standard history and examination
Management Options
Seek advice from treating specialist
Referral Guidelines
Patients who are receiving or who have
recently received
chemotherapy/radiotherapy and are septic
and neutropenic should be referred for
immediate assessment. Category 1
If febrile during a course of therapy and
neutrophil status is not readily available refer
for immediate assessment. Category 1
Patients with severe gastrointestinal
complications eg severe mucositis
uncontrolled vomiting or diarrhoea should be
discussed with the treating specialist with a
view to immediate management and
possible admission. Category 1
Non-acute side effects or complications of a
non-life-threatening nature to be referred as
non-urgent. May be discussed with the
treating specialist.
Last updated February 2006
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