Refer scalp lumps requiring excisional biopsy to a surgeon.

Batchelor and Handfield-Jones’s recommendation that cases of diagnostic uncertainty should be urgently referred to a dermatologist in secondary care does not stand up.Of the three cases presented, two needed to be excised by surgeons, and although not stated, almost certainly, so did the third—a tumour. The National Institute for Health and Clinical Excellence’s recommendation that all cases of suspected skin cancer be referred to dermatology, which has been adopted by most regional cancer networks, has produced increased costs to the NHS and adverse outcomes for patients. Where previously GPs used their own excellent instincts as to when a suspicious skin lesion needed the skills of a surgeon (usually a plastic surgeon), these new “rules” have resulted in patients first seeing a dermatologist and then being cross referred to a surgeon. This has doubled consultation costs and resulted in a needless delay to definitive treatment.