Knowing what to look for is one thing. Knowing what to do next is where many clinicians stall. In my experience, the hesitation is rarely about whether to refer. Most clinicians understand that a suspicious lesion needs medical assessment. The hesitation is about how to raise it with the patient, where to send them, and what the professional obligation actually is.
This article addresses all three.
The professional obligation
In Australia, the shared Code of Conduct for registered health practitioners requires practitioners to recognise the limits of their competence, facilitate continuity of care, and seek advice, consult, or refer when another practitioner is better placed to manage the problem.
For suspicious skin lesions, that is clear. Definitive diagnosis and procedural management are medical tasks. The allied health obligation is to notice, document, and facilitate the referral, not to diagnose or treat.
This is not a narrow interpretation of scope. It is good clinical practice. A physiotherapist or massage therapist who identifies a lesion that looks atypical during an assessment and refers the patient to a GP or dermatologist is doing exactly what the Code requires, and the evidence suggests they are likely identifying something clinically significant when they do.
When to refer: the non-negotiables
Any lesion that meets one or more of the ABCDE criteria warrants referral. Any non-healing ulcer, rapidly growing nodule, or lesion that bleeds without trauma warrants referral. Any presentation the patient identifies as new, changing, or different from their other spots warrants referral.
You do not need to be certain something is malignant to refer. The threshold for referral in this context should be low. The cost of an unnecessary referral is a GP appointment. The cost of a missed melanoma is potentially much higher.
When to escalate urgently
Most suspicious lesions warrant prompt rather than urgent referral. The presentations that should be escalated more urgently are those that are rapidly expanding, visibly ulcerated, bleeding without trauma, or accompanied by systemic features such as fatigue, weight loss, or swollen lymph nodes. If a patient reports that a lesion has changed significantly in a matter of weeks, that time course warrants faster action than a lesion that has been slowly evolving over months.
For rapidly changing or ulcerated lesions, advise the patient to seek same-day or next-day medical assessment rather than waiting for a routine GP appointment.
Having the conversation
Many clinicians feel more confident about the referral decision than about raising it with the patient. The concern is usually about alarming someone unnecessarily. In practice, a direct and matter-of-fact approach works best.
"I noticed something on your back during the assessment that I think is worth having looked at. It's probably nothing to worry about, but it's changed recently and I'd rather you get it checked by a GP or skin clinic. Can I note that down for you?"
That's the entire conversation. You are communicating a clinical observation, not a diagnosis. Patients respond well to this framing when it is delivered calmly and without visible anxiety. The referral is a routine clinical action, not an alarm.
Document what you observed, where on the body, what specifically prompted the referral, and that the patient was advised to seek medical review. That note is good clinical practice and appropriate professional protection.
Where to refer
For most presentations, a GP is the appropriate first step. GPs can assess the lesion, decide whether further investigation is warranted, and refer to a dermatologist or arrange a biopsy if needed.
For athletes who are not engaged with a regular GP, dedicated skin cancer clinics with direct access appointments are often the most practical pathway. These clinics are widely available across Australia and can usually accommodate an appointment within a few days for non-urgent concerns.
For presentations that appear urgent, including rapidly expanding or ulcerated lesions, direct referral to a dermatologist or an emergency department may be appropriate. If in doubt, call the patient's GP directly to discuss rather than leaving it to a letter or a patient relay.
The follow-up
Make a note in the patient's file to follow up at the next appointment. Ask whether they have seen a GP or skin clinic and whether the lesion has been assessed. This follow-through signals to the patient that the referral was clinically meaningful, not a throwaway comment, and ensures that the referral actually happens rather than being deferred indefinitely.
In practice, the single most common reason a referred lesion doesn't get assessed is that the patient didn't follow through. A brief check-in at the next session costs nothing and can make a meaningful difference to the outcome.
The Clinician's Guide to Skin Health in Sport & Exercise covers lesion recognition, the referral conversation, and a complete framework for skin health in clinical practice.
