Dermatology Referral for Suspicious Ear Lesion
Referral Letter Template
To: Dermatology Department
Re: Urgent Referral - Suspicious Pigmented/Skin Lesion on Ear
Patient Details:
- Name: [Patient Name]
- Date of Birth: [DOB]
- Contact: [Phone Number]
Reason for Referral:
I am referring this patient urgently for evaluation of a suspicious skin lesion on the [specify: helix/antihelix/postauricular/external auditory canal/earlobe] of the [right/left] ear that raises concern for possible melanoma or other skin malignancy.
Clinical Features (ABCDE Assessment):
Document the following features systematically 1, 2:
Major Signs:
- Change in size: [Yes/No - specify duration and rate of growth] 1
- Irregular shape: [Yes/No - describe asymmetry] 1, 2
- Irregular color: [Yes/No - note multiple shades of brown/black, heterogeneity] 1, 2
Minor Signs:
- Diameter: [Measure in mm - note if ≥6mm, though melanomas can be <5mm] 1, 2
- Inflammation: [Yes/No - reddish tinge within lesion] 1
- Oozing/bleeding/crusting: [Yes/No] 1
- Sensory change: [Yes/No - itching, increased awareness] 1
Additional Features:
- Border irregularity: [Yes/No] 1, 2
- Evolution: [Describe recent changes in color, elevation, or size] 1, 2
- Ulceration: [Present/Absent] 1
Examination Findings:
- Site: [Precise anatomical location on ear] 1
- Size: Maximum diameter in mm 1
- Elevation: [Flat/palpable/nodular] 1
- Regional lymph nodes: [Preauricular and cervical nodes - enlarged/normal] 3
- Satellites or in-transit metastases: [Present/Absent] 1
Patient History:
- Duration of lesion: [Specify] 1
- Risk factors: [Previous melanoma, multiple atypical nevi, family history, immunosuppression, sun exposure history] 1
- Symptoms: [Itching, bleeding, pain] 1
Clinical Concern:
This lesion demonstrates [number] of the major/minor features concerning for melanoma. Lesions suspicious for melanoma should not be removed in primary care, as clinicopathological correlation by specialist teams is vital for diagnostic accuracy, prognosis determination, and treatment planning 1.
Request:
Urgent dermatology assessment for:
- Clinical evaluation with dermoscopy 1, 2
- Consideration for excisional biopsy with 1-3mm margins if melanoma suspected 1
- Complete skin examination 1
Urgency: This referral is marked as URGENT based on suspicion of melanoma 1.
Key Referral Principles
When to Refer Urgently 1:
- New mole after puberty that is changing in shape, color, or size
- Long-standing mole changing in shape, color, or size
- Any mole with three or more colors or loss of symmetry
- Mole that is itching or bleeding
- Any new persistent skin lesion, especially if growing, pigmented, or vascular in appearance
Critical Pitfall to Avoid: Never perform excisional biopsy in primary care for suspected melanoma 1. The ear location requires specialist evaluation due to anatomical considerations and the need for functional preservation 1. Modifications to standard surgical margins are often necessary for ear melanomas 1.
Regional Lymph Node Assessment: Examine preauricular and cervical lymph nodes carefully, as regional lymph node enlargement is highly suggestive of melanoma with nodal metastasis 3. The ear drains to these nodal basins, and nodal involvement significantly impacts staging and prognosis 3.
Anatomical Considerations: The antihelix and postauricular areas have the highest proportion of premalignant and malignant diseases in older adults 4, making thorough examination of these sites particularly important.