The task
Assume that today's date is 22 October 2026. You have just seen Mr Ainsworth in your surgery.
You are Dr Babatunde Olawale, a general practitioner at the general practice at 8 Mill Lane. Using the information in the case notes, write a letter to Dr Rhiannon Sandercock, Consultant Dermatologist, requesting urgent excision and assessment of a suspicious pigmented lesion. Address the letter to Dr Rhiannon Sandercock, Consultant Dermatologist, Dermatology Outpatient Clinic, 120 Harbour Road. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Referral letter.
Case notes
Patient details
- Name: Mr Hugo Ainsworth
- DOB: 14/03/1977 (49 yrs)
- Address: 27 Quarry Street
- Occupation: self-employed landscape gardener — outdoors approx. 25 yrs
- Pt at practice since 2015; infrequent attender
Social background
- Married, 2 teenage children
- Rarely uses sunscreen or hat at work; frequent sunburn as a child/teenager
- Ex-smoker (quit 2019); alcohol: 6–8 standard drinks/wk
- Enjoys surfing and fishing at weekends
- Wife says pt 'only came in because she nagged him for weeks'
- Pt complained to reception about long wait for today's appt
Medical history
- Fair skin, red hair, freckles; > 50 naevi
- BCC L forearm excised 2021 — margins clear
- FHx: father — melanoma dx age 60, treated, well
- Hypertension — perindopril 5 mg daily
- R knee arthroscopy 2017 (sports injury)
- No anticoagulants or antiplatelet medication
- Allergies: penicillin (rash)
Presentation (22/10/26)
- Pigmented lesion upper L back (L scapular region); first noticed by wife 3/12 ago
- ↑ size and darkening over 3/12; bled ×2 in past 2/52 after minor contact with clothing
- Mild itch; no pain; otherwise well, no wt loss
Examination
- Lesion 9 × 7 mm; asymmetrical; irregular, notched border; variegated colour (dark brown, black, blue-grey areas); slightly raised centrally
- Dermoscopy: atypical pigment network, blue-white structures, irregular dots/globules
- Small area of crust at inferior edge — recent bleeding
- No palpable cervical, supraclavicular or axillary lymphadenopathy
- Full skin check: multiple benign-appearing naevi; no other suspicious lesions
- Clinical and dermoscopic photos taken
Assessment
- High suspicion of melanoma — ABCDE features, evolving lesion, bleeding
Plan
- Urgent referral to dermatology for excisional biopsy and assessment — appt requested within 2/52
- Images sent electronically with referral
- Pt informed of possible dx; anxious but keen to proceed; contactable by mobile
- Advised: sun protection, avoid trauma to lesion, report further bleeding or new lumps
- Pt prefers appts not on Fridays (busy work day)
- GP review after histology results
Who is reading, and what do they need?
Dr Sandercock is a consultant dermatologist who will triage and perform the excision. She does not know the patient. She needs the history of change, lesion and dermoscopic features, nodal examination, risk factors, and anything relevant to the procedure. Detail should be clinical and concise, with routine social information kept out.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Upper L back lesion, noticed 3/12 ago; increased size and darkening; bled ×2 in 2/52 | The change over time and recent bleeding are the main features of an evolving lesion that justify urgency. |
| 9 × 7 mm, asymmetrical, irregular notched border, variegated colour, slightly raised centrally | These examination features support the suspicion and let the dermatologist triage and plan the excision. |
| Dermoscopy: atypical network, blue-white structures, irregular dots/globules; crust at edge | Dermoscopic findings strengthen the suspicion and are expected in a specialist referral. |
| No cervical, supraclavicular or axillary lymphadenopathy; full skin check otherwise benign | Nodal status and the absence of other suspicious lesions are essential to the assessment and staging picture. |
| Fair skin, red hair, > 50 naevi; 25 yrs outdoors, rarely sun protection, childhood sunburn | These risk factors explain the pre-test probability and are relevant to the specialist's overall assessment. |
| BCC L forearm excised 2021; father had melanoma at 60 | Personal skin cancer history and a first-degree relative with melanoma raise concern and are expected in a referral. |
| No anticoagulants or antiplatelets; penicillin allergy (rash) | Relevant to planning an excision, including bleeding risk and any antibiotic choice. |
| Appt within 2/52; images sent; pt informed of possible diagnosis, contact by mobile; avoid Fridays | Sets the urgency, tells her the images are available, and gives the practical patient contact and scheduling information. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Wife says he came only because she nagged him for weeks | Personal comment on attendance that does not help the dermatologist's assessment. |
| Pt complained to reception about long wait | A practice service issue unrelated to the referral. |
| Enjoys surfing and fishing at weekends | Looks like additional sun exposure, but the occupational exposure already makes the point and this adds length. |
| Ex-smoker (quit 2019); alcohol 6–8 standard drinks/wk | Lifestyle detail with no bearing on the lesion or its excision. |
| Hypertension on perindopril; R knee arthroscopy 2017 | Unrelated history that does not affect the excision plan. |
| Married with 2 teenage children; infrequent attender since 2015 | Social and attendance detail not needed for triage. |
A paragraph plan for this case
Open with the urgent request, patient identification and the lesion's site and history of change. Follow with examination and dermoscopy, nodes and risk factors including the personal and family history, then medication, allergy and practical arrangements.
Where candidates slip on this task
- Express the assessment as a high suspicion, as the notes do, rather than stating a confirmed melanoma; the diagnosis awaits excisional biopsy and histology.
- Include the penicillin allergy and the absence of anticoagulants because they matter for planning the excision, but keep other medical history out.
- State the requested timeframe (within 2 weeks) and the practical points (images sent, mobile contact, Friday preference) clearly, without adding commentary about the patient's attitude.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Medicine letter tasks
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Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
Should the wife's comment about nagging be included?
No. It is a personal remark that tells the dermatologist nothing about the lesion. What matters is that the lesion changed over 3 months and bled twice, which are already in the history.
Is the patient's anxiety worth mentioning?
A short statement that he has been informed of the possible diagnosis and is happy to proceed is useful. Extended description of his emotions is not, and the letter should focus on clinical and practical information.
Sources
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