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Benign Skin and Subcutaneous Lesions

Assessment OR removal of benign skin or subcutaneous lesions using surgery, cryotherapy or laser treatment is not routinely commissioned by NHS Devon.

There are pre-referral criteria attached to this CRG. Referrals not including the requested information may be returned.

Diagnostic uncertainty with no suspicion of malignancy is NOT an indication for referral. A watchful waiting approach can often be helpful if there is uncertainty.

Where available Tele-dermatology can be helpful for non-pigmented lesions

In cases of diagnostic uncertainty where malignancy needs to be excluded, please consider a 2WW referral.

Mucosal lesions are excluded from this policy

Scope

This guidance covers non-malignant lesions of the skin and subcutaneous tissues including melasma.

Treatment of keloid scarring is not routinely commissioned and comes under the Cosmetic Treatments Policy Cosmetic Treatments.

Treatment of alopecia and vitiligo IS covered by the Benign Skin Lesion policy, but it has been agreed Devon-wide that referrals for ASSESSMENT of these conditions can be made to dermatology.

Please note pre-referral criteria are applicable in this referral and referrals may be returned if this information is not contained within the referral letter.

Referral Criteria

Assessment or removal of benign skin or subcutaneous lesions using surgery, cryotherapy or laser treatment is not routinely commissioned by NHS Devon.

Referral will only be funded if:

Recurrent (2 or more documented episodes) or persistent infection of a lesion which has required treatment with systemic antibiotics

Or

Child with port wine stains (capillary malformations) should be referred early to a paediatric dermatologist for confirmation of the diagnosis and prognosis.

Cosmetic treatment of port wine stains is not routinely commissioned and will not normally be funded by the NHS though a clinician may request exceptional funding.

Clinicians referring on this basis should make the patient and parent/carer explicitly aware that treatment of the lesion may not occur.

Or

Child with large, complex or facial capillary haemangiomas at risk of causing significant disfigurement or functional impairment or haemangioma which is ulcerating should be referred urgently to a paediatric dermatologist for confirmation of the diagnosis and consideration of early propranolol therapy.

Or

Vascular anomalies (including capillary malformations, capillary haemangiomas, venous and arterial malformations) in children if diagnostic uncertainty, particularly for head and neck anomalies.

Clinicians referring on this basis should make the patient and parent/care explicitly aware that treatment of the lesion may not occur.

Or

Pyogenic granuloma IF the lesion is persistent (more than 3 months) AND if recurrently bleeding OR There is diagnostic concern (amelanotic melanoma can masquerade as PG).

Where the original referral was for suspected malignancy, once it is established that a skin lesion is not malignant, its removal will not normally be funded by the NHS though a clinician may request exceptional funding. Clinicians referring on this basis should make the patient explicitly aware that removal of the lesion may not occur.

NHS Devon Commissioning policy: Assessment and Removal of Benign Skin and Subcutaneous Lesions

Referrals submitted without this information may be returned.

For more information please see 'DermNet NZ' or 'PCDS'

Out of scope

  • Lesions with suspected malignancy including BCCs, SCCs
  • Acne and rashes
  • Ganglia
  • Giant cell tumours (including bone and tendon sheath)
  • High-flow Arteriovenous Malformations (AVMs) - confirmed with imaging
  • Mucosal lesions, i.e. lesions inside the buccal or vaginal mucosae
  • Anogenital warts
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Signs and Symptoms

Please include size, shape, colour, site, description or border and general skin condition.

History and Examination

  • Length of time present
  • Family history

  • Rapid growth
  • Crusting with ulceration

Practices which carry out minor surgery may wish to consider excision of a pyogenic granuloma using curettage and cautery and those which don't, could consider referral to an adjacent practice under the minor surgery LES.

Referral Criteria

Refer for specialist assessment if:

Assessment or removal of benign skin or subcutaneous lesions using surgery, cryotherapy or laser treatment is not routinely commissioned by NHS Devon.

Referral will only be funded if:

Recurrent (2 or more documented episodes) or persistent infection of a lesion which has required treatment with systemic antibiotics

Or

Child with port wine stains (capillary malformations) should be referred early to a paediatric dermatologist for confirmation of the diagnosis and prognosis.

Cosmetic treatment of port wine stains is not routinely commissioned and will not normally be funded by the NHS though a clinician may request exceptional funding.

Clinicians referring on this basis should make the patient and parent/carer explicitly aware that treatment of the lesion may not occur.

Or

Child with large, complex or facial capillary haemangiomas at risk of causing significant disfigurement or functional impairment or haemangioma which is ulcerating should be referred urgently to a paediatric dermatologist for confirmation of the diagnosis and consideration of early propranolol therapy.

Or

Vascular anomalies (including capillary malformations, capillary haemangiomas, venous and arterial malformations) in children if diagnostic uncertainty, particularly for head and neck anomalies.

Clinicians referring on this basis should make the patient and parent/care explicitly aware that treatment of the lesion may not occur.

Or

Pyogenic granuloma IF the lesion is persistent (more than 3 months) AND if recurrently bleeding OR There is diagnostic concern (amelanotic melanoma can masquerade as PG).

Where the original referral was for suspected malignancy, once it is established that a skin lesion is not malignant, its removal will not normally be funded by the NHS though a clinician may request exceptional funding. Clinicians referring on this basis should make the patient explicitly aware that removal of the lesion may not occur.

NHS Devon Commissioning policy: Assessment and Removal of Benign Skin and Subcutaneous Lesions

Clinicians referring patients for assessment or removal of a benign skin or subcutaneous lesion should note that any digital images sent with referrals will not be reviewed by the CCG in the process of determining whether the referral meets the policy criteria.

To aid secondary care decisions, referring clinicians are still encouraged to attach images to their referrals. However, after legal advice for clarification of the position, DRSS clinical staff are no longer able to use digital images to aid referral triage decisions. DRSS clinical triage decisions will be made solely on the textual content of referrals.

Referrals submitted without this information may be returned.

For more information please see 'DermNet NZ' or 'PCDS'

Out of scope

  • Lesions with suspected malignancy including BCCs, SCCs
  • Acne and rashes
  • Ganglia
  • Giant cell tumours (including bone and tendon sheath)
  • High-flow Arteriovenous Malformations (AVMs) - confirmed with imaging
  • Mucosal lesions, i.e. lesions inside the buccal or vaginal mucosae
  • Paediatric anal or genital warts

Referral Instructions

Dermatology

e-Referral Service Selection:

  • Specialty: Dermatology
  • Clinic Type: Skin Surgery for Benign Skin Lesions
  • Service: DRSS-Western-Dermatology-NHS Devon ICB-15N
Paediatrics

e-Referral Service Selection:

  • Specialty: Children & Adolescent Services
  • Clinic Type: Dermatology
  • Service: DRSS-Western-Paediatrics- Devon ICB-15N

Referral Forms

DRSS Referral Form

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