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Page last updated: 29/06/2022 Home > Clinical Thresholds Policy > A - D > Benign Skin Lesions

Benign Skin Lesions and Mild Inflammatory Skin Disorders in Adults and Children <16 years

Patient Information (NHS England) - Removal of benign skin lesions video

 

Threshold

 

Clinicians should refer cases of concern regarding melanoma, or squamous cell carcinoma under the two-week wait cancer pathway using the suspected skin cancer referral form. The relevant two-week wait referral form can be found on the Acute 2ww forms page (not viewable by patients)

The NICE guidance can be found at: https://www.nice.org.uk/guidance/ng12

Norfolk and Waveney Integrated Care Board (ICB) will routinely fund referral to Secondary Care for treatment of the following lesions and conditions for Adults and Children under the specific indications as listed below:

Condition

Circumstances

Adults AND Children Funded

Adults only Funded

Children Only Funded

Actinic Keratosis

Which has been unresponsive to two courses of application of topical Efudix cream (4 weeks duration) and reviewed after 6-8 weeks following completion of the therapy

 

NO

YES

 

Mild to Moderate Eczema

Which has failed to respond to treatment with emollients, appropriate topical steroids and oral antihistamines of at least 4 weeks duration

YES

 

 

Mild to Moderate Psoriasis

Which has failed to respond to treatment with emollients, appropriate vitamin D analogue and topical steroid combination in adults and appropriate topical steroids application in children has failed to respond.

 

YES

 

 

Seborrhoeic Dermatitis

 

 

 

 

Which has failed to respond to topical Ketoconazole administered in a cream or shampoo or to clotrimazole-hydrocortisone cream in Adults.

In cases of children, if failed emollients+/-topical mild steroids in infancy

 

YES

 

 

Mild to Moderate Rosacea

 

 

 

Which has failed to respond to 6 months of standard systemic therapy with tetracycline* or erythromycin and a licenced topical treatment

 

NO

YES

*

Mild to Moderate Acne Vulgaris

 

 

Which has failed to respond to 3 months of conventional treatment with systemic Tetracycline* or Erythromycin, at the correct dose for acne, in combination with a prescribed retinoid or other non-antibiotic topical therapy

 

 

YES

 

*

 

 

Note: Severe, scarring or cystic acne should be referred for consideration of treatment with Isotretinoin.

* Tetracycline not to be used for children below 12 years of age

 

The following lesions and conditions are NOT routinely funded by Norfolk and Waveney ICB:

Conditions:

  • Benign Naevi
  • Comedones
  • Congenital Vascular Lesions – for adults requiring cosmetic intervention
  • Corns and Calluses
  • Dermatofibroma
  • Epidermoid, Pilar or Sebaceous Cysts unless symptomatic due to severe recurrent infections requiring multiple courses of oral antibiotics
  • Fungal Infections of Toenails
  • Milia
  • Physiological Androgenic Alopecia (male pattern baldness)
  • Seborrhoeic Keratosis
  • Skin Tags (including Anal/Rectal)
  • Removal of Tattoos
  • Xanthelasma

 

The following lesions and conditions are NOT routinely funded by Norfolk and Waveney ICB except for:

Condition

Exceptions

Hirsutism

Unless thought to be part of an endocrinological disorder, in which case refer to Endocrinology

Melasma/Chloasma

 

Unless thought to be due to Addison’s Disease or other systemic disease (refer suspected Addison’s Disease to endocrinology)

Molluscum Contagiosum

Except if immunosuppressed in children and adults.

Vascular Lesions:

 

Telangiectasia, spider navei and small haemangiomas (Campbell de Morgan spots)

Unless thought to be part of systemic syndrome (i.e. Fabry’s etc) in Adults

OR

Proliferative haemangioma in children associated with obstruction/associated symptoms (requiring beta-blocker treatment)

Viral Warts

Except if immunosuppressed

OR

Where facial viral warts are present and the patient is aged 10-18 years old and suffering with significant functional/psychological impact, as evidenced in GP referral letter.

(The GP will need to provide independent evidence from a health professional or a teacher that the child’s health and wellbeing is being severely adversely affected despite all reasonable steps being taken to address the issues)”

Lipomata: See separate policy on –

https://nww.knowledgeanglia.nhs.uk/KMS/Norwich/Home/ClinicalThresholdsPolicy/I-N/Lipoma(surgicaltreatmentof).aspx

 

Referrals for the above lesions and conditions, from Primary to Secondary Care should ONLY be initiated if:

  • There is diagnostic doubt (e.g. lipomata >5cm in diameter)

 OR

  • Lesions are a manifestation of an underlying syndrome 

 OR

  • There is a risk of malignancy

 OR

  • There is documented evidence of significant recurrent infection that has required 3 or more courses of oral antibiotics within in a year OR hospital admission has been required and a course of IV antibiotics has been administered.
  • There is documented evidence of significant recurrent bleeding of 3 or more bleeds within a year of sufficient severity to require a dressing for 24 hours.

 OR

  • There are significant pressure symptoms

 

CASES FOR INDIVIDUAL CONSIDERATION

On a case to case basis, patients might be eligible for intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.

 

Ratification date 30 March 2021
Next Review date April 2022

 

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