Benign Skin Lesions and Inflammatory Skin Disorders in Children <18 Years

(Non-cancerous growths on skin)

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

Threshold

For paediatric patients’ early intervention for treatment of some conditions provides the best outcome for this patient group and whilst the list of treatments is non-exhaustive, specialist clinicians are expected to apply appropriate clinician judgement on a case-to-case basis

Soft tissue sarcoma should be considered for any unexplained lump that is increasing in size. The on-call consultant paediatrician can be phoned for same day advice. Further information is available on the USC referral form

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 at:

Referral Forms – Knowledge NoW

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

Norfolk and Suffolk ICB will routinely fund referral to Secondary Care for treatment of the following lesions and conditions for children under the specific indications as listed below:

Condition	Funded Where Meets Stipulated Indication
Eczema	Which has failed to respond to treatment with emollients, appropriate topical steroids
Psoriasis	Which has failed to respond to treatment appropriate topical steroids application in children has failed to respond.
Seborrhoeic Dermatitis	Which has failed to respond to emollients and mild topical corticosteroids
Rosacea	Which has failed to respond to 6 months of standard systemic therapy with tetracycline* or erythromycin and a licenced topical treatment *Tetracycline not to be used for children below 12 years of age
Acne Vulgaris	Which meets the criteria for referral to secondary care NICE NG198 Overview \| Acne vulgaris: management \| Guidance \| NICE Note: Severe, scarring or cystic acne should be referred for consideration of treatment with Isotretinoin

The following lesions and conditions are NOT routinely funded by Norfolk and Suffolk ICB unless the following exceptions are met:

Condition	Exceptions
Melasma/Chloasma	Thought to be due to Addison’s Disease or other systemic disease (refer suspected Addison’s Disease to endocrinology)
Molluscum Contagiosum	If immunosuppressed
Congenital Vascular Skin Lesions: Telangiectasia, spider naevi and small haemangiomas (Campbell de Morgan spots)	Thought to be part of systemic syndrome OR Symptomatic proliferative haemangioma Note: Treatment started in childhood is not guaranteed to continue, unless it is a direct continuation of treatment started prior to 18^th birthday
Viral Warts	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/Consultant will need to provide independent evidence from a teacher, social worker or health professional that the child’s health and wellbeing is being severely adversely affected despite all reasonable steps being taken to address the issues)”

The following lesions and conditions are NOT routinely funded for referral by Norfolk and Suffolk ICB:

Conditions:

Benign Naevi
Comedones
Corns and Calluses
Dermatofibroma
Epidermoid, Pilar or Sebaceous Cysts unless symptomatic due to severe recurrent infections requiring a minimum of 3 courses of antibiotics over the last 24 months.
Fungal Infections of Toenails
Lipomas
Milia
Other benign lesions without significant malignant potential
Physiological Androgenic Alopecia (male pattern baldness)
Seborrhoeic Keratosis
Skin Tags (including Anal/Rectal)
Removal of Tattoos
Xanthelasma
Verrucas

Removal of one of the benign skin lesions listed above should only be considered if they meet at least one of the following criteria:

The lesion is obstructing an orifice or impairing field of vision causing significant visible ocular irritation
Lesions are a manifestation of an underlying syndrome.
There is documented evidence of significant recurrent infection that has required 3 or more courses of oral antibiotics within 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.
There are significant pressure symptoms – The size or location of the lesion has a direct and significant impact on physical function, e.g. restricts joint movement or directly impacts on ADLs (activities of daily living) OR the lesion causes pressure symptoms directly on nerve or tissue e.g. neuropathic pain, or visible soft tissue irritation.

Please see links below regarding podiatry services

Podiatry Service | East Coast Community Healthcare CIC
Podiatry – Community | NCH&C
Podiatry – Suffolk GP Federation

Cases for Individual Consideration

On a case to case basis, patients might be eligible for surgical 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.