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

(Non-cancerous growths on skin)

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 at:

Referral Forms – Knowledge NoW

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

Norfolk and Waveney 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 at least 12 weeks following completion of the therapy	NO	YES
Mild to Moderate Eczema	Which has failed to respond to treatment with emollients, appropriate topical steroids	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 in adults has failed to respond to topical Ketoconazole cream or shampoo or to clotrimazole-hydrocortisone cream and which in children has failed to respond to emollients and mild topical corticosteroids	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 meets the criteria for referral to secondary care NICE NG198 Overview \| Acne vulgaris: management \| Guidance \| NICE	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 a minimum of 3 courses of antibiotics over the last 24 months.
Fungal Infections of Toenails
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

Please see links below regarding podiatry services

Podiatry Service | East Coast Community Healthcare CIC (ecch.org)

Podiatry – Community | NCH&C (norfolkcommunityhealthandcare.nhs.uk)

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 Symptomatic proliferative haemangioma
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 –

https://nwknowledgenow.nhs.uk/content/lipoma-surgical-treatment/

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)

Lesions are a manifestation of an underlying syndrome

There is a risk of malignancy

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.

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.

Cases for Individual Funding Consideration (Patients who do not meet the policy criteria)

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.