Benign Skin Lesions and Mild Inflammatory Skin Disorders in Adults >18 Years

(Non-cancerous growths on skin)

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

Threshold

If the lesion is more than 5cm in maximum diameter, clinically ‘fixed’, painful, or rapid growth please refer to the Sarcoma USC referral form for guidance- these either need direct USC referral or USS depending upon clinical suspicion.

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 adults under the specific indications as listed below:

Condition	Funded where meets stipulated indication
Actinic Keratosis	Which has been unresponsive to two courses of application of topical Efudix cream (4 weeks duration) and reviewed a minimum of 12 weeks post completion of therapy
Eczema	Which has failed to respond to treatment with emollients, appropriate topical steroids
Psoriasis	Which has failed to respond to treatment with emollients, appropriate vitamin D analogue and topical steroid combination in adults
Seborrhoeic Dermatitis	Which has failed to respond to topical Ketoconazole cream or shampoo or to clotrimazole- hydrocortisone cream
Rosacea	Which has failed to respond to standard systemic therapy with tetracycline or erythromycin and a licenced topical treatment for a period of 6 months
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
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
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
Congenital Vascular Skin Lesions: Telangiectasia, spider naevi and small haemangiomas (Campbell de Morgan spots)	Unless 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	Except if immunosuppressed

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

Conditions:

Benign Naevi
Comedones
Congenital Vascular Lesions – for adults requiring cosmetic intervention.
Corns and Calluses
Dermatofibroma
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

Treatment for cosmetic reasons will NOT be funded.

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 and 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 (ecch.org)

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

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.