Skin Lesions Without Malignancy

Treatment of benign skin lesions, with no risk of malignancy or infection, is considered to be cosmetic and should NOT normally be referred or treated. This includes:

• Benign moles (excluding large congenital naevi)
• Solar comedones
• Corn / callus
• Dermatofibroma
• Lipomas
• Milia
• Molluscum contagiosum (non-genital)
• Epidermoid and pilar cysts (sometimes incorrectly called sebaceous cysts)
• Seborrhoeic keratoses (basal cell papillomata)
• Skin tags (fibroepithelial polyps) including anal tags
• Spider naevi (telangiectasia)
• Non-genital viral warts in immunocompetent patients
• Xanthelasmata
• Neurofibromata

The benign skin lesions, which are listed above, must meet at least ONE of the following criteria to be removed and prior approval will need to be obtained:

• The lesion is unavoidably and significantly traumatised on a regular basis with evidence of this causing regular bleeding or resulting in infections such that the patient requires 2 or more courses of antibiotics (oral or intravenous) per year:
• There is repeated infection requiring 2 or more antibiotics per year
• The lesion bleeds in the course of normal everyday activity
• The lesion causes regular pain
• The lesion is obstructing an orifice or impairing field of vision
• The lesion significantly impacts on function e.g. restricts joint movement
• The lesion causes pressure symptoms e.g. on nerve or tissue
• If left untreated, more invasive intervention would be required for removal
• Facial viral warts
• Facial spider naevi in children causing significant psychological impact
• Lipomas on the body > 5cms, or in a sub-fascial position, with rapid growth and/or pain – these should be referred to Sarcoma clinic

Skin Lesions with Suspected Malignancy

The following are OUTSIDE of the scope of this policy:

Lesions that are suspicious of malignancy should be treated or referred according to NICE skin cancer guidelines

Any lesion where there is diagnostic uncertainty, pre-malignant lesions (actinic keratoses, Bowen disease) or lesions with pre-malignant potential should be referred or, where appropriate, treated in primary care

Removal of lesions other than those listed above

If (following a secondary care referral) malignancy is no longer suspected (and if the lesion has not already been excised for diagnostic purposes), any further treatment should be in line with the policy set out below

It is therefore important that patients understand the reason for referral, and that referral in these circumstances will NOT automatically lead to excision of a benign lesion

Referral to Dermatology or Plastic Surgery

The decision as to whether a patient meets the criteria is primarily with the referring clinician.

If lesions are referred, then the referrer should state that this policy has been considered and why the patient meets the criteria

Requests for treatment where a patient meets the criteria do not require prior approval or an IFR

This policy applies to all providers, including general practitioners (GPs), GPs with enhanced role (GPwer), independent providers, and community or intermediate services