Benign Skin and Subcutaneous Lesions Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

This guidance refers to:

  • The assessment and management of Benign Skin and Subcutaneous Lesions in adults and children

Commissioning Statements

Assessment

Signs & Symptoms

  • Warts
  • Seborrhoeic keratosis
  • Skin tags
  • Epidermal naevus
  • melanocytic naevus
  • Haemangioma
  • Chondrodermatitis nodularis helicis (CDNH)
  • Pyogenic granuloma
  • Keloid scar
  • Lipoma

Most do not need treatment. Diagnosis is important to provide reassurance that lesions are benign.

History

  • Time – when did it first appear?
  • What were the circumstances? Is it the result of trauma?
  • Changes/growth – size, shape and colour
  • Symptoms – is it bleeding, itching or painful?

Examination

  • Location
  • Appearance – colour, shape and size

Red Flags

Seek immediate or urgent specialist advice/treatment if:

  • Arising from existing mole
  • Change of existing mole
  • Rapid growth
  • Not improving with treatment

Management

Most can be left with reassurance, however refer as below.

Referral

Referral Criteria

North Kirklees
Wakefield
  • All Referrals should be sent to The Integrated MYHT & Novus Adult Dermatology Clinical Assessment Service (age 16+) or The Integrated MYHT & Novus Children's and Adolescent Services Dermatology CAS (Under 16)
  • All referrals will be reviewed by a consultant dermatologist, who will determine the most appropriate treatment

Commissioning Statements

Referral requirements

  • Referrals for surgical treatment of benign skin lesions for cosmetic reasons should be supported by an IFR authorisation form
  • North Kirklees - referrals should include full patient details along with a comprehensive history, to include medications used to date and any current medication
  • Wakefield - Consultant triage decisions are based upon the information contained within the GP referral, it is therefore essential that as much information as possible is provided. This is particularly relevant to Low Risk BCC's which can now be dealt with in the Community service, size and location of lesion is a key requirement in the referral information.

Referral Instructions

  • e­Consultation is not currently available for this specialty
  • Referrals should be made via ICG to TRISH (if training has been undertaken) - See user guides (EMIS & S1) for further information.
  • For those Practices who have not received ICG training referrals should be made via eRS
  • Please identify speciality and clinic type
  • North Kirklees
    • Referrals to PriDerm Community Dermatology Service should be made via eRS
    • *For urgent referrals please contact the PriDerm office stating suspected diagnosis and request urgent appointment
    • Please note that this service is NOT directly bookable the patient is required to make their appointment by telephoning the service directly quoting their UBRN and Password.
    • Attach an electronic referral letter to the UBRN, via your clinical system, containing full patient details along with a comprehensive history, to include medications used to date and any current medication
  • Wakefield
    • All Referrals should be sent to The Integrated MYHT & Novus Adult Dermatology Clinical Assessment Service (age 16+) or The Integrated MYHT & Novus Children's and Adolescent Services Dermatology CAS (Under 16) via eRS
    • Face to face appointments are not directly bookable.
      • Patients that require hospital treatment will be sent an appointment letter
      • Patients that are better treated in the community will be contacted directly by Novus Health and offered a choice of appointment and location

Supporting Information

Shared Decision Making

  • Patients have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation.

Patient information/Public Health/Self Care

Evidence/Supporting Information


Assurance & Governance

  • This guidance was developed on: 10.2017
  • This guidance was ratified by: The OSCAR Assurance Group
  • Date ratified:12.2017
  • Publication Date: 12.2017
  • Review Date: 10.2019
  • Ref No: DM5 - 10.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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