Removal of a benign skin or subcutaneous lesion for cosmetic purposes using surgery, cryotherapy or laser treatment is not routinely commissioned. Assessment or removal of a benign skin or subcutaneous lesion is routinely commissioned only in the following circumstances:

• Recurrent (2 or more documented episodes) or persistent infection of a lesion which has required treatment with systemic antibiotics.
• Children with port wine stains (capillary malformations) should be referred early to a paediatric dermatologist for confirmation of the diagnosis and prognosis. Cosmetic treatment of port wine stains is not routinely commissioned and will not normally be funded by the NHS though a clinician may request exceptional funding. Clinicians referring on this basis should make the patient and parent/carer explicitly aware that treatment of the lesion may not occur.
• Children with large, complex or facial capillary haemangiomas at risk of causing significant disfigurement or functional impairment or a haemangioma which is ulcerating should be referred urgently to a paediatric dermatologist for confirmation of the diagnosis and consideration of early propranolol therapy.
• Vascular anomalies (including capillary malformations, capillary haemangiomas, venous and arterial malformations) in children can cause diagnostic uncertainty in primary care. Referral to a paediatric dermatologist is recommended if there is diagnostic uncertainty, particularly for head and neck anomalies, in children. Clinicians referring on this basis should make the patient and parent/carer explicitly aware that treatment of the lesion may not occur.
• Pyogenic granuloma should only be referred if the lesion is persistent and has not responded to treatment in primary care (curettage and cautery and sending for histological confirmation of diagnosis) and if recurrently bleeding.

Where the original referral was for suspected malignancy, once it is established that a skin lesion is not malignant its removal will not normally be funded by the NHS though a clinician may request exceptional funding. Clinicians referring on this basis should make the patient explicitly aware that removal of the lesion may not occur.

Clinicians referring patients for assessment or removal of a benign skin or subcutaneous lesion should note that any digital images sent with referrals will not be reviewed by NHS Devon in the process of determining whether the referral meets the policy criteria.

To aid secondary care decisions, referring clinicians are still encouraged to attach images to their referrals. However, after legal advice for clarification of the position, DRSS clinical staff are no longer able to use digital images to aid referral triage decisions. DRSS clinical triage decisions will be made solely on the textual content of referrals.

Referral Instructions

Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of NHS Devon upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.

Applications for consideration for funding approval should be sent to:

Email: d-icb.ifr-newsdt@nhs.net

Patient Information

Accompanying clinical policy patient support information for the Benign Skin and Subcutaneous Lesions Policy

Individual Funding Request (IFR)

Date of publication: 11 January 2016

This policy has been adopted from Northern, Eastern and Western Devon CCG

and South Devon and Torbay CCG by NHS Devon from 1 April 2019

Updated following consideration of NHS England Evidence-Based

Interventions Guidance for CCGs: 20 January 2020