SRP 018 Benign Skin Conditions

Policy Number: SRP 018
Policy Name: Benign Skin Conditions
Status: Individual Prior Approval
Effective Date: 1st April 2024
Next Review Date: 1st April 2026

This policy does not include patients with suspected malignancy who should continue to be referred under the two week wait (2ww) pathway rules for assessment and testing as appropriate. Where it is subsequently confirmed that a suspect lesion is benign, funding approval will be required before further treatment or surgery is offered and provided to patients.

Lipomas on the body larger than 5cms, or in a sub-facial position with rapid growth and/or pain should be referred to a sarcoma clinic.
Once it is established that a skin lesion is not malignant its removal will not routinely be funded by the NHS, though a clinician may request funding via the prior approval process. Clinicians referring on this basis should make the patient explicitly aware that removal of the lesion may not be funded by the NHS.

Removal of benign skin lesions means treating asymptomatic lumps, bumps or tags on the skin that are not suspicious of cancer. This policy covers all benign skins lesions on the body including those which are cutaneous, subcutaneous and within the mouth or other orifices such as the ear canal or genitals. This policy relates to all treatments including all forms of surgical excision, laser treatment and cryotherapy.

Funding approval for treatment will only be funded by the ICB for patients meeting criteria set out below.

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

GPs providing Minor Surgery as an Additional Service (curettage and cautery and, in relation to warts, verrucae and other skin lesions e.g. seborrhoeic keratosis, cryocautery) or Minor Surgery as a Directed Enhanced Service (DES) under GMS/APMS contracts must adhere to the restrictions as detailed within this service restriction policy. Although these services are commissioned by NHS England, GPs should note that removal of benign skin lesions for purely cosmetic reasons will not be funded by NHS England under this DES and as such should apply this policy.

Funding approval will only be given in line with these general principles. Where patients are unable to meet these principles in addition to the specific treatment criteria set out in this policy, funding approval will not be given.

MSE ICB does not commission surgery for cosmetic purposes alone.

MSE ICB does not fund laser/pulse dye laser/intense pulsed light (IPL) treatment of clinically benign skin lesions/conditions.

The decision as to whether a patient meets the criteria is primarily with the referring clinician. If such lesions are referred, then the referrer should state that this policy has been considered and why the patient meets the criteria.

Funding approval must be secured by the patient’s clinician prior to referring patients for surgical opinions. Referring patients to secondary care without funding approval having been secured not only incurs significant costs in out-patient appointments for patients who may not qualify for surgery, but inappropriately raises the patient’s expectation of treatment.

On limited occasions, the ICB may approve funding for an assessment only in order to confirm or obtain evidence demonstrating whether a patient meets the criteria for funding. In such cases, patients should be made aware that the assessment does not mean that they will be provided with surgery and surgery will only be provided where it can be demonstrated that the patient meets the criteria to access treatment in this policy.

Funding approval will only be given where there is evidence that the treatment requested is effective and the patient has the potential to benefit from the proposed treatment. Where it is demonstrated that patients have previously been provided with the treatment with limited or diminishing benefit, funding approval is unlikely to be agreed.

Individual prior approval must be obtained before referral in ALL circumstances other than a patient with suspected malignancy.

Requests for removal of benign skin lesions will be considered where:

There is documented evidence that conservative management has been sufficiently tried and failed to resolve the condition.

AND at least ONE of the following criteria is met:

The lesion is obstructing an orifice or impairing field of vision (see also Oculoplasty Procedures policy).
Lesions with confirmed, evidenced history of recurrent infection (two or more, in a year of the same lesion) requiring systemic antibiotics.
Sebaceous cysts with confirmed, evidenced history of recurrent infection (two or more in a year of the same cyst) requiring systemic antibiotics.
Lesions causing significant pain (as direct result of the lesion) requiring regular prescribed prescription-only analgesics.
Lesions which cause demonstrable severe functional impairment which prevents the individual from fulfilling activities of daily living*
Lesions on the face where the extent, location and size of the lesion can be regarded as considerable disfigurement**, and which sets them apart from the cohort of people with similar lesions.

*Being unable or unwilling to sunbathe, swim or take part in other recreational activities due to the cosmetic impact of a benign skin lesion is unlikely to satisfy the ICB that the patient is suffering from significant functional impairment.

**Significant disfigurement is permanent and substantial defect that which is noticeable from a ‘conversational’ distance, face to face, rather than needing a deliberate inspection. Lesions should be on areas that cannot typically be covered up, for example face and hands.

EXAMPLES OF LESIONS COVERED BY THIS POLICY INCLUDE, BUT ARE NOT EXHAUSTIVE: