Benign Skin Lesions
The removal of a benign skin lesion, wherever it appears on the body, is regarded as a procedure of low clinical priority. Surgery to improve appearance alone is not provided. The list below gives examples of conditions covered by the policy. This list is not exhaustive:
- Benign pigmented melanocytic naevi
- Lipomata - patients with multiple subcutaneous lipomata may need a biopsy to exclude neurofibromatosis.
- Molluscum Contagiosum
- Post acne scarring
- Epidermoid / pilar cysts (sebaceous) - rarely truly infected - in lesions with evidence of persistent or recurrent infection the removal of the lesion may be undertaken as an exception.
- Seborrhoeic keratoses
- Skin tags
- Spider naevi
- Thread veins
- Warts and Plantar Warts (genital and anal warts are referred to GUM).
- Anal skin tags
- Keloid scars
- Childhood vitiligo
- Physiological androgenic alopecia
Indications for referral include:
Skin lesions are often referred for specialist opinion because of concerns that there may be malignancy. A routine referral is not appropriate in this scenario.
Once it is established that a skin lesion is not malignant, its removal will not be routinely funded by KCCG though a clinician may request exceptional funding.
Once the diagnosis of lipoma is confirmed, excision is not routinely funded by KCCG.
Port Wine Stains (Capillary Malformations) and Capillary Haemangiomas in Children
Children with large or facial Port Wine Stains (capillary malformations) should be referred early to a Paediatric Dermatologist for confirmation of the diagnosis/prognosis.
Cosmetic treatment of Port Wine Stains is not routinely commissioned and will not normally be funded by KCCG though a clinician may request exceptional funding.
Children with large capillary haemangiomas at risk of causing significant cosmetic or functional impairment should be referred urgently to a paediatric dermatologist for confirmation of the diagnosis and consideration of early propranolol therapy.
Pyogenic Granulomas (PG)
If due to pregnancy PG usually settle after delivery, otherwise they tend to persist. Those cases not amenable to treatment in General Practice or those cases where there is diagnostic uncertainty should be referred. Beware, amelanotic melanoma can mimic PG. Where PG is excised, histological confirmation of the diagnosis is mandatory.
Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes there is an exceptional clinical need that warrants a deviation from the rule of this policy.
Individual cases will be reviewed at the KCCG Individual Funding Request Panel upon receipt of a completed application from the patient’s GP, Consultant or Clinician. In making a case for exceptional clinical need it should be demonstrated that the patient is significantly different to the general population of patients with the condition in question and
the patient is likely to gain significantly more health benefit from the intervention than might be normally expected for patients with that condition.
The fact that a treatment is likely to be efficacious for a patient is not in itself a basis for exceptionality. An application cannot be considered from patients personally. The individual funding request process is described here