Download Skin Health Service Referral Form

Skin Health Service Referral Form
(Please complete the relevant pages in full. Failure to do so may delay the application)
(Please refer suspected Squamous Cell Carcinoma or Malignant Melanoma and other non BCC suspected
skin cancers as a two week wait. Refer to attached guidelines.)
Patient Details:
GP Details:
NHS No:
Name:
Date of Birth:
GP Practice:
Male / Female:
Address:
Mr / Mrs / Miss / Other (please state):
Surname:
Post Code:
First Name:
Tel No.
Address:
Fax No.
Post Code:
Mental Capacity:
Tel No.
Does this patient have capacity
Yes / No
Mobile No.
Details of skin condition/ lesion (not including suspected cancers - for suspected BCC instead complete box below and for
suspected SCC or malignant melanoma please refer as two week wait on 2 week wait form)
Description:
Site:
Size (mm):
Further information (including why lesion cannot be managed in GP surgery, how patient meets referral criteria or
exceptionality):
Suspected BCC:
Size (mm):
Site - in particular if on face describe if close to eyes, nose lips or ears (diagram if possible).
Is patient immunosuppressed or has Gorlin’s Syndrome? Yes/No.
If yes, please give details. ……..
Is the BCC/ suspected BCC overlying an important underlying structure (artery or vein)? Yes/No
Is this a recurrent BCC? Yes/No
Relevant Medical History:
If yes, please give details:
Relevant Investigations / Results / Blood Tests etc.
Current Medication Including Anticoagulants
Send UBRN notification via email to :
OR
[email protected]
Send via Fax No.
01438 712381
Telephone No. for queries only
01438 841848
Please note that inappropriate referrals which do not meet the referral guidelines and/or the Beds and Herts
priorities forum guidance or do not state sufficient exceptional circumstances will be sent back to the
referring GP.
HCT Skin Health Referral Guidelines for Adults (16 years and above)
Whilst referral guidance is given for each condition, where diagnostic uncertainty exists, the patient should be
referred to a skin specialist. Central triage is managed by Skin Health Service.
Please use the Skin Health Service Referral Form or ensure that a detailed clinical referral is made which includes
the size (mm) and site of the skin condition.
Skin Condition
GP Core Service Treatment
Squamous cell carcinoma
Secondary Care 2
week rule
Refer under the two
week rule
Secondary Care 2
week rule
A multi coloured Lentigo could be
Lentigo Maligna and these can turn
into a melanoma – any concerns
refer via 2 week wait as for
melanoma
Central Triage
Central Triage
or
2 week wait
or
2 week wait
If concern re melanoma refer under 2
week rule.
Central Triage
Central Triage
Melanoma
http://www.dermnetnz.org/lesions/me
lanoma.html
http://www.dermnetnz.org/lesions/len
tigo-maligna.html
Atypical Naevi
http://dermnetnz.org/lesions/atypicalnaevi.html
http://www.dermnetnz.org/lesions/ba
sal-cell-carcinoma.html
http://dermnetnz.org/viral/viralwarts.html
Molluscum Contagiosum
http://dermnetnz.org/viral/molluscumcontagiosum.html
Central Triage
*Please clearly
state in referral the
size/site of possible
BCC if the patient is
immunosuppressed
or has Gorlin’s
syndrome, if it is
overlaying an
artery/vein or if
close to
eye/nose/lips/ears
Refer under 2 week rule.
Refer under the two
week rule
Leave alone or use cryo therapy or
topical paints (sign post to
community pharmacy). Use patient
info leaflet.
Do not refer- Part of
GMS contract
essential services
Cryotherapy painful -avoid in small
children – Duct Tape worth trying
Exception when
florid/severe e.g. in
immunosuppressed
Treatment for molluscum
contagiosum (MC) is not routinely
recommended because most cases
clear up in around 6 to 18 months
Do not refer – Part
of GMS contract
essential services
http://dermnetnz.org/lesions/keratoac
anthoma.html
Viral Warts
Or 2 week wait
Central Triage –
Urgently
Basal Cell Carcinoma (BCC)
Kerato-acanthoma
If Referring
Refer to:
Refer under the two
week rule
http://dermnetnz.org/lesions/squamo
us-cell-carcinoma.html
Lentigo/Lentigo Maligna
Referral
Secondary Care 2
week wait
Secondary Care
without the need for treatment
Products available over the counter
but no convincing evidence
Skin tags
http://dermnetnz.org/lesions/skintags.html
Seborrhoeic Warts / Keratoses
http://dermnetnz.org/lesions/seborrho
eic-keratosis.html
Spider Naevi /Cambell de Morgan
Spots / Vascular Angiomata
http://dermnetnz.org/vascular/angiom
a.html
Benign Naevi
http://dermnetnz.org/lesions/moles.ht
ml
Solar Lentigines
http://www.dermnetnz.org/lesions/len
tigines.html
Epidermoid /Pilar (Sebaceous) Cysts
http://www.dermnetnz.org/lesions/cys
ts.html
Lipoma
http://dermnetnz.org/lesions/lipoma.h
tml
Dermatofibroma / Histiocytoma
http://dermnetnz.org/lesions/dermatof
ibroma.html
Treat only if problematic. Cosmetic
removal not available on the NHS Use patient info leaflet
Do not refer – Part
of GMS contract
essential services
Treat using cryotherapy or curettage
and cautery only when problematic.
Cosmetic surgical removal not
available on the NHS. Use patient
info leaflet
Do not refer – Part
of GMS contract
essential services
Snip &/or cautery with Hyfrecator.
Cosmetic surgical treatment not
available on the NHS
Do not refer – Part
of GMS contract
essential services
Pigmented lesions should not be
shaved if there is any chance at all of
malignancy. Shave and cautery for
intradermal moles only if clinically
indicated due to physical impairment.
Cosmetic removal not available on
the NHS. Always send for histology
Do not refer – Part
of GMS contract
essential services
Cosmetic. Treatment not indicated &
not available on the NHS.
Do not refer
If problematic can be excised under
the minor surgery directed enhanced
service.
Refer to Central
Triage only if have
documented repeat
infection and
unable to remove in
primary care.
Please clearly
document how the
patient meets
criteria in referral
Central Triage
Cosmetic removal not available on
the NHS. If problematic can be
excised under the minor surgery
Directly Enhanced Service
If beyond the scope
of DES/ difficult site
or size and causing
significant problems
refer to Central
Triage. Please
clearly document
how the patient
meets criteria in
referral
Central Triage
Cosmetic removal not available on
the NHS. If problematic can be
excised under the minor surgery
Directly Enhanced Service. Take
care as ugly scars possible.
Histology essential. Please seek
exceptional panel treatment approval
prior to referral
If diagnostic
uncertainty refer to
Central Triage
Central Triage
NB there is rare form of sarcoma –
dermatofibrosarcoma protuberans
(DFSP) which can look similar -they
are solitary, and tend to recur after
removal
Pyogenic Granuloma
If unable to remove
in primary care
refer to Central
Triage urgently
because of rapid
growth (if concern
of malignant
melanoma refer
under 2 week wait)
Central Triage
http://dermnetnz.org/lesions/solarkeratoses.html
Treatment with cryotherapy or
curettage and cautery or by topical
treatment e.g. 3% Diclofenac gel
NICE recommends
these are treated in
Primary Care
Central Triage, if
significant problem
managing in
primary care
Bowen’s Disease
Refer to Central Triage
Central Triage
Central Triage
Curettage and cautery (histology
essential)
If unable to remove
in primary care
refer to Central
Triage.
Central Triage /
Secondary Care
Can be incised and contents
expressed. Lesions over 5mm need
excision. As this is cosmetic
treatment not available on the NHS
If causing
significant problems
refer to Central
Triage.
Central Triage
Probably should be excised in
adulthood because of long-term risk
of malignancy although this risk is
small.
If unable to remove
in primary care
refer to Central
Triage.
Central Triage
Cosmetic. Treatment not available on
the NHS
Central Triage
20cm in diameter or
2cm in neonate
because of possible
malignant risk.
Central
Triage/Secondary
Care
Appropriate topical and systemic
treatment (oral antibiotics) or
hormonal therapy should be tried
If failure to respond,
refer to Central
Triage
Central Triage
http://dermnetnz.org/vascular/pyogen
ic-granuloma.html
N.b. Occasionally a melanoma gets
mistaken for a pyogenic granuloma the history is key. Pyogenic
granulomas have a very short history
from a few days up to a month.
Treatment is curettage and cautery
(histology essential), treat rapidly as
fast growing
Actinic/Solar Keratosis
(refer under 2 week
wait if concern of
malignant
melanoma)
http://dermnetnz.org/lesions/bowen.h
tml
Keratin Horn
http://www.dermnetnz.org/lesions/cut
aneous-horn.html
Giant Comedones
http://www.pcds.org.uk/clinicalguidance/giant-comedone#images
Naevus Sebaceous
http://dermnetnz.org/lesions/sebaceo
us-naevus.html
Congenital Naevi
http://www.dermnetnz.org/lesions/na
evi.html
Acne
http://www.dermnetnz.org/acne/index
.html
See
http://dermnetnz.org/acne/rosacea.ht
ml
http://cks.nice.org.uk/acnevulgaris#!scenario
If has had adequate
treatment with
topical treatments
and/or antibiotics
and not improved
refer to Central
Triage
If scarring – send
urgently
Rosacea
See
http://dermnetnz.org/acne/rosacea.ht
ml
http://cks.nice.org.uk/rosacea#!scena
rio
Psoriasis
Topical therapy to be tried.
http://www.dermnetnz.org/scaly/psori
If very widespread, if has lots of
If severe refer to
Central Triage
If failure to control
refer to Central
Central
Triage/Secondary
asis-general.html
previous treatments, if severe or if
the patient is very affected by it refer
to secondary care.
Triage. If severe
refer to Secondary
Care.
Care
Needs adequate topical treatment –
emollients, topical steroids and
treatment of infection. For amounts of
topical refer to BNF section 13
If failure to respond
despite adequate
treatment trial, refer
to Central Triage.
Central Triage
For Urticaria that has gone on for 6
weeks or more an allergic cause is
VERY UNLIKELY. Patch testing or
RAST testing will not help.
If failure to respond,
refer to Central
Triage
Central Triage
Central Triage if
concern or 2 week
wait if cancer
suspected
Central Triage (or 2
week wait)
If failure to respond,
or Norwegian
Scabies refer to
Secondary Care.
Secondary Care
See HMMC topical treatment
algorithm guidance
Atopic Eczema/ hand
eczema/undifferentiated dermatitis
http://www.dermnetnz.org/dermatitis/
dermatitis.html
Urticaria
http://www.dermnetnz.org/reactions/u
rticaria.html
Regular antihistamines in increasing
doses are the key to treatment
Undiagnosed lump - cancer not
suspected
If no functional problems reassure
and manage/ treat in Primary Care.
If GP concerned, refer to Central
triage.
N.B. Remember rare forms of skin
cancer and cancer elsewhere can
spread to skin. Nodules need to be
diagnosed urgently – consider 2
week wait.
Scabies
http://www.dermnetnz.org/arthropods
/scabies.html
Scabies should be diagnosed
accurately and not treated until
diagnosis confirmed as this will
exacerbate other skin conditions.
Many cases of itch are not due to
scabies. Dermoscopy can be very
helpful in diagnosing scabies.
Failure to respond is usually due to
inadequate treatment or re -infection
Onychodystrophy (fungal nail)
http://www.dermnetnz.org/fungal/ony
chomycosis.html
Fungal nail is a common and mostly
benign condition. Therefore most
patients require self- care or
pharmacy preparations only, and
treatment for fungal nail infection
is not routinely funded by the
NHS.
Exceptions to this are where the
onychomycosis causes significant
pain; secondary infection (cellulitis);
functional impairment (e.g. inability to
use footwear or difficulty walking) or
where the patient is at significant risk
of complications due to, for example,
diabetes, peripheral vascular disease
or immunosuppression.
It is essential, in those exceptional
cases where treatment is planned,
that before treatment is
commenced the diagnosis must
be first confirmed with nail
scrapings or clippings.
(see priorities forum guidance -
If failure to respond,
or for Crusted
Scabies refer to
Secondary Care
Refer to
dermatology if child
<18 needing oral
medication;
uncertain
diagnosis;
unsuccessful
treatment; immunecompromised
patient.
Consider referral to
podiatry for nail
surgery if nails are
traumatized by
footwear, or
deformed toenails
traumatize adjacent
toes
http://www.enhertsccg.nhs.uk/sites/d
efault/files/guidance_19__fungal_nail_infection_mar_12.pdf)
Sometimes it can be difficult to
diagnose and very difficult to
distinguish from psoriatic nails
Fungal nails can lead to widespread
fungal disease of the skin in
diabetics, the elderly and those who
are immunosuppressed.
Fungal infections in the feet are a
significant cause of cellulitis
It is essential, in those cases where
treatment is planned, that the
diagnosis must be first confirmed
with nail scrapings or clippings before
treatment is commenced.