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LOW PRIORITY PROCEDURE - Policy T28
Benign Skin Lesions in Secondary Care
Policy author:
NHS Suffolk Public Health Team
Policy start date:
Minor amendments:
Review date:
July 2011
July 2012
July 2013
Policy Summary
Referral to or treatment of benign skin lesions in secondary care should only be undertaken in accordance with
the criteria below. The majority of minor symptomatic benign skin lesions can be monitored and treated in
primary care.
Please note that as of July 2012, this policy does not apply to the treatment of benign skin lesions in the
perianal area. The clinician is referred to NHS Suffolk’s Low Priority Procedure policy ‘T37: Treatment of
benign perianal skin lesions in secondary care’ for treatment of these patients.
Background to condition
Benign skin lesions are those lesions that are not malignant, and include a range of cutaneous lesions. These
include:
• Benign pigmented moles
• Molluscum contagiosum
• Comedones
• Seborrhoeic keratoses (basal cell papillomata)
• Corn/callous
• Skin tags
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• Lipoma (unless exceptionally large – ie more than 20mm )
• Spider naevus (telangiectasia)
• Male pattern baldness
• Hirsuitism (unless severe or associated with endocrine abnormalities)
• Sweating/hyperhidrosis
• Warts
• Milia
• Sebaceous cysts
• Xanthelasma
• Dermatofibromas
Eligibility criteria:
Management and treatment of benign skin lesions in secondary care will only be funded when one or more of
the following criteria are met:
 Where the diagnosis of a benign condition is uncertain and there are other features that are suspicious
of dysplasia or malignancy (please refer as appropriate)
 Lesions that are painful or impairing function where patients are on certain medications (eg Warfarin)
that make treatment in primary care unsafe.
 Viral warts in immunosuppressed patients (If patients have multiple warts that are unusually severe
consider investigating for immunodeficiency).
 Facial warts
 Patients, who have skin lesions on their eyes where the lesion is infected, extremely large or painful
and excision of these, are not deemed to be cosmetic.
 Patient is 12 years or younger and the management of a benign skin lesion is not deemed to be
cosmetic
 The benign skin lesion is of a size (eg. 10mm or greater) where it cannot be managed in primary care
and is deemed to be not cosmetic
Rationale behind the policy decision
Many benign skin conditions occur commonly and cause few serious symptoms and can be managed in the
primary care setting. The surgical removal of benign skin lesions are generally cosmetic, or occur in conditions
that are self-limiting without specialist treatment. Therefore most of the benign skin lesions can be successfully
be managed in a primary care setting, allowing dermatologists and plastic surgeons to concentrate their efforts
on those patients who are most likely to benefit from specialist intervention thus maximising health benefits
within the available resources.
Originally the policy was developed as a partially excluded policy (PE). However due to the increasing number
of individual funding requests for secondary care management of benign skin lesions this policy was developed
into a threshold policy, with the criteria detailed above. The criteria are aimed at offering treatment to those
who need it most and who are most likely to benefit from secondary care treatment.
This policy was developed based on a review of published evidence, guidelines and consensus statements, in
consultation with local primary and secondary care clinicians, community representatives, clinical
commissioners, and commissioning managers.
Clinicians are aware of the difficulty that can occur in distinguishing benign from malignant lesions.
This policy is not intended to limit freedom of referral if there is uncertainty about diagnosis of
malignancy.