TNRF2: Dermatology

Overview

The removal of a benign skin lesion is the surgical procedure of removing non-malignant (not cancerous) skin lesions or abnormal growths from different parts of the body including the trunk, arms, and legs.

Thresholds and eligibility 

Where malignancy is suspected, the patient should be referred to an appropriate service under the two-week rule.  Benign lesions (excluding lipomas and viral warts; please refer to the separate policy for these lesions).  Clinically benign lesions should not be removed for cosmetic reasons and such procedures will not be funded. Details should be provided as to the nature of the lesion, the size and how it is affecting the patient.  Removal of benign skin lesions is only available as a treatment option for patients where: 

• The lesions size or position causes serious functional limitations which severely impair activities of daily living (see note below), as documented by the applicant.

OR

• There is documented evidence that the lesion is causing recurrent symptoms such as bleeding, infection, or discharge over at least three months and has not responded to appropriate conservative treatment over this period. All clinicians must be prepared to justify to NHS Surrey Heartlands the criteria applicable for the treatment of any benign skin lesions. Any treatment of skin lesions outside of the criteria will not be funded.

Note: Daily living means dressing, personal hygiene (washing and toileting), functional mobility (moving from one place to another to perform activities required in the home or at work) and meeting nutritional needs (shopping, preparing, and eating food). 

Resources

Treatments not routinely published policy (TNRF2)

Additional information

Assuming patients meet the criteria for this procedure, the consultant can provide the treatment.  

However, if the patients does not meet the criteria, the consultant has the option of submitting an Individual Funding Request (IFR) application to the Effective Commissioning Initiative Team at NHS Surrey Heartlands via the Blueteq database if they consider them to be clinically exceptional.

Overview

Lipomas are soft, fatty lumps that grow under your skin. They're harmless and do not usually need any treatment.

Thresholds and eligibility 

Soft tissue subcutaneous lesions, particularly over 5 cm, which are rapidly enlarging and not clearly longstanding and asymptomatic may be a soft tissue sarcoma. These patients should be referred to the appropriate service under the two-week rule. 

Removal of lipomatous lesions is permitted where the lesion is associated with at least one of the following criteria: 

• The lesion is an obvious or proven lipoma that is large (> 5cm). 

OR 

• The lesion causes serious functional limitation of movement resulting in documented impairment of activities of daily living (details of the impact on daily activities to be included in the application).

Resources

Treatments not routinely published policy (TNRF2)

Additional information

Assuming patients meet the criteria for this procedure, the consultant can provide the treatment.  

However, if the patients does not meet the criteria, the consultant has the option of submitting an Individual Funding Request (IFR) application to the Effective Commissioning Initiative Team at NHS Surrey Heartlands via the Blueteq database if they consider them to be clinically exceptional.

Overview

Viral warts are viral infections of the skin that are most common on the hands and feet.

Thresholds and eligibility 

Viral warts are usually of aesthetic significance only and surgical removal and / or laser treatment is not routinely funded by NHS Surrey Heartlands.

NHS Surrey Heartlands will fund removal of viral warts in patients who are immunocompromised. There are no restrictions of genital or anal warts.

• The patient is immunocompromised

OR

• Does the patient have genital or anal warts?

Resources

Treatments not routinely published policy (TNRF2)

Additional information

Assuming patients meet the criteria for this procedure, the consultant can provide the treatment.  

However, if the patients does not meet the criteria, the consultant has the option of submitting an Individual Funding Request (IFR) application to the Effective Commissioning Initiative Team at NHS Surrey Heartlands via the Blueteq database if they consider them to be clinically exceptional.

Overview

In severe and chronic cases, in people with lymphoedema that does not respond to conservative treatment, liposuction can be used. This involves the use of suction to remove fluid and fat through punctures in the skin, and these treatments are not the same techniques as those used for cosmetic liposuction.

Thresholds and eligibility 

NHS Surrey Heartlands will not routinely fund cosmetic liposuction.

Liposuction may be funded:

• As part of other surgical procedures when indicated for other conditions, e.g., thinning of a transplanted flap.

In lymphoedema patients: 

• With moderate to severe lymphoedema (International Society of Lymphology stage II/III respectively).

AND

• Where all conservative methods (such as MLD and DLT) for treatment have been attempted and have failed.   
  • Note: Manual lymphatic drainage (MLD) for lymphoedema is currently routinely funded. However, if clinicians wish to provide Complex Decongestive Therapy of which MLD is usually a component, then pre-authorisation will need to be sought.

AND

• Patient selection should only be done by a multidisciplinary team as part of a lymphoedema service.

AND 

• Standard arrangements are in place for clinical governance, consent, and audit.
   

Resources

Treatments not routinely published policy (TNRF2)

Additional information

Assuming patients meet the criteria for this procedure, the consultant can provide the treatment.  

However, if the patients does not meet the criteria, the consultant has the option of submitting an Individual Funding Request (IFR) application to the Effective Commissioning Initiative Team at NHS Surrey Heartlands via the Blueteq database if they consider them to be clinically exceptional.