Login

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
  • Dermatofibroma
  • 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
  • Milia
  • Spider naevi (telangiectasia)
  • Thread veins
  • Warts and Plantar Warts (genital and anal warts are referred to GUM).
  • Xanthelasmas
  • Anal skin tags
  • Keloid scars
  • Childhood vitiligo
  • Tattoos
  • Comedones
  • Physiological androgenic alopecia
  • Corns
  • Neurofibromata
  • Lipoma that does not meet the criteria for referral

 

Indications for referral include

  • Diagnostic Uncertainty
    • Skin lesions are often referred for specialist opinion because of concerns that there may be malignancy. This should be on the fast-track dermatology referral form.
    • Once it is established that a skin lesion is not malignant, it’s removal will not be routinely funded by NHS Cornwall ICB though a clinician may request exceptional funding.
  • Lesion is unavoidably and significantly traumatised on a regular basis
    • With evidence of this causing regular bleeding (more than twice weekly for at least four weeks caused by everyday activities i.e. not due to picking)
  • Repeated infection requiring two or more antibiotic courses per year
  • The lesion bleeds (more than twice weekly for at least four weeks)
  • The lesion causes pain requiring long term daily medication
  • The lesion is obstructing an orifice or impairing field vision
  • The lesion significantly impacts on function (E.G restricts joint movement)
  • The lesion causes unavoidable pressure symptoms
    • Which cannot be managed conservatively and which cause atrophy. Verruca on the feet do not normally meet this criteria as they can be pared back to avoid pressure symptoms.
  • If untreated, more invasive intervention would be required for removal
     
  • Facial viral warts causing significant psychological distress (E.G school avoidance)
    • In those <18yrs who can tolerate cryotherapy
  • Lipoma
    • Please see the Lipoma guideline for lipoma with features requiring exclusion of sarcoma.  These should be referred via fast-track sarcoma referral form.
    • Patients with multiple subcutaneous lipomata may need a biopsy to exclude neurofibromatosis.
    • Once the diagnosis of benign lipoma is confirmed, excision is not routinely funded by NHS Cornwall ICB.
  • 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. 

 

Additional Information

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 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

 

Page Review Information

Partial Update         06 May 2025

Next review date     06 May 2026

Clinical editors         Dr Madeleine Attridge

        Dr Rebecca Hopkins

Contributors             Dr Kate Northridge