HCT Skin Health Referral Guidelines for Adults (16 years and above) Whilst referral guidance is 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 Referral If Referring Refer to: Squamous cell carcinoma under the two Secondary Care 2 week rule week rule Melanoma Refer under the two Secondary Care 2 week rule week rule Lentigo/Lentigo Maligna A multi coloured Lentigo could be Central Triage Central Triage Lentigo Maligna and these can turn or or into a melanoma any concerns – 2 week wait 2 week wait refer via 2 week wait as for melanoma Atypical If concern re melanoma refer under 2 Central Triage Central Triage week rule. Or 2 week wait Basal Cell Carcinoma (BCC) Central Triage Central Triage – Urgently *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 Kerato-acanthoma Refer under 2 week rule. Refer under the two Secondary Care 2 week rule week wait Viral Warts Leave alone or use cryo therapy or Do not refer- Part of topical paints (sign post to GMS contract community pharmacy). Use patient essential services info leaflet. Cryotherapy painful -avoid in small Exception when children Duct Tape worth trying Secondary Care – florid/severe e.g. in immunosuppressed Molluscum Contagiosum Treatment for molluscum Do not refer Part – contagiosum (MC) is not routinely of GMS contract recommended because most cases essential services clear up in around 6 to 18 months without the need for treatment Products available over the counter but no convincing evidence Skin tags Treat only if problematic. Cosmetic Do not refer Part – removal not available on the NHS - of GMS contract Use patient info leaflet essential services Seborrhoeic Warts / Keratoses Treat using cryotherapy or curettage Do not refer Part – and cautery only when problematic. of GMS contract Cosmetic surgical removal not essential services
HCT Skin Health Referral Guidelines for Adults (16 years and above) Whilst referral guidance is 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 Referral If Referring Refer to: Squamous cell carcinoma under the two week rule Secondary Care 2 week rule Melanoma Refer under the two week rule Secondary Care 2 week rule Lentigo/Lentigo Maligna 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 or 2 week wait Central Triage or 2 week wait Atypical If concern re melanoma refer under 2 week rule. Central Triage Central Triage Or 2 week wait Basal Cell Carcinoma (BCC) Central Triage – Urgently *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 Central Triage Kerato-acanthoma Refer under 2 week rule. Refer under the two week rule Secondary Care 2 week wait Viral Warts Leave alone or use cryo therapy or topical paints (sign post to community pharmacy). Use patient info leaflet. Cryotherapy painful -avoid in small children – Duct Tape worth trying Do not refer- Part of GMS contract essential services Exception when florid/severe e.g. in immunosuppressed Secondary Care Molluscum Contagiosum Treatment for molluscum contagiosum (MC) is not routinely recommended because most cases clear up in around 6 to 18 months without the need for treatment Products available over the counter but no convincing evidence Do not refer – Part of GMS contract essential services Skin tags Treat only if problematic. Cosmetic removal not available on the NHS - Use patient info leaflet Do not refer – Part of GMS contract essential services Seborrhoeic Warts / Keratoses Treat using cryotherapy or curettage and cautery only when problematic. Cosmetic surgical removal not Do not refer – Part of GMS contract essential services