Skin lesion

South Tees Hospitals NHS Foundation Trust

Definition/Description

Most benign lesions can be diagnosed using the Skin Lesion Diagnostic Tool from the homepage of www.pcds.org.uk. A free skin lesion tutorial can be found at Primary Care Dermatology Society

Which Speciality- Plastics or Dermatology? - images for all referrals are useful to aid triage

PLASTICS - Head > 10 mm and all periocular, nose, lip, ear. | Trunk, arms, limbs > 15 mm | Shins, feet, hands > 8 mm | Nails – an irregular pigmented line growing from the nail base of a single nail, or any lesion destroying a single nail (or raw/ulcerated tissue)

DERMATOLOGY – all other lesions not referred to above

Red Flag Symptoms

Suspected melanoma
SCC
Other serious skin tumour

Guidelines on Management

From a diagnostic perspective most benign lesions (eg seborrhoeic keratoses) and actinic keratoses can be screened out and managed in Primary Care using the free and easy to navigate Skin Lesion Diagnostic Tool from the homepage of www.pcds.org.uk.

Even if you do not provide a teledermoscopy service please consider using dermoscopy to screen out benign lesions. It is also very helpful to provide a clinical image with every referral, including nails. In addition to the referral proforma, a clinical image helps get your patient to the right clinic at the first time of asking

Please do not refer to multiple providers for any given referral.

Referrals choice include:

Urgent skin cancer referrals (formerly 2WW) - these are only for suspected melanoma and SCC, NOT basal cell carcinoma
Basal cell carcinoma - higher risk lesions (as identified on the proforma) should be directed to a service in which patients can be seen within 6-8 weeks. While patient choice is important, there is currently only one consultant-led provider (plastics at Tees Valley Hospital) that can See & Treat very-high risk BCC in a matter of weeks
Teledermoscopy – we triage all referrals within 7 days enabling excellent patient care. Please provide both clinical and dermoscopic images. In terms of the dermoscopic image:
- All lesions should have a small amount of gel applied to the skin lesion before taking an image
- Most dermoscopic images are best taken in the polarised mode (the softer light), one exception is the comedo-like openings and milia-like cysts of a seborrhoeic keratosis, which are best seen with the non-polarised light (harsher light), the button under the head of the scope changes mode
- Short videos on how best to take images are on the PCDS website (currently linked to the purple tile on the homepage ‘PCDS videos’)
Skin lesions – other (non-2WW). This can be used for lumps & bumps that meet the necessary referral criteria, thicker actinic keratoses requiring cryosurgery, and lesion diagnosis (excluding possible USC cases) if not using teledermoscopy. In terms of ‘minor’ lumps & bumps it is more cost-effective to refer to local GP services than the services highlighted on this proforma

Please note – ‘’nuisance’’ lesions referred on an urgent skin cancer pathway and found to be clinically benign cannot be treated in a skin cancer clinic and will be discharged accordingly; priority must be given to those patient with skin cancer needing urgent treatment.

If any practice or PCN would like in-house teaching on skin lesion recognition and / or teledermoscopy then please email please email timothy.cunliffe@nhs.net, this is provided free of charge.

If any relevant healthcare professional would like to attend our team teledermoscopy clinic, held on a Thursday morning, which is a great learning opportunity, then please email perdykamali@nhs.net.

Please be aware that later this year NHSE will be changing the names of clinic types, at which point we will update the proformas.

Referral Criteria/Information

Checklist for the Urgent Suspected Skin Cancer (USC) pathway – refer to the most relevant clinic (Dermatology or Plastics). This does NOT include BCC.

All USC (FDS) referrals must be received via e-RS/C&B, making sure the following steps have been taken:

Patient has been informed that this is an urgent referral for suspected melanoma / SCC
Clinical image attached if available
The patient has been informed that their referral and/or photos may be reviewed by a specialist and reprioritised if they feel their condition does not require such an urgent appointment
The patient is available and willing to attend hospital for tests/appointment within 14 days
The patient has been given the Urgent Suspected Cancer Referral Patient Information leaflet (links below)
Patient is aware that this is a clinic appointment, and that treatment may not be provided same day depending on their individual clinical problem and needs.