Bradford and Airedale CCGs SKIN LESIONS Version: 2 Ratified by: Date ratified: Author(s): Responsible Committee: Consultant in Public Health Individual Funding Request Panel Date issue: September 2013 Reviewed: Intended audience: Version 1 Presented to Collab and Ratified : Sept 2012 Revised September 2013 IFR Panel, Provider Organisations, Referrers On behalf of Airedale, Wharfedale and Craven CCG, Bradford City CCG and Bradford Districts CCG 1
TREATMENT: Removal of Skin Lesions POLICY: Requests for Removal of Skin Lesions will be considered as a request for Plastic Surgery and subject to the screening and classification processes as detailed in the CCGs Commissioning Plastic Surgery: Guidance for Individual Funding Request Panel This commissioning policy will be used in conjunction with the above plastic surgery document to inform a decision on requests for removal of skin lesions. THIS POLICY DOES NOT APPLY TO ANY LESIONS WHERE CARCINOMA IS SUSPECTED - THESE SHOULD BE REFERRED UNDER THE APPROPRIATE PATHWAY PATHWAY/REFERRAL PROTOCOL:- Removal of skin lesions is funded on a Prior Approval basis according to the criteria detailed below: Commissioning Principles: The principles applying to this process are as set out in the document Commissioning Plastic Surgery: Guidance for Individual Funding Request Panel, and in particular the funding criteria, i.e.: Category 1 Reconstructive These requests will be funded routinely without need for Prior Approval or an Individual Funding Request Category 2 Functional These requests will be funded on Prior Approval if there is an existing commissioning pathway that the patient satisfies. If the patient does not satisfy an existing commissioning pathway, then the request will be funded on Prior Approval if: 1. Documentary evidence has been received that all other treatment options currently funded by the NHS have been exhausted or are contraindicated. 2. This is accompanied by a letter from a Consultant or appropriate specialist in the specialty related to the clinical reason cited for surgery (e.g. a Consultant Dermatologist or Consultant Psychiatrist) confirming that there are no suitable evidence-based treatment options other than surgery 2
If these conditions are not satisfied the request will be classed as an Individual Funding Request and will be processed as set out in the CCGs Policy and Procedures for Individual Funding Requests Category 3 Aesthetic These requests will be funded where the patient is defined as exceptional according to standard definition contained within the CCGs Policy and Procedures for Individual Funding Requests. Note - Assessment of patients being considered for referral to Plastic Surgery who may have an underlying genetic, endocrine or severe psychosocial condition should have had this fully investigated by a relevant specialist prior to the funding request being made. Patients will normally be expected to be 18 years old, or older. Category 4 Opportunistic These requests will be considered on a case by case basis and classified through the screening process as outlined above. Category 5 Other These requests will be considered on a case by case basis and classified through the screening process as outlined above. In addition: The CCGs consider that interventions to remove benign skin lesions satisfy the criterion of effectiveness on an operator dependent basis. The CCGs recognise that removal of benign skin lesions may result in scarring and will rely on the judgement of the clinician responsible for managing the patient s condition as to whether the benefits of the procedure are likely to outweigh the harm. The CCGs consider that interventions to remove benign skin lesions satisfy the criterion of cost effectiveness. The clinical opinion is that the benefit of the procedure in terms of symptom resolution for the individual patient outweighs the risk of harm (scarring). Scope This policy applies to surgical excision of skin lesions, including dermabrasion / shaving on any part of the body, including the face, unless they are covered separately by another discrete funding policy. Lesions This policy covers the following skin lesions, including facial lesions: Acne vulgaris and post acne scarring Benign pigmented melanocytic naevi (moles) Other pigmented lesions Comedones (blackheads); 3
Corns Dermal neurofibromas Dermatofibromas Ganglion (except wrist ganglion) Keloid scars Lipomata Milia Molluscum contagiosum lesions Rhinophyma Scars Sebaceous cysts (pilar and epidermoid cysts), Seborrhoeic keratoses Skin hypo-pigmentation Skin resurfacing techniques Skin tags Spider naevi Thread veins Other small benign, acquired vascular lesions including haemangioma, port wine stain, telangiectasia Veruccas Warts and plantar warts Xanthelasma (Note - The Individual Funding Requests Panel (IFRP) may apply this policy to unusual or rare lesions that are not listed above, should there be agreement by the Panel that the policy is appropriate) Exceptions The following are not appropriate for the IFR/Prior Approval process and should be referred through appropriate pathways Where there is a suspicion of malignancy the IFR or Prior Approval process is not appropriate, these cases should be urgently referred under the appropriate pathway with the exception of suspected basal cell carcinoma. (Note - If it is established that a skin lesion is not malignant, its removal will not normally be funded by the NHS though a clinician may request funding in exceptional cases). Diagnostic uncertainty where excision biopsy is necessary for diagnosis. As part of the treatment of specific conditions affecting the facial skin e.g. cutis laxa, pseudoxanthoma elasticum, neurofibromatosis. Facial palsy (congenital or acquired paralysis) 4
The correction of the consequences of trauma To correct deformity following surgery. Operations on congenital anomalies of the face and skull is usually available on the NHS. Some such conditions are considered highly specialised and are commissioned in the U.K. through the National Specialist Commissioning Advisory Group. Requests will be classified as Functional when: There is repeated trauma to the lesion due to its anatomical location, where all conservative measures have been exhausted as specified in the CCGs Commissioning Plastic Surgery: Guidance for Individual Funding Request Panel There is long-term risk of malignancy or disfigurement There is psychological distress where all conservative measures have been exhausted as specified in the CCGs Commissioning Plastic Surgery: Guidance for Individual Funding Request Panel There is persistent or recurrent infection where all conservative measures have been exhausted as specified in the CCGs Commissioning Plastic Surgery: Guidance for Individual Funding Request Panel There is drainage, inflammation, bleeding, burning, intense itching, or pain associated with the lesion where all conservative measures have been exhausted as specified in the CCGs Commissioning Plastic Surgery: Guidance for Individual Funding Request Panel The lesion obstructs a body orifice or vision leading to interference with normal function Notes on Specific Conditions All patients with congenital vascular lesions who have or potentially have functional problems should be referred for assessment Large benign tumours causing functional impairment and requiring general anaesthetic should be referred to secondary care Procedure for Applying for Prior Approval Requests for funding under Prior Approval should be submitted on a Form B, found on page 26 of the CCGs Policy and Procedures for Individual Funding Requests TREATMENT COSTS: Operative procedure PBR tariff 2013/2014 activity: 5