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Referral information for GPs

Criteria for referral:

The patient is suspected as having one or more of the below conditions:
• Low risk BCC
• Bowen’s Disease
• Actinic Keratosis

Pigmented lesions and squamous cell carcinomas are out of scope and require direct referral to a hospital dermatology department.

BCC criteria:

Low-risk BCCs appropriate for treatment under this service are defined as follows:
The patient is not:
• aged 24 years or younger (that is, a child or young adult)
• immunosuppressed or has Gorlin’s syndrome.

The lesion:

• is located below the clavicle (that is, not on the head or neck)
• is less than 1 cm in diameter with clearly defined margins
• is not a recurrent BCC following incomplete excision
• is not a persistent BCC that has been incompletely excised according to histology
• is not morphoeic, infiltrative or basosquamous in appearance
• is not located:
• over important underlying anatomical structures (for example, major vessels or nerves)
• in an area where primary surgical closure may be difficult (for example, digits or front of shin)
• in an area where difficult excision may lead to a poor cosmetic result or at another highly visible anatomical site (for example, anterior chest or shoulders) where a good cosmetic result is important to the patient.

If the BCC does not meet the above criteria, or there is any diagnostic doubt, following discussion with the patient they should be referred to the hospital dermatology department. Incompletely excised BCCs should be discussed with the hospital dermatology department.


Bowens Disease

Bowens is an increasingly common premalignant skin disease characterised by flat erythematous scaly patches commonly on the lower legs. Treatment options are varied and include efudix, cryotherapy, PDT and shave excision, curettage and cautery. If your patient is suspected of having Bowens disease and has failed topical treatment with efudix for 4-6 weeks then it is appropriate to refer to the Community Dermatology Clinic. We will offer shave excision, curettage and cautery. We do not offer cryotherapy.


Solar Keratosis

Solar keratosis is common and increasing in prevalence due to an ageing population with a history of sun exposure. The condition may be managed in primary care. This service specification will provide an option for treatment when prior appropriate management in primary care has not led to resolution. We are able to offer shave excision, curettage and cautery. We recommend the use of topical treatments according to the Oxfordshire Solar Keratosis Primary Care Treatment Pathway. We do not offer cryotherapy.

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