Referral information for GPs
Criteria for referral:
The patient is suspected as having one or more of the below conditions:
- Basal Cell Carcinoma
- Bowens Disease
- Actinic Keratosis
- Benign symptomatic skin lesions (see below)
Pigmented lesions and squamous cell carcinomas are out of scope and require direct 2 week wait referral to a hospital dermatology department.
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.
- is less than 2 cm in diameter on the body, and less than 1cm on the head and neck, with clearly defined margin
- is not on the nose, ears, lips or eye lids
- is not a recurrent or persistent BCC following previous surgery
- is not morphoeic, infiltrative or basosquamous in appearance
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 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 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.
Symptomatic Benign Skin Lesions
Lesions which recurrently bleed and are problematic, for example Pyogenic Granulomas, can be treated in the community dermatology service. We do not offer treatment for simple cysts, lipomas, seborrhoeic keratoses or skin tags which may be irritating only.