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Referral Guidelines for West Kent CCG

West Kent Dermatology is able to provide a comprehensive consultant-led dermatology service to patients referred with a skin rash or skin lesions. However, there a few exceptions to this, which have been pre-agreed with West Kent CCG. Please see as follows:

Skin Rash Referrals – We can see and treat

We are more than happy to see patients with skin rashes or general skin problems in our dermatology clinics.

WE CAN SEE:

Wherever possible, mild/moderate skin rashes should be treated within primary care and only referred:

  1. If standard treatment fails to treat the problem
  2. If there is any doubt about the underlying diagnosis

 

SKIN RASHES TO BE REFERRED URGENTLY:

  • Acute widespread pustular psoriasis (>70% body surface area)
  • Generalised erythroderma (>70% body surface area)
  • Severe drug reactions
  • Server erythema multiforme/Steven’s Johnson Syndrome
  • Severe bullous pemphigoid (>30 blisters)
  • Moderate/Severe Vasculitis (systemic symptoms/necrotic skin lesions)

Advice & Guidance is also available via Kinesis – search for ‘Dermatology’. Where possible, please include photographs so the Consultant Dermatologist can assess the condition as much as possible.

EXCEPTIONS: Skin Rashes to be managed in Primary Care

Examples of skin rashes that should be routinely managed in primary care include the following:

  • Mild/moderate acne not requiring Isotretinoin (Roaccutane) – please include recent blood test results with the referral
  • Mild/moderate childhood atopic eczema
  • Mild discoid eczema, xerosis, or generalised pruritus
  • Plaque psoriasis confined to discrete areas
  • Recurrent bacterial infections/tinea including pityriasis versicolor
  • Urticaria/angioedema
  • Alopecia areata (always refer if there is diagnostic doubt or if scarring is present)
  • Androgenic alopecia
  • Hirsutism
  • Vitiligo
  • Melasma/Cholasma
  • Leg ulcers – we can only see patients in the community service to exclude basal cell carcinoma or Bowen’s Disease
  • Any suspected SCC should be referred urgently on a 2-week proforma to secondary care

 

Skin Lesion Referrals

We are more than happy to see patients with skin lesions, including Basal Cell Carcinomas. Any referral letter must state that referral is warranted because of diagnostic doubt or medical symptoms.

WE CAN SEE:

We can see patients with skin lesions provided that any of the following conditions apply:

  1. Skin lesions where there is a diagnostic doubt and a referral is warranted to exclude a skin cancer or underlying inflammatory process
  2. Basal Cell Carcinoma (Low-Risk triaged to GPwSPI doctors and High-Risk to Consultants)
  3. Benign skin lesions that cause acute severe symptoms which interfere with quality of life

Examples would include:

  • A recurrent discharging cyst
  • Recurrent bleeding from a vascular angioma
  • Recurrent infection/bleeding from an irritated seborrhoeic keratoses

 

URGENT SKIN CANCER REFERRALS (TWO WEEK RULE)

Any patients with suspected Squamous Cell Carcinoma or Malignant Melanoma should be referred directly into the two week rule pathway via Queen Victoria Hospital.
Referrals should be made using the standard two week proforma forms. If we receive a referral in error then we will upgrade the referral and send it on to the local hospital as an urgent referral. Under theses circumstances, we will let both the GP and the patient know that this course of action has been considered necessary.

EXCEPTIONS: Benign Skin Lesions & Low Priority Procedures

Asymptomatic benign lesions should be considered cosmetic and the patient should be either advised that treatment is not routinely available via the NHS or an application should be made to the PCT Exceptions Panel. NHS funding has become more targeted in recent years and there are a range of treatments and procedures that we are unable to fund including the following:

  • Viral warts – All referrals for viral warts will be rejected, as funding does not cover this.
  • Acne scarring
  • Chemical peels
  • Dermabrasion for Hair Removal
  • Hair Transplant / Replacement
  • Electrolysis foe Hair Removal
  • Hirsutism treatments
  • Botulinum toxin therapy for hyperhidrosis
  • Laser therapy/laser treatment for aesthetic reasons
  • Laser tattoo removal
  • Laser hair removal
  • Removal of benign asymptomatic skin lesions (Includes papillomas, seborrhoeic keratosis, lipomas and sebaceous cysts) – these should be referred to the Local Enhanced Service
  • Skin Grafts for Scars
  • Skin Resurfacing Techniques

 


West Kent Dermatology
Worthing Laser & Skin Clinic, 51 Chesswood Road, Worthing, West Sussex, BN11 2AA
GP Hotline: 01732 651042