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Removal of benign skin lesions

Removal of benign skin lesions

Statutory Guidance

Retired guidance

This guidance has been withdrawn. The evidence base has changed significantly since its first publication.

This page is for historical reference only. It should NOT be used to influence clinical guidance or best practice.

Summary

Removal of benign skin lesions means treating asymptomatic lumps, bumps or tags on the skin that are not suspicious of cancer. Treatment carries a small risk of infection, bleeding or scarring and is not usually offered by the NHS if it is just to improve appearance. In certain cases, treatment (surgical excision or cryotherapy) may be offered if certain criteria are met. A patient with a skin or subcutaneous lesion that has features suspicious of malignancy must be treated or referred according to NICE skin cancer guidelines. This policy does not refer to pre-malignant lesions and other lesions with potential to cause harm.

Recommendation

This policy refers to the following benign lesions when there is diagnostic certainty and they do not meet the criteria listed below:

  • benign moles (excluding large congenital naevi)
  • solar comedones
  • corn/callous
  • dermatofibroma
  • lipomas
  • milia
  • molluscum contagiosum (non-genital)
  • epidermoid & pilar cysts (sometimes incorrectly called sebaceous cysts)
  • seborrhoeic keratoses (basal cell papillomata)
  • skin tags (fibroepithelial polyps) including anal tags
  • spider naevi (telangiectasia)
  • non-genital viral warts in immunocompetent patients
  • xanthelasmata
  • neurofibromata

The benign skin lesions, which are listed above, must meet at least ONE of the following criteria to be removed:

  • The lesion is unavoidably and significantly traumatised on a regular basis with evidence of this causing regular bleeding or resulting in infections such that the patient requires 2 or more courses of antibiotics (oral or intravenous) per year
  • There is repeated infection requiring 2 or more antibiotics per year
  • The lesion bleeds in the course of normal everyday activity
  • The lesion causes regular pain
  • The lesion is obstructing an orifice or impairing field vision
  • The lesion significantly impacts on function e.g. restricts joint movement
  • The lesion causes pressure symptoms g. on nerve or tissue
  • If left untreated, more invasive intervention would be required for removal
  • Facial viral warts
  • Facial spider naevi in children causing significant psychological impact
  • Lipomas on the body > 5cms, or in a sub-facial position, with rapid growth and/or pain. These should be referred to Sarcoma clinic.

The following are outside the scope of this policy recommendation:

  • Lesions that are suspicious of malignancy should be treated or referred according to NICE skin cancer guidelines
  • Any lesion where there is diagnostic uncertainty, pre-malignant lesions (actinic keratoses, Bowen disease) or lesions with pre-malignant potential should be referred or, where appropriate, treated in primary care
  • Removal of lesions other than those listed above.

Referral to appropriate speciality service (eg dermatology or plastic surgery):

  • The decision as to whether a patient meets the criteria is primarily with the referring clinician. If such lesions are referred, then the referrer should state that this policy has been considered and why the patient meets the criteria
  • This policy applies to all providers, including general practitioners (GPs), GPs with enhanced role (GPwer), independent providers, and community or intermediate services.

 

For further information, please see:

NICE Improving outcomes for people with skin tumours including melanoma [CSG8]

NIICE Suspected cancer: recognition and referral [NG12]

 

Rationale for recommendation

There is little evidence to suggest that removing benign skin lesions to improve appearance is beneficial. Risks of this procedure include bleeding, pain, infection and scarring. Though in certain specific cases as outlined by the criteria above, there are benefits for removing skin lesions, for example, avoidance of pain and allowing normal functioning.

Patient information

Information for Patients

Surgery to remove a benign or harmless skin lesion is a procedure that should only be carried out when specific criteria are met. This is because the medical evidence tells us they will often disappear of their own accord over time and there are risks associated with surgical intervention.

About the condition

A lesion is a general term that we use for things like moles, cysts, skin tags, warts, ulcers and other lumps and bumps we sometimes get on our skin. These lesions might have an impact on our appearance, but are otherwise are usually harmless. Some benign lesions, such as warts, may clear up on their own. However, if they don’t then your pharmacist can provide useful information on how to manage them.

Treatment to remove skin lesions should only be carried out in certain circumstances and if certain criteria are met. If your GP is has concerns or if the lesion persistently catches on your clothing or bleeds recurrently then you can be treated by the GP or referred to an appropriate specialist for an opinion.

As with all treatments, when deciding what’s best, you should consider the benefits, the risks, the alternatives and what will happen if you do nothing.

What are the BENEFITS of the intervention?

Treatment to remove a skin lesion should only be carried out in certain circumstances, for example, if the lesion is painful, bleeds regularly, if it becomes repeatedly infected or if it impacts on your everyday activities, such as causing pain at your joints or affects your vision.

What are the RISKS of the intervention?

Surgical removal carries a small risk of complications such as bleeding, scarring and infection.

What are the ALTERNATIVES?

Most benign lesions can be left alone. Your GP or pharmacist can advise you if the lesion is troublesome.

What if you do NOTHING?

Doing nothing is usually the best course of action. Most children get better within a few weeks without any treatment.

Coding

Code script

WHEN LEFT(der.Spell_Dominant_Procedure,4) in 'S063','S064','S065','S066','S067','S068','S069','S081','S082','S083’,'S088','S089','S091','S092','S093','S094','S095','S098','S099','S101’,'S102','S111','S112','B353','C101','C108',’C109','C111','C112','C118’,'C119','C121','C122','C123','C124','C125','C126','C128','C129','D021’,'D022','D028','D029','E091','E092','E096','E098','E099','F011’,'F018’,'F019','F021’,'F022','F028','F029','N012','N013','N018','N019','N242’,'N271','N272','N273','N278','N279','P054','P058','P059','P061','P062’,'P063','P065','P068','P069','P111','P112','P113','P114’,'P118’,'P119’,'T291','T292','T293','T298','T299')
AND not (apcs.der_diagnosis_all like '%C4[34][0123456789]%')
AND not (apcs.der_diagnosis_all like '%D0[34][0123456789]%' or apcs.der_diagnosis_all like '%L570%’) 
AND APCS.Admission_Method not like ('2%')
THEN 'F_skin_lesions'

Code Definitions

Procedure codes (OPCS)

S063 Shave excision of lesion of skin of head or neck
S064 Shave excision of lesion of skin NEC
S065 Excision of lesion of skin of head or neck NEC
S066 Re-excision of skin margins of head or neck
S067 Re-excision of skin margins NEC
S068 Other specified other excision of lesion of skin
S069 Unspecified other excision of lesion of skin
S081 Curettage and cauterisation of lesion of skin of head or neck
S082 Curettage and cauterisation of lesion of skin NEC
S083 Curettage of lesion of skin of head or neck NEC
S088 Other specified curettage of lesion of skin
S089 Unspecified curettage of lesion of skin
S091 Laser destruction of lesion of skin of head or neck
S092 Laser destruction of lesion of skin NEC
S093 Photodestruction of lesion of skin of head or neck NEC
S094 Infrared photocoagulation of lesion of skin of head or neck
S095 Infrared photocoagulation of lesion of skin NEC
S098 Other specified photodestruction of lesion of skin
S099 Unspecified photodestruction of lesion of skin
S101 Cauterisation of lesion of skin of head or neck NEC
S102 Cryotherapy to lesion of skin of head or neck
S111 Cauterisation of lesion of skin NEC
S112 Cryotherapy to lesion of skin NEC
B353 Extirpation of lesion of nipple
C101 Excision of lesion of eyebrow
C108 Other specified operations on eyebrow
C109 Unspecified operations on eyebrow
C111 Excision of lesion of canthus
C112 Destruction of lesion of canthus
C118 Other specified operations on canthus
C119 Unspecified operations on canthus
C121 Excision of lesion of eyelid NEC
C122 Cauterisation of lesion of eyelid
C123 Cryotherapy to lesion of eyelid
C124 Curettage of lesion of eyelid
C125 Destruction of lesion of eyelid NEC
C126 Wedge excision of lesion of eyelid
C128 Other specified extirpation of lesion of eyelid
C129 Unspecified extirpation of lesion of eyelid
D021 Excision of lesion of external ear
D022 Destruction of lesion of external ear
D028 Other specified extirpation of lesion of external ear
D029 Unspecified extirpation of lesion of external ear
E091 Excision of lesion of external nose
E092 Destruction of lesion of external nose NEC
E096 Laser destruction of lesion of external nose
E098 Other specified operations on external nose
E099 Unspecified operations on external nose
F011 Excision of vermilion border of lip and advancement of mucosa of lip
F018 Other specified partial excision of lip
F019 Unspecified partial excision of lip
F021 Excision of lesion of lip
F022 Destruction of lesion of lip
F028 Other specified extirpation of lesion of lip
F029 Unspecified extirpation of lesion of lip
N012 Excision of lesion of scrotum
N013 Destruction of lesion of scrotum
N018 Other specified extirpation of scrotum
N019 Unspecified extirpation of scrotum
N242 Operations on skin of male perineum NEC
N271 Excision of lesion of penis
N272 Cauterisation of lesion of penis
N273 Destruction of lesion of penis NEC
N278 Other specified extirpation of lesion of penis
N279 Unspecified extirpation of lesion of penis
P054 Excision of lesion of vulva NEC
P058 Other specified excision of vulva
P059 Unspecified excision of vulva
P061 Laser destruction of lesion of vulva
P062 Cryosurgery to lesion of vulva
P063 Cauterisation of lesion of vulva
P065 Excision of lesion of labia
P068 Other specified extirpation of lesion of vulva
P069 Unspecified extirpation of lesion of vulva
P111 Excision of lesion of female perineum
P112 Laser destruction of lesion of female perineum
P113 Cauterisation of lesion of female perineum
P114 Destruction of lesion of female perineum NEC
P118 Other specified extirpation of lesion of female perineum
P119 Unspecified extirpation of lesion of female perineum
T291 Excision of umbilicus
T292 Excision of urachus
T293 Extirpation of lesion of umbilicus
T298 Other specified operations on umbilicus
T299 Unspecified operations on umbilicus

Diagnosis codes (ICD)

Exclusions
C430 Malignant melanoma of lip
C431 Malignant melanoma of eyelid, including canthus
C432 Malignant melanoma of eyelid, including canthus
C433 Malignant melanoma of other and unspecified parts of face
C434 Malignant melanoma of scalp and neck
C435 Malignant melanoma of trunk
C436 Malignant melanoma of upper limb, including shoulder
C437 Malignant melanoma of lower limb, including hip
C438 Overlapping malignant melanoma of skin
C439 Malignant melanoma of skin, unspecified
C440 Other malignant neoplasms of skin of lip
C441 Other malignant neoplasms of skin of eyelid, including canthus
C442 Other malignant neoplasms of skin of ear and external auricular canal
C443 Other malignant neoplasms of skin of other and unspecified parts of face
C444 Other malignant neoplasms of skin of scalp and neck
C445 Other malignant neoplasms of skin of trunk
C446 Other malignant neoplasms of skin of upper limb, including shoulder
C447 Other malignant neoplasms of skin of lower limb, including hip
C448 Other malignant neoplasms of skin – Overlapping lesion of skin
C449 Other malignant neoplasms of skin, unspecified
D030 Melanoma in situ of lip
D031 Melanoma in situ of eyelid, including canthus
D032 Melanoma in situ of ear and external auricular canal
D033 Melanoma in situ of other and unspecified parts of face
D034 Melanoma in situ of scalp and neck
D035 Melanoma in situ of trunk
D036 Melanoma in situ of upper limb, including shoulder
D037 Melanoma in situ of lower limb, including hip
D038 Melanoma in situ of other sites
D039 Melanoma in situ, unspecified
D040 Carcinoma in situ of skin of lip
D041 Carcinoma in situ of skin of eyelid, including canthus
D042 Carcinoma in situ of skin of ear and external auricular canal
D043 Carcinoma in situ of skin of other and unspecified parts of face
D044 Carcinoma in situ of skin of scalp and neck
D045 Carcinoma in situ of skin of trunk
D046 Carcinoma in situ of skin of upper limb, including shoulder
D047 Carcinoma in situ of skin of lower limb, including hip
D048 Carcinoma in situ of skin of other sites
D049 Carcinoma in situ of skin, unspecified
L570 Actinic keratosis

Additional Exclusions
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and 
apcs.der_diagnosis_all not like '%D0%' and 
apcs.der_diagnosis_all not like '%D3[789]%' and
apcs.der_diagnosis_all not like '%D4[012345678]%’

This code captures code in the ranges C00-C99, D00-D09 and D37-D48.
Age range: the codes use the following age ranges 0-18 for children and 19-120
for adults.
— Private Appointment Exclusion
AND apcs.Administrative_Category<>’02’

References

  1. Higgins JC, Maher MH, Douglas MS. Diagnosing Common Benign Skin Am Fam Physician. 2015 Oct 1;92(7):601-7. PubMed PMID: 26447443.
  2. Tan E, Levell NJ, Garioch JJ. The effect of a dermatology restricted-referral list upon the volume of referrals. Clin Exp Dermatol. 2007 Jan;32(1):114-5. PubMed PMID: 17305918

How up to date is this information?

Last revised May 2024


Changes

May 2024: Guidance retired | December 2023: Coding updated August 2022 - Coding updated