Referral Guidelines for Brighton & Hove
The Brighton & Sussex Community Dermatology Service is able to provide a comprehensive dermatology service to patients referred with a skin rash or skin lesion. However there are a few exceptions to this, which have been pre-agreed with commissioning teams.
Please contact us on 01273 665 141 if you wish to clarify any particular issue with regards to a referral.
Skin Rash Referrals
We are more than happy to see patients with skin rashes or general skin problems in our community dermatology clinics.
WE CAN SEE
Wherever possible, mild / moderate skin rashes should be treated within primary care and only referred:
- If standard tretment fails to treat the problem
- If there is any doubt about the underlying diagnosis
EXCEPTIONS: SKIN RASHES TO BE REFERRED URGENTLY INTO SECONDARY CARE
The following should be referred urgently to a hospital department rather than a community clinic:
- 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)
An urgent referral to a dermatology department is considered more appropriate for theses categories of patients. Most NHS Trust als operate an on-call service for advice. All other cases may be referred urgently to the community service and will generally be triaged to a Consultant or combined Consultant / GPwSPI clinic.
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)
- 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 (please refer if there is diagnostic doubt or if there is a significant psychological impact to the patient’s quality of life – advice and guidance referrals also welcome as many treatments available in primary care)
- Androgenic alopecia
- Leg ulcers – we can only see patients with suspected skin cancer, pyoderman gangrenosum or those with suspected contact allergy. All other cases should be managed in primary care or by tissue viability
- Melasma – should not be referred
- Facial veins
Skin Lesion Referrals
Patients referred with skin lesion will fall into four groups:
1. URGENT SKIN CANCER 2 WEEK REFERRALS -SUSPECTED SCC/MELANOMA
Please refer on the standard ‘TWO WEEK WAIT CANCER REFERRAL’ forms for suspected SCC / MM / Keratoaconthoma / Pyogenic Granuloma (age > 40, no trauma history). & Lentigo Maligna.
2. HEAD & NECK CANCER REFERRALS – DIAGNOSTIC LESION CLINICS BGH
Diagnosis of suspicious head/neck lesions, clinical BCCs on the head / neck,and non-cosmetic lesions.
3. LOW-RISK BCC TRUNK & SYMPTOMATIC FOR EXCISION – DERMATOLOGY LES SERVICE
All low-risk BCCs < 2cm diameter and for excisional surgery of symptomatic skin lesions on the scalp, posterior neck, trunk, anterior neck/face should be referred to secondary care if medical. All LES referrals are now booked through the dermatology service or direct referral to LES practices.
4. BENIGN SYMPTOMATIC SKIN LESIONS – REFER TO DES SERVICE
All other skin lesions that are non-cosmetic should be referred to the DES service. See website for practices supporting DES services.
All LES referrals are now centrally booked via Dermatology Booking HUB and doctors work closely with the dermatology service. Please send a referral on the dedicated ‘LES Referral Proforma’. The service is intended for the diagnosis and treatment of suspected BCCs on the trunk, and highly symptomatic skin lesions requiring excision (e.g recurrent infected cysts, painful dermatofibroma).DES practitioners may excise lesions but should not excise low-risk BCCs.
BENIGN COSMETIC LESIONS – Not funded within the NHS
Cryotherapy, curettage and shaves should be performed within the standard NHS primary care GMS contract and the DES in intended for symptomatic skin lesions. LES minor surgery is for lesions that need excision. LES practitioners are accredited to treat low-risk skin cancers and for the excision of symptomatic skin lesions on the trunk, limbs, scalp and posterior neck. Larger facial / anterior neck lesions should be referred to secondary care. Patients should be advised that benign lesions are not routinely funded in the NHS. Approval for low priority procedures is possible through the CCG’s IFR for patients.
Brighton General Hospital, Elm Grove, Brighton, BN2 3EW