Information
- We offer only routine appointments and there is no facility to see patients urgently.
- We can only see patients that are registered with a GP in East Lothian.
- This service is a lesions removal service. Patients should not be sent for an ‘opinion’. If you are uncertain of the diagnosis, then the patient should be referred to Dermatology.
- Patients should be advised that the appointment they will receive from the minor surgery service is for surgical removal of the lesion during that appointment and not for a discussion of whether it ought to be removed or not.
- The locality surgeons reserve the right to decline to remove lesions which do not meet the guidelines or are inappropriate for the locality minor surgery service.
Who to refer:
- We accept referrals for patients of 12 years and over who can consent to, and co-operate with, the intended procedure.
- Benign lesions will only be removed if they are causing “significant disability” (e.g. pain, recurrent infection, bleeding, functional problems, recurrent trauma and recurrent/risk of infection). Please make this clear if this is the reason for referral.
- See Primary Care Management Tab for advice on specific conditions.
Who not to refer:
- This service is NOT appropriate for suspected cancers. Suspected skin cancers should be referred urgently to Dermatology or Plastic Surgery.
- Lesions where there is diagnostic uncertainty or for diagnostic biopsy. These should be referred to Dermatology.
- Patients that do not meet the referral criteria (see who to refer).
- Lesions that do not meet the referral criteria but the patient finds cosmetically unacceptable. These should be referred to Plastic surgery under the Exceptional Aesthetic Referral Pathway (EARP). Aesthetic Surgery (nhslothian.scot)
How to refer:
- Refer Via Sci Gateway – RIE – General Surgery – Basic Sign Referral
Please indicate that the referral is intended for the Minor Surgery Service at East Lothian Community Hospital.
Skin Tags
These are soft flesh coloured or pigmented pedunculated tags in body folds (neck, armpit, groin). They should NOT be referred unless they meet the criteria for removal of benign lesions. Small (few mm in size) skin tags rarely cause significant disability. Patients should be advised that they can remove small (few mm in size) skin tags themselves with suitably disinfected nail clippers or scissors. When they are treated at the LCTC clinic local anaesthetic is often not used and they are simply snipped off by the locality surgeon.
Dermatofibromata
A dermatofibroma is a benign skin lesion. The exact aetiology is uncertain, some believe it to represent a traumatic fibrotic dermal reaction to a minor injury such as an insect bite. They require a full thickness excision of the skin and effectively replace one scarring reaction with a potentially larger one. The preferred management is to leave them alone.
http://www.pcds.org.uk/clinical-guidance/dermatofibroma-syn.-histiocytoma
Epidermoid (sebaceous/pilar) cysts
An epidermoid cyst is a very common cyst that contains keratin and its breakdown products, surrounded by an epidermoid wall. Morphologically it is a smooth mobile flesh coloured nodule within and fixed to overlying skin, the presence of a punctum helps confirm diagnosis.
Do not refer until they have reached a minimum diameter of 1.5 cm and they meet the referral criteria for a benign lesion. Cysts greater than 5cm should be referred to General Surgery at RIE. Please do NOT refer cysts whilst acutely infected but first treat them with a course of antibiotics +/- incision and drainage and review after 6 weeks. If the cyst is still present, and more than 1.5cm, then referral to the Minor Surgery Service may be appropriate. Many cysts will resolve after they have been infected and do not require surgical removal. We are not able to provide a service for the incision and drainage of acutely infected cysts. If this is required, it would need to be done in the GP practice or at A&E.
http://www.pcds.org.uk/clinical-guidance/epidermoid-cyst
Lipomata
Lipomas are a common benign tumour of adipose tissue and are usually found in the subcutaneous tissue. Morphologically they are a subcutaneous nodule, often lobulated, with a soft doughy consistency. The overlying skin surface is normal and freely mobile over the lipoma. Lesions are often 2-10 cm in diameter but can be much larger. Do not refer lipomas to the minor surgery service if they exceed 5cm in any plane or are on the head and neck but instead they should be referred to General Surgery at RIE.
There is a higher chance of liposarcoma in lesions greater than 5cm. If the soft tissue mass is not clinically typical of a lipoma or if it is a rapidly enlarging soft tissue mass then these should be referred to the USOC Orthopaedic Sarcoma service at RIE.
http://www.pcds.org.uk/clinical-guidance/lipoma
Seborrhoeic Keratoses:
A seborrhoeic keratosis (SK) is a benign overgrowth of epidermal keratinocytes, and is of unknown aetiology.
They are yellow/brown greasy papules or rough grey/black hyperkeratotic papules with a ‘stuck-on’ appearance. They are often multiple and most commonly found on the face and trunk though they can be found on any body site. The presence of keratin plugs (inclusion cysts) may help differentiate them from melanoma. If diagnosis certain reassure that no treatment is needed unless they meet the benign lesion referral criteria.
Warts:
Warts are caused by a common viral infection, the Human Papillomavirus (HPV). Most resolve spontaneously within a year or two. They may vary in appearance depending on the types of HPV, the anatomical site involved and the host immune response. They often have small black dots, representing coagulated capillaries, particularly evident on paring.
Most patients with viral warts can be managed in Primary Care:
- Consider no treatment as warts usually resolve spontaneously
- Self treatment daily with salicylic acid paints or gels after paring the warts
- Continue treatment for at least three months
- Consider 3 weekly Cryotherapy by practice nurse in non-responders but use in combination with topical therapy
Patient information: https://www.bad.org.uk/shared/get-file.ashx?id=176&itemtype=document
http://www.pcds.org.uk/clinical-guidance/warts
Benign Melanocytic Naevi:
Benign Melanocytic Naevi should only be referred if there is repeated trauma or there is significant disability. If there is any suspicion of malignancy then refer to Dermatology.
If a patient requests removal of a lesion for cosmetic reasons then a referral must be made via the Exceptional Aesthetic Referral Pathway (EARP):”
Scottish Government exceptional Referral Protocol www.sehd.scot.nhs.uk/cmo/CMO(2019)05.pdf
