Document type
Clinical pathways
East and North Hertfordshire
Output type
Clinical Pathways
Dermatology for Adults Over 16 Years OldDermatology and Skin Health Referrals & Prior ApprovalPsoriasis Topical Treatment - Adults
Referral form
Dermatology Suspected Skin Cancer (ENHT)

Dermatology / Skin Lesions / Skin Health for Adults over 16 years old

Do not refer directly to plastic surgery or dermatology (except for urgent exclusions below).  Unless the referral is urgent or a 2WW, referrals should be to the skin health triage service.  BCCs should not be referred under a 2WW but instead urgently to the HCT skin health triage service.  In all cases, please check pathway and primary care management before referral.  A summary of the pathway is detailed below.  NB: most benign lumps and bumps are low priority and referral should only be made if they meet the criteria for referral or the GP has obtained IFR approval.  In case of diagnostic uncertainty and/or cannot exclude malignancy refer under 2WW rule.

Refer URGENTLY to secondary care dermatology - contact Dermatology Department at the hospital by phone:

  • If patient is unwell with severe and/or blistering rash (including severe eczema or severe psoriasis) and/or 
  • If required urgent dermatology opinion 

Consider advice & guidance, and Consultant Connect options prior to referral to HCT Skin Health Service (please use skin health referral form) for the following:

  • Mild to moderate see HMMC guidance
  • Acne which has failed to respond to topical treatments and/or antibiotics or scarring acne
  • Severe rosacea
  • Eczema/urticaria which has failed to respond despite adequate treatment trial
  • Repeated infection and unable to remove sebaceous cysts in primary care (please describe in referral form how patient meets criteria)
  • Lipoma causing significant problems and unable to be removed under minor surgery DES (please describe in referral form how patient meets criteria)
  • Dermatofibroma/histiocytoma ONLY if diagnostic uncertainty
  • Pyogenic granuloma ONLY if unable to remove in primary care (NB: if concern about malignant melanoma refer under 2WW)
  • Actinic/solar keratosis ONLY if unable to be managed in primary care
  • Bowen’s disease
  • Keratin horn unable to be removed in primary care
  • Giant comedones >5mm and causing significant problems
  • Sebaceous Naevus unable to be removed in primary care
  • Congenital naevi >20cm diameter or >2cm in neonate

NB: the following will be triaged to secondary care by the skin health service:

  • Psoriasis that is very widespread, lots of previous treatment or patient very affected
  • Florid/severe viral warts

Do not refer:

  • Molluscum contagiosum
  • Skin tags
  • Seborrhoeic warts/keratosis
  • Spider Naevi/Campbell de Morgan Spots/Vascular Angiomata
  • Benign naevi
  • Solar lentiginies
  • Lipoma/ serbaceous cysts, lumps that do not meet referral criteria

For suspected cancer, please see suspected skin cancer pathway (attached)

For condition specific management prior to referral, please see dermatology pathway (attached)

To refer to Skin Health Services, use e-referral and email proforma to  For enquiries contact 01438 841848 

For secondary care outpatient appointments please use Choose and Book/eReferral