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Benign skin lesions in children

Checked: 12-07-2023 by Rob Adams Next Review: 12-07-2025

Overview

This page relates to the management of benign skin lesions in children (aged under 16 years old). For patients aged 16 years and older then please refer to the Benign Skin Lesions (Adults) page.

Benign skin lesions in children can usually be diagnosed and managed in primary care.

Diagnosis of Benign Skin Lesions

Dermnet NZ DermNet | Dermatology Resource (dermnetnz.org) and PCDS Dermoscopy (and photography) - an overview (pcds.org.uk) are useful resources to support primary care assessment including both macroscopic and dermoscopic images alongside description of skin lesions.

Dermoscopea is an educational website which may be helpful in acting as a guide when diagnosing common benign skin lesions with dermoscopy. The aim of this resource is to help primary care clinicians identify some of the key dermoscopic features of benign lesions, to improve confidence in being able to diagnose these lesions and reassure the patient/ parent.

Red Flags

Suspected Skin Cancer

Please note that skin cancer is exceptionally rare in children. Please see advice from the BNSSG cancer transformation team (updated June 2018):

'Fast growing skin lesions without a diagnosis should be considered for referral, please include history and examination findings of the lesion to support this referral.

When melanoma occurs in childhood it is usually atypical or amelanotic.

Moles that appear in childhood that gradually grow/ become more raised or are very dark are normal and should not raise a concern about melanoma.'

If a skin lesion is suspicious of cancer then refer using the Urgent Suspected Childhood Cancer proforma.

Dermoid Cysts

Dermoid cysts can have complications and therefore may need referral to consider excision. If you suspect a dermoid cyst then please see the Dermoid Cyst page for further information: Dermoid Cysts (Remedy BNSSG ICB).

Birthmarks

Vascular Birthmarks (including Haemangiomas, Port Wine Stain, Salmon patches and Strawberry Naevi) are covered by the Benign Skin Lesion policy and therefore referrals require prior approval.

However, the funding team have advised that if a child has a port wine stain or birthmark on the face then a referral can be made without funding in place as removal may be covered by a NHS England policy.

Referral

Funding Approval Required

If cancer is not suspected then referral for children with benign skin lesions is usually not required. Benign skin lesions in children currently fall under the Benign Skin Lesion Prior Approval Policy and referrals for opinions or requests for removal require Prior Approval. Referrals not meeting criteria will be returned. In exceptional circumstances where PA critieria are not met then an exceptional funding application can be made.

Advice and Guidance

If malignancy is not suspected but a diagnostic opinion or advice is required then consider using the paediatric dermatology advice and guidance service. See the Paediatric Dermatology Advice & Guidance page for details.

Community Services

The community dermatology services will also not accept referrals for children with pigmented skin lesions and will not remove benign skin lesions.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.