Dermatology  |  Elective Services




Dermatology

Elective Services

Dermatology referrals are prioritised by Senior Medical Officers based on the information contained within. Additional information should be attached where available. The priorisation tool used to triage referrals can be found below under Access Criteria.

All accepted referrals will be seen within a maximum waiting time of 4 months, unless there is a clinical reason for delay.

Skin lesions that may require removal are processed via the Coordinated Primary Options (CPO) programme. Those referrals are triaged and allocated to appropriately credentialled practitioners, including general practitioners with a special interest in skin surgery, and plastic surgeons.

Referral acceptance is a follows:

For disease information please refer to the New Zealand Dermatological Society

First Specialist Assessments:

Waiting priority 1

Accepted

Waiting priority 2A

Declined

Waiting priority 2B

Declined

Waiting priority 3A

Declined

Waiting priority 3B

Declined

Waiting priority 4

Declined

Access Criteria

Note:  Access criteria that determine prioritisation primarily on the referral diagnosis have their limitations and this is acknowledged.  For those referrals in which the referring doctor has not been able to make a confident diagnosis it may be difficult, or impossible, to apply these ACA criteria.  It is therefore stressed that these are guidelines only and that clinical judgement must be applied in all cases in which they are used.

Immediate and urgent cases must be discussed with the Specialist or On Call Medical Officer in order to get appropriate prioritisation and then a referral letter sent with the patient, faxed or emailed.  The times to assessment may vary depending on size and staffing of the department.

Referral Guidelines:  Dermatology

Category

Criteria

Examples
(not an exhaustive list)

1 - Immediate

  • Severe blistering disorders.
  • Severe psoriasis.
  • Toxic  untreated erythema.
  • Severe Skin infections.
  • Cutaneous failure.
  • Sepsis.
  • Most inpatient referrals except lesions.
  • Erythrodermic  psoriasis.
  • Generalised pustular psoriasis.
  • Eczema herpeticum.
  • TEN.
  • Cellulitis.
  • Necrotising fasciitis.
  • Steven-Johnson's syndrome.
  • Pemphigus.
  • Exfoliative/Erythrodermic dermatitis.

2A - Urgent

  • Severe but stable dermatoses.
  • Adverse drug reactions.
  • Generalised dermatitis.
  • Bullous Pemphigoid.
  • Generalised severe psoriasis.

2B -  Urgent (Lesions)

  • Melanoma or suspected melanoma.
  • Squamous Cell Carcinoma (SCC) lip or ear.
  • Large tumours or rapidly enlarging tumours.
  • Biopsy in primary care if possible. 

3A - Semi-Urgent Clinic

  • Severe scarring nodular cystic acne. Failed primary care management.
  • Skin diseases (psoriasis, eczema, rashes) that are widespread or debilitating.  Failed primary care management.
  • Most severe connective tissue diseases.
  • Progressive psoriasis.
  • Eczema.
  • Lupus.
  • Scleroderma.
  • Allergic contact dermatitis.
  • Severe acne with scarring.
  • Unresponsive acne with scarring.

3B - Semi-Urgent (Lesions)

  • Basal Cell Carcinoma (BCC) head and neck.
  • All other SCC's.
  • Biopsy or lesions can improve triage and management times.

4 - Routine

 

  • Skin diseases (psoriasis, eczema, rashes) that are widespread but stable.
  • Venous ulceration.
  • Unresponsive acne without scarring.
  • Mild/moderate acne.
  • Longstanding conditions (eczema, psoriasis) with moderate symptoms.
  • Minor skin infections.
  • Cosmetic conditions.
  • Benign nuisance lesions.
  • Actinic Keratoses.
  • Seborrheic Keratosis
  • Superficial BCC's
  • BCC's trunk or limbs (any type)
  • SCC's in situ (Bowens) anywhere including head and neck
  • Atypical naevus syndrome
  • Epidermoid cysts
  • Dermatofibroma
  • Warts
  • Most vitiligo

Note: Superficial BCC's or Bowens or BCC's can be seen if particularly large, extensive or unresponsive to treatment.  Biopsy proven lesions can be accepted.


Notes:

Since September 2010, all skin lesions should be referred to the PHO skin lesion service in the first instance. Lesions requiring specialist assessment and treatment in the hospital should still be sent to the PHO skin lesion service for grading.

The DHB does not offer a skin surveillance service.

(Depending on facilities available, skin cancers are booked at a surgical procedure clinic.  This may include removal of large or multiple tumours/flaps/grafts.  When more complex intervention is required or facilities are not available, appropriate referral is made).

Children falling into Category 1 need to be referred immediately to a paediatric service for assessment, as many of these conditions will require hospital admission.



Last updated : Friday, March 31, 2017
Next review date : Saturday, March 31,2018


Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.