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Dermatology

Vale of York and Scarborough and Ryedale CCGs have a policy that all dermatology referrals should have three photos including a dermatoscopic image attached. This helps GP reviewers and specialists advise GPs and may save your patient an unnecessary appointment in secondary care. The policy is here. Were photos cannot be attached for legitimate reasons please have a go at describing skin lesions. 
 
The website Dermnetnz has a good description of all the common dermatological terms. The Primary Care Dermatology Society has similar, plus additional useful information on history and examination.  
 
The following is adapted from Ashton & Leppard's book "Differential Diagnosis in Dermatology" (second edition, 1992).  When describing rashes and skin lesions, please detail the : 
  1. Site and distribution - single / multiple and where on the body.
  2. Shape - discoid, linear, target, annular, gyrate.
  3. Colour - erythematous (blanches on pressure), non-erythematous (meningitis rash), other colour - skin coloured, pink, red, mauve, brown, white, yellow, cream, golden.
  4. Duration - acute or chronic, persistent, relapsing,
  5. Surface features - normal or smooth OR warty, papillomatous / scaly, dry and flakey / Keratin - rough, horn, corn / excoriated / exudate or erosion / crust or ulcer / hairy.
  6. Morphology - flat (macules <1cm and patches >1cm), or raised papules <1cm, vesicles <1cm, pustules <1cm, plaques >1cm, nodules >1cm, bullae >1cm) 

Remember, a good picture can say a thousand words so please upload a photo too wherever possible.  Here's a guide on how to do it via EMIS Web and SystmOne

If you are using the Schuco Dermatoscopes bought by York Against Cancer for local practices please click here to watch the guidance video and follow these instructions ;

For practices with WiFi :

For practices without WiFi :

  1. Turn Handyscope on using switch at top of the device and unlock iPod.
  2. Click on Handyscope app which will open up on image capturing page. 
  3. Ensure graticule option is turned on by pressing on graticule image and take image by tapping anywhere on the screen. 
  4. When image has been captured and saved, open up local images tab within the app.
  5. Tap upload in the top right corner, select the correct image and then tap photo album.  This will transfer the image into the iPod's camera roll ready for upload.
  6. Then plug iPod into computer using charging / USB lead.  Open up files and then transfer image. 

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Minor Skin Surgery for Skin Lesions - Commissioning Policy