Removal of Ganglion

NHS Vale of York CCG does not routinely commission surgical removal of ganglia and surgical excision will not be commissioned for cosmetic reasons.

GPs must obtain prior approval from the IFR Panel before referring to secondary care. The CCG does commission the routine aspiration of ganglions in primary care within the local enhanced service contract.

Funding will only be considered on the grounds of clinical exceptionality if they meet the threshold below:

There is doubt about the diagnosis (if there is any concern about possible malignancy, patients should be referred via the 2 week wait route)
OR
The ganglion is causing significant functional impairment
AND/OR
The patient is experiencing considerable pain as a result of the ganglion’s size or position despite the use of analgesics (e.g. inability to fit shoes or walk)
AND
Conservative measures such as aspiration and bandaging have been attempted at least twice. Ganglia on the feet may need podiatry input

Referral for soft tissue ultrasound can be made where there is diagnostic uncertainty. Where access to soft tissue ultrasound is not available, referral for a surgical opinion can be made to provide diagnostic support. However, in these situations, even where a diagnosis of ganglion is made clinically, excision will not be funded unless deemed an exceptional clinical circumstance by the Individual Funding Request Panel.

The clinician needs to submit an application to the CCG’s IFR panel. The following information with examples of significant functional impairment should be provided:

Precise location of ganglion e.g. flexor tendon
Size in cm/inches (length and width)
How is functioning of the area impaired? (What is the patient unable to do?)
Impact on quality of life e.g. is the patient unable to fulfill any essential activities such as cooking, dressing, washing etc.?
Degree of pain
How long it has existed and treatments tried to date

To submit an application to the CCG's Individual Funding Request Panel, please click here for further information.

Please click here to view the full Ganglion Surgery Commissioning Statement.

Policy date: September 2016

Next Review date: September 2018