Skin cancer is common among white populations and rapid increases in incidence are being observed in many countries, leading to a large burden on healthcare systems. Unnecessary referrals from general practitioners (GPs) may contribute to this burden. The aim of this study was to analyse the quality of referrals from GPs of patients with skin tumours. Referral letters for 734 patients were collected. The proposed diagnoses were compared with definitive diagnosis made by dermatologists. In 44.5%, lesions appeared to be benign. Malignant skin tumours were poorly recognised by GPs and seborrheic keratoses were often mistaken for naevi (33.6%). Furthermore, with total body examination, dermatologists found 111 additional malignant lesions. We discussed several recommendations to minimise unnecessary referrals as well as the future role of GPs in skin cancer care.

Summary Background The rising incidence rates of skin cancer (SC) lead to an enormous burden on healthcare systems. General practitioners (GPs) might play an important part in SC care, but research has shown poor clinical recognition of SC, leading to a high rate of potentially unnecessary referrals. Objectives The aim of this study was to evaluate if a dermato‐oncological training programme (DOTP) for GPs improved their diagnostic skills and quality of referrals. Methods Out of 194 GPs in the Nijmegen area, 83 (42·8%) followed a DOTP on SC. Referrals from both a trained cohort (TC) and two cohorts of untrained GPs [untrained present cohort (UPC) and untrained historical cohort (UHC)] were included. Data on diagnostic skills, quality of referrals and the number of potentially unnecessary referrals were evaluated. Results A total number of 1662 referrals were analysed. The referral diagnosis was correct more often in the TC (70·3%) compared with the UPC (56·2%; P < 0·001) and the UHC (51·6%; P < 0·001). Furthermore, the TC also provided a better lesion description, mentioned a diagnosis more often in their referral letters and more often performed diagnostics before referral. In addition, fewer potentially unnecessary referrals were identified in the TC compared with the UPC (62·7% vs. 73·7%; P < 0·001) and the UHC (75·2%; P < 0·001). Conclusions GPs who followed a DOTP had better diagnostic skills and quality of referrals than untrained GPs, leading to fewer potentially unnecessary referrals. This might enhance a more efficient use of the limited capacity in secondary dermatological care and consequently lead to lower healthcare costs.

Background: Due to a rapid increase in the incidence of skin cancer, it seems inevitable that general practitioners (GPs) will play a larger role in skin cancer care. Objectives: To assess surgical procedures used by GPs in skin tumour management. Methods: We performed a retrospective study of 1,898 pathology reports of skin tumours excised by GPs in 2009. Results: In 22.9% no diagnosis was provided on the application form. Mostly, once-off excisions (no preceding biopsy) were performed, 7% of the excised lesions were malignant, and 35% of incisions were incomplete. Excisions in the face and neck region were incomplete in 65.4%; 22% of melanomas were biopsied or shaved. Conclusion: This study underlines the difficulties in skin tumour management in primary care. To stimulate adequate resource use, the number of excisions of benign lesions could be lowered, and pretreatment biopsy in non-melanoma skin cancer management should be encouraged. GPs should be aware of their limitations and consider referral of high-risk malignancies.

Most GPs are willing to extend their role in SC care; however, more training is requested and the usage of guidelines should be encouraged. Those willing to extend their role should focus on improving their clinical diagnosis of skin tumours, treatment of low-risk skin (pre)malignancies, including field-directed treatment of AK and noninvasive treatment of BCC, and on prevention.

Actinic keratoses (AK) occur frequently; however, real-life clinical data on personalized treatment choice and costs are scarce. This multicentre one-year observational study investigated patient-characteristics, cost and effectiveness of methylaminolaevulinate photodynamic therapy (MAL-PDT), imiquimod (IMI) and 5-fluorour-acil (5-FU) in patients with AKs on the face/scalp. A total of 104 patients preferred MAL-PDT, 106 preferred IMI and 110 preferred 5-FU. At baseline, significant differences between treatment groups were found; most patients were severely affected (mean 32.5 AK in PDT-group, 20.2 in IMI-group, 22.8 in 5-FU-group). A mean reduction in lesions of 81% after MAL-PDT, 82% after IMI and 88% after 5-FU was found after one year. Annual costs were €1,950 for MAL-PDT, €877 for IMI and €738 for 5-FU. These results show that, compared with clinical trials, in the real-life clinical setting AK patients are usually more severely affected and treatment costs are much higher. Furthermore, patient characteristics are important factors in treatment choice.