Open Access Research article

Skin lesions suspected of malignancy: an increasing burden on general practice

Cecile JL Koelink*, Boudewijn J Kollen, Feikje Groenhof, Klaas van der Meer and Wouter K van der Heide

Author Affiliations

Department of General Practice, University of Groningen, University Medical Center Groningen, PO Box 196, Huispostcode FA 20, 9700 AD Groningen, The Netherlands

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BMC Family Practice 2014, 15:29  doi:10.1186/1471-2296-15-29

Published: 12 February 2014



Skin cancer is believed to impose a heavy burden on healthcare services, but the burden of skin lesions suspected of malignancy on primary healthcare has never been evaluated. Therefore the aim of this study was to determine the demand for care in general practice due to these suspected skin lesions (i.e. lesions that are suspected of malignancy by either the patient or the GP).


Registry study based on data (2001–2010) from the Registration Network Groningen. This is a general practice registration network in the northern part of the Netherlands with an average annual population of approximately 30,000 patients. All patient contacts are coded according to the International Classification of Primary Care (ICPC). Consultations for skin lesions suspected of malignancy were selected according to the assigned ICPC codes. Subsequently, the number of consultations per year and the annual percent change in number of contacts (using the JoinPoint regression program) were calculated and analysed. Additionally, the percentage of patients referred to secondary care or receiving minor surgery within one year after the first contact were calculated.


From 2001 onwards we found an annual increase in demand for care due to skin lesions suspected of malignancy of 7.3% (p < 0.01) and in 2010 the benign:malignant ratio was 10:1. In total 13.0% of the patients were referred and after 2006, minor surgery was performed on 31.2% of the patients. Most surgeries and referrals took place within 30 days.


Suspected skin lesions impose an increasing burden on primary healthcare and most likely on healthcare costs as well. General practitioners should therefore be trained in diagnosing skin lesions suspected of malignancy, as a high diagnostic accuracy can save lives in the case of melanoma, and may also prevent unnecessary, costly, excisions and referrals to secondary healthcare.

Skin Neoplasms; Family practice; Physicians; Family; Netherlands; Referral and consultation; Surgical procedures; Minor