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

Klaas Van Der Meer,Wouter K Van Der Heide,Cecile Jl Koelink,Boudewijn J Kollen,Feikje Groenhof

doi:10.1186/1471-2296-15-29

Klaas Van Der Meer, Wouter K Van Der Heide + Show 3 more

Open Access

https://doi.org/10.1186/1471-2296-15-29

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Abstract

BackgroundSkin 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).MethodsRegistry 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.ResultsFrom 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.ConclusionsSuspected 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.

Highlights

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
We believe that knowledge on healthcare demands for skin lesions suspected of malignancy is important
The total number of contacts per year increased by 54.8% from 60.6 contacts/1,000 patients in 2001 to 93.8 contacts/1,000 patients in 2010. This was a significant increase with an annual percent increase of 7.3 (p < 0.01) (Table 1, Figure 1). This increase was shown for both malignant (ICPC S77; annual percent change 11.8) and non-malignant lesions (Figure 2)

Summary

Introduction

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. Skin cancer incidence is rising [1,2,3,4,5,6]. Public awareness is rising as a result of many public information campaigns [8,9,10,11] and this may lead to an increased consultation rate. The majority of patients visiting their physician for a skin lesion suspected of malignancy do not have skin cancer. De Vries et al.has suggested that for every new case of skin cancer another 20–50 patients will consult their general

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