ABSTRACT
BACKGROUND: The role of general practitioners (GPs) in skin cancer care is increasing. Previous, hospital-based studies suggest that GPs might not have the capabilities to gain responsibility concerning skin cancer care. OBJECTIVES: To evaluate the current approach of GPs towards skin lesions suspected of malignancy in the Netherlands. METHODS: In three general practices, all consultations in 2015 concerning skin lesions suspected of malignancy were identified and reviewed. Patients demographics, circumstances of consultation, evaluation of skin lesion(s), presumed diagnosis, diagnostic accuracy and policy were evaluated. RESULTS: Five hundred and eighty consultations were identified. Patient took initiative for encounter in 90%. Case-finding occurred in 2%. Diagnostic tools were used in 22%; dermoscopy was used in 8% and a diagnostic excision in 10%. The GP diagnosed a benign lesion in 69%. Therapeutic interventions were applied in 31% and a wait-and-see policy in 40%. The diagnosis after referral was a benign tumour in 39% of the cases, a malignancy in 29% and a premalignant lesion in 17%. The positive predictive value (PPV) of the presumed benign, malignant and premalignant diagnoses was 86%, 54% and 18%, respectively. CONCLUSIONS: Most lesions that are presented to the GP with a suspicion of a malignancy appear to be benign lesions. In the examined practices, the diagnosis of the GP is mainly based on clinical examination and little use is made of available diagnostic tools. The use of a diagnostic tool like a biopsy might prevent unnecessary referrals.
Subject(s)
General Practice/methods , Physician's Role , Practice Patterns, Physicians' , Precancerous Conditions/diagnosis , Skin Neoplasms/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy/statistics & numerical data , Child , Child, Preschool , Dermoscopy/statistics & numerical data , Female , Humans , Infant , Infant, Newborn , Male , Medical History Taking , Middle Aged , Netherlands , Referral and Consultation/statistics & numerical data , Retrospective Studies , Skin Diseases/diagnosis , Skin Diseases/therapy , Skin Neoplasms/therapy , Watchful Waiting/statistics & numerical data , Young AdultABSTRACT
The 1999 practice guideline 'Acne vulgaris' from the Dutch College of General Practitioners has been revised. Benzoyl peroxide and local retinoids are first choice in local treatment of acne. When treatment with oral antibiotics is indicated, doxycycline is first choice. Use of minocycline is not recommended in general practice. It is recommended that both local and oral antibiotics are always combined with local benzoyl peroxide or a local retinoid. Oral contraceptives are only recommended in women with acne who also desire contraception. Use of oral contraceptives containing cyproterone acetate is no longer recommended in women with acne, because they are not more effective than other oral contraceptives. Treatment with oral isotretinoin may be given by the general practitioner, as long as the treatment guidelines are carefully followed.
Subject(s)
Acne Vulgaris/drug therapy , Anti-Bacterial Agents/therapeutic use , Family Practice/standards , Practice Patterns, Physicians' , Administration, Oral , Administration, Topical , Contraceptives, Oral , Humans , Netherlands , Societies, Medical , Treatment OutcomeSubject(s)
Adjuvants, Immunologic/adverse effects , Cross Infection/microbiology , Cyclophosphamide/adverse effects , Gram-Negative Bacterial Infections/microbiology , Immunosuppressive Agents/adverse effects , Isoxazoles/adverse effects , Skin Diseases, Infectious/microbiology , Stenotrophomonas maltophilia , Adult , Aged , Arthritis, Rheumatoid/drug therapy , Cross Infection/immunology , Female , Gram-Negative Bacterial Infections/immunology , Humans , Leflunomide , Skin Diseases, Infectious/immunologyABSTRACT
A 13-year-old boy had a fastly recurring and readily bleeding skin lesion on his back caused by pyogenic granuloma.
