Melanomas usually present as an irregular pigmented lesion of varying size, but presentation may be atypical. Based on clinical assessment, the general practitioner (GP) decides to reassure the patient, excise the lesion himself or refer the patient to a hospital. The latter will especially occur in case of a high index of suspicion, but also for larger lesions and lesions on body parts that will cause technical or cosmetic problems for the GP such as hands, feet or face. However, previous studies have shown that clinical diagnosis of pigmented skin lesions by GPs is not very accurate. Our own studies showed that 1.9% of pigmented skin lesions submitted for histopathology bared a (pre) malignancy, 62% of the malignancies being an unsuspected melanoma. Although it has not convincingly been proven that (incisional) biopsies of melanomas worsen prognosis, best practice for a GP is yet to radically excise suspicious lesions whenever possible or refer to a dermatologist or surgeon. Therefore, proper assessment of the index of suspicion by GPs would result in optimal care for patients with pigmented lesions: primary excision followed by sentinel node biopsy if indicated for patients with a high index of suspicion by dedicated specialists (surgeons or dermatologists), and narrow excision with good cosmetic outcome by GPs of lesions with a low index of suspicion.
Buis PAJ, van Kemenade FJ, Frijling BD, van Diest PJ (2011) Skin Melanomas Excised by General Practitioners: More Often Unsuspected, of Nodular Type and Less of Often Radically Excised Than Those Excised in an Academic Setting. J Clin Exp Dermatol Res 2:125.