From February until October 2003, the data of patients referred to four dermatologists in private practices, with a commuter belt of about 150 000 inhabitants in northwestern Switzerland, were collected prospectively. 20.5% (total 1691; F 55.9%, M 44.1%, mean age 45.9 years) of all patients, visiting the dermatologists with a new skin problem during this period, were referred, to 83.4% by GP's, to 16.6% by other specialists (OS). The GP's diagnostic accuracy was 54.3% (family physician), 52.3% (internist), 66% (pediatrician) and did not differ from the diagnostic accuracy of OS (53.4%). 42.3% of 274 patients referred for nonpigmented skin tumors and 5.8% of 243 referred for pigmented skin tumors revealed skin malignancy. The GP's accuracy in diagnosing BCC was 42.9%, in malignant melanoma 41.7%. There is an open cooperation between GP's dealing with skin disease and dermatologists. Limiting direct access to GP's or dermatologists would be followed by loss of quality in managing skin problems.