More melanoma deaths in areas without dermatologists: study

NEW YORK Thu Feb 23, 2012 1:21pm EST

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NEW YORK (Reuters Health) - Fewer people die from the skin cancer melanoma in U.S. counties that have at least one dermatologist, according to a new study.

It's not clear why that is, but one dermatologist not linked to the study was quick to credit her colleagues.

"Melanoma is an easily detectible disease," Dr. Melody Eide of the Henry Ford Health System in Troy, Michigan, told Reuters Health. "And if we catch it early, we can have an almost complete cure rate."

About one in 50 white Americans born today will get melanoma at some point during their life, according to the American Cancer Society, and roughly 8,800 will die.

Earlier studies have found that people who have more family physicians and pediatricians nearby live longer, said Dr. Jeremy Bordeaux, a dermatologist at Case Western Reserve University in Cleveland, who led the new study.

"However, there have been some conflicting results (about whether) having specialists decreases mortality from specific diseases," he said.

To determine whether the density of dermatologists could have an effect on cancer outcomes, Bordeaux and his colleagues looked at the number of these specialists in nearly 2,500 non-rural counties with more than 200 million residents overall.

They found that in counties without any dermatologists, about 15 out of every one million people died from melanoma.

In counties that had up to one dermatologist for every 100,000 residents, the melanoma death rate was only two-thirds of that in counties with no specialists.

And with one or two dermatologists, the rate was about half, but there was no extra decrease in areas with even more dermatologist.

"This is really showing (the effect of) access to care with regard to people getting in to see dermatologists," Bordeaux told Reuters Health. "Another thing we found is there was a decrease in mortality based on the number of hospitals with oncologic services."

The results, which are published in the Archives of Dermatology, held up after accounting for things like how many primary care doctors a county had and the percentage of elderly people.

Still, Bordeaux's team did not actually prove that the lower rates of skin cancer deaths were due to the presence of dermatologists, and Eide said unknown factors could have influenced the findings.

Another limitation of the study is that the group did not compare the deaths from melanoma in each county to the total number of deaths from all causes.

Bordeaux said it's possible that counties with fewer dermatologists might have higher death rates, unrelated to skin cancer.

Even if specialists were responsible for the lower death rates, it's not clear that screening would be involved. Instead, it could be better treatment or faster access to care.

Contrary to earlier findings, Bordeaux's results showed that the number of primary care physicians in a county didn't impact the number of melanoma deaths.

"I was surprised they didn't find any effect of primary care clinicians," Eide told Reuters Health.

She said primary care providers are considered important if skin cancers are going to be reduced through screening, because there will never be enough dermatologists to pick up every case.

"Right now I think that we as a society are trying to ask our primary care physicians to do a lot," said Bordeaux. "And I think there are many things (that) primary care physicians have not had adequate training to do."

Bordeaux and his colleagues say there is an "unmet demand" for dermatologists, and that younger dermatologists tend to go into research or cosmetics.

He added that it will be difficult to get dermatologists evenly distributed to counties that don't have any.

"It's tough because we can't make people move to underserved areas," Bordeaux said.

SOURCE: bit.ly/wc2mrq Archives of Dermatology, February, 2012.

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