Too few dermatologists, or a plethora of “skin check” patients?

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To the Editor:

In recent years we have all noted an increase in the number of patients who want to have their ‘skin checked.’ This heightened interest in skin health has, no doubt, been stimulated by the skin cancer screening campaign of the American Academy of Dermatology, as well as the media's focus on the ‘skin cancer scare.’ Another major factor that accounts for this growth is the surge of managed care referrals, most frequently for the evaluation of benign and malignant tumors.1

In 2001 the well-publicized melanoma cases of presidential candidate John McCain and the wife of baseball pitcher Curt Schilling, as well as the death from metastatic melanoma of Maureen Reagan, in all likelihood, have stimulated a further interest in, and fear of, skin cancer among many of these anxious patients and their families. Furthermore, recent US presidents have been shown on television and in newspapers sporting adhesive bandages on their faces after having had actinic keratoses and basal cell carcinomas treated.

In my practice, particularly in the past 2 years, I've seen a dramatic increase in these ‘skin check’ patients' often 4 to 5 per day. Almost without fail, I have found very little of any pressing skin disorders, let alone skin cancers, in these ‘just checking to make sure’ patients. Arguably, such an increase in the number of these patients will result in an occasional pickup of a significant lesion and certainly provides us with an opportunity to educate and reassure currently healthy patients. Nevertheless, these visits have consumed many of my appointment slots, often at the expense of patients who have been waiting weeks or months for more necessary appointments.

The question has been raised as to whether there are too few dermatologists. Rather, I feel that there are currently too many patients. Perhaps we should train more dermatologists, but I also believe that patients would be better served if primary care clinicians became better educated in distinguishing between benign and malignant skin growths.

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References 

1. Lowell BL, Froelich CW, Federman DG, Kirsner RS. Dermatology in primary care: prevalence and patient disposition. J Am Acad Dermatol. 2001;45:250–255
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