Melanoma Mortality Is Related to Dermatologist Density

Jeremy S. Bordeaux, MD

Within a given county in the United States, the presence of a dermatologist is associated with a lower melanoma mortality rate compared with counties where there is no dermatologist, recent data suggest.

Jeremy S. Bordeaux, MD, director of Mohs Micrographic and Dermatologic Surgery at University Hospitals Case Medical Center, Cleveland, Ohio, and coworkers examined the association between melanoma-related deaths and dermatologist density.

The investigators used a merged dataset from the National Program for Cancer Registries, the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program, and the Centers for Disease Control and Prevention’s National Vital Statistics System for the time period from January 2002 through December 2006.

The availability of information on the regional distribution of dermatologists is requisite for developing healthcare policies that aim to improve patient outcomes.

The analysis included 2472 counties with a total population of 225,981,679 people. The primary outcome measure was melanoma mortality rate per 100,000 people at the county level.

Results showed that the numbers of dermatologists and subspecialist density varied from city to city, with some areas having no such physicians at all. The presence of 0.001 to one dermatologist per 100,000 people was associated with a lower melanoma mortality rate by more than one-third compared with counties that lacked dermatologists. More than one to two dermatologists per 100,000 people was associated with a 53.0% reduction in melanoma mortality (95% CI, 30.6%-75.4%). The addition of more than two dermatologists per 100,000 people did not confer additional benefit.

The study found that there were no dermatologists in a large portion of the country. There was a higher density of dermatologists along the Pacific Coast, throughout the state of Hawaii, and in clusters in the Midwest and along the East Coast.

The authors cited as a drawback to their study the exclusion of rural counties. They said that they excluded rural counties because there were limited mortality data from these areas and few rural counties had any dermatologists.

They added that efforts to draw dermatologists to counties where there were no dermatologists may yield a population-wide reduction in melanoma mortality. However, they were quick to emphasize that recruiting more dermatologists to counties where there already were dermatologists probably wouldn’t have much of an impact on melanoma mortality since “having two dermatologists is not statistically different from having four dermatologists when considering mortality rates,” the researchers said.

The authors concluded that more research is needed to determine whether dermatologist density is associated with early diagnosis of melanoma or improved treatment.

Aneja S, Aneja S, Bordeaux JS. Association of increased dermatologist density with lower melanoma mortality. Arch Dermatol. 2012;148(2):174-178. doi:10.001/archdermatol.2011.345.