Women's Health

deserted

A single black dot on her right breast, the size of the tip of a Sharpie marker. That’s what Amanda Greene noticed as she was getting out of the shower one morning in 2010. “I was standing about five feet away from the mirror and I thought, That’s weird—I don’t remember that being there before,” she recalls. Amanda, then 24, a radio host and producer in Pittston, Pennsylvania, had never had any skin problems. “It didn’t scare me or anything. I just went on with my life.”

But the mark grew bigger. Darker. So at her annual gyno checkup, Amanda showed it to her doctor, who insisted she see a dermatologist right away. Yet when she called a local derm’s office, explaining that her gynecologist recommended she be seen immediately for a changing mole, she was told that the first open appointment was in two months. Surely, if the problem were urgent, she thought, the derm would have squeezed her in.

That wasn’t the case. When Amanda finally saw the dermatologist, he biopsied her mole and diagnosed her with melanoma—the most serious form of skin cancer—scheduling her for surgery that very week. The doctor told Amanda that her cancer had already spread to two nearby lymph nodes, requiring a harder, and more invasive, operation, with more potential for recurrence. Though the surgeon was able to remove the cancer along with the affected lymph nodes, what can’t be erased are these shocking facts: Melanoma is the third leading cause of cancer death among women ages 25 to 39, and fastgrowing types can become deadly in as little as several weeks. Getting an appointment quickly can be the difference between life and “there’s nothing we can do.”

Even though studies show the odds of a suspect mole being melanoma are quite low, if you do have melanoma, catching it early, stopping its spread, and getting treated right away is your best chance at survival. Had Amanda been seen even a month sooner, the cancer could have been removed before it reached her lymph nodes and threatened her life.

The problem extends far beyond one dermatology office in northeastern Pennsylvania. Millions of Americans are being given months-long dermatologist wait times because of a critical shortage of skin doctors. There’s a national dearth of M.D.s in general, but the derm problem is particularly alarming: The U.S. has about 55,000 practicing pediatricians, 40,000 gynecologists, 38,000 psychiatrists—and a mere 10,845 dermatologists. Yet according to the American Academy of Dermatology (AAD), the country needs 22,000 dermatologists in order to treat everyone with skin issues in an appropriate amount of time.

A study published in February in the journal JAMA Dermatology explored this further. The report found that among areas of the country with at least one derm, three-quarters have fewer than four for every 100,000 people, the number needed for adequate care. What the text didn’t delve into were places with no derms at all. Only by combining the papers’ stats with our own research, then crunching the numbers, did Women’s Health unearth a more distressing statistic: One out of every five areas in the country has zero dermatologists.

If you’re in a big city, chances are there’s a derm has termed a “derm desert,” an area without a single dermatologist within 50 or even 100 miles, or one with a menacingly low number of these docs for the population.

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