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- Presentation
Impact of Expanding Dermatology Services in Rural Kansas on Skin Cancer Detection
Description
The speaker described efforts to expand dermatology access in rural and underserved Kansas through a hub-and-spoke model centered in Wichita, with clinics across the state and a new clinic started in Garden City in 2021. They reviewed evidence that rural areas tend to have higher melanoma incidence and mortality, while also noting limitations of database studies and likely underreporting, especially where dermatology access is limited. At the new Garden City clinic, staffed by a nurse practitioner with periodic physician support, the team initially had to send Mohs cases to Wichita but later secured a state grant to provide Mohs locally. Early results from the clinic showed substantial numbers of basal cell and squamous cell carcinomas and a melanoma incidence that appeared roughly double the pre-clinic reported rate, suggesting that bringing dermatology services into an underserved area uncovers previously missed skin cancers. The team plans to gather more data on tumor depth, size, and treatment needs to better measure the impact of improved access over time.
View moreConclusions
- Rural areas appear to have a higher burden of skin cancer, especially melanoma, than urban areas, but current database estimates likely undercount the true burden.
- Melanoma mortality and incidence seem worse in many rural counties, suggesting real geographic disparities in outcomes.
- Areas with fewer dermatology providers may have substantially underdiagnosed or underreported skin cancers, making incidence data less reliable.
- Installing dermatology services in an underserved rural county can reveal many more cases of basal cell carcinoma, squamous cell carcinoma, and melanoma than were previously recorded.
- In the Garden City clinic, many basal cell cancers were on the head and neck and frequently required Mohs surgery, indicating significant treatment needs in rural populations.
- Squamous cell carcinomas in this rural setting were often on the extremities and needed Mohs surgery less often than basal cell carcinomas.
- The number of melanomas detected in the new clinic was higher than prior county registry estimates, implying that dermatology access improves case finding.
- Overall, the findings support expanding dermatology access, including nurse practitioner-led and physician-supported models, to improve skin cancer detection and care in underserved rural communities.
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