Melanoma cases are more common in rural areas; one reason: lack of dermatologists, Michigan researchers say

Melanoma is the the third most-common cancer found in rural America. A new study from Cancer Reports on residents from rural Michigan that shows the frequency and deadliness of undiagnosed skin cancer among rural residents when compared to urban dwellers. "One reason for that dramatic disparity: lack of dermatologists in rural counties," reports Eric Freedman of Capital News Service in review of the report. "Michigan has almost twice the number of dermatologists per capita practicing in urban counties And 38 of the state’s 62 rural counties have no dermatologists at all."

Lead researcher Richard Shellenberger, an internal medicine specialist at Trinity Health Ann Arbor Hospital in Ypsilanti, told Freedman, “The lack of doctors in rural areas was a significant factor. It takes a special person to say, ‘I want to practice in the Upper Peninsula; I want to practice in rural Northern Lower Peninsula.’”

3D structure of a melanoma cell derived by ion abrasion
scanning electron microscopy. (Image from Unsplash)

If cancer is diagnosed late, it is more likely to be severe. Dearborn dermatologist Karen Chapel told Freedman, “The more deeply melanomas invade the skin, the higher their risk of metastasizing – spreading to internal organs – and being deadly."

Steven Daveluy, professor at the Wayne State University School of Medicine, told Freedman that rural residents are more than three times as likely to work outdoors than their urban counterparts, increasing their exposure to the sun,

While there is a national dermatologist shortage, the lack is more acutely felt in rural areas. Daveluy gave Freedman an example of a farmer he treated: "After years of sun exposure working outdoors, he found an open sore that wouldn’t heal on his scalp. He didn’t like to go to doctors, plus he was busy working his farm to keep everything running, so he delayed coming to get treatment. When he did come, the sore had grown significantly. Due to his delay in seeking care, his surgery was more extensive.”

Chapel and Shellenberger gave Freeman a short list of items that could help ease the medical care gap between rural and urban areas, which included telehealth, incentives for rural rotations by medical students, and government support for new physicians entering rural communities with a focus on specialty physicians.