Addressing the Dermatologist gap: A Novel Approach

In an innovative move to tackle the scarcity of dermatologists, the Occitania region of France has launched a pioneering program. Thirteen physiotherapists, representing each department within the region, have undergone specialized training in the early detection of skin melanoma, the most aggressive form of skin cancer. This initiative aims to improve early diagnosis and ultimately, patient outcomes.

Physiotherapists on the Front Lines of Detection

The program leverages the unique position of physiotherapists who often have the opportunity to observe patients’ skin during treatment sessions. As Xavier Font, a physiotherapist from Narbonne, explains:

People undress in front of us, and it happens that we ask questions about a mole. It was so obvious!
Xavier Font, Physiotherapist in Narbonne

This direct patient interaction allows trained physiotherapists to identify perhaps suspicious skin lesions that might otherwise go unnoticed.

Equipping Professionals with Advanced Tools

Each participating physiotherapist received training in using a dermatoscope, a specialized magnifying device, to examine skin lesions more closely.Dr. Bes,a dermatologist from Montpellier,spearheaded the initiative,with support from the URPS-MK (Regional Union of Health Professionals,physiotherapy section). The URPS-MK also financed the purchase of high-quality dermatoscopes,costing €1,200 each,ensuring that the physiotherapists have the necessary tools for effective screening.

The Growing Threat of Melanoma: Why Early Detection Matters

melanoma is a serious public health concern, with incidence rates steadily increasing worldwide. According to the World Cancer Research Fund International, melanoma is the 19th most common cancer worldwide, with over 325,000 new cases in 2020. Early detection is crucial for prosperous treatment and improved survival rates. This initiative in Occitania represents a proactive step towards addressing this challenge by expanding the network of professionals capable of identifying suspicious lesions.

A Model for Othre Regions?

The success of this program in Occitania could serve as a model for other regions facing similar shortages of dermatologists.by empowering other healthcare professionals to participate in skin cancer screening, healthcare systems can improve access to early detection and potentially save lives. The program’s innovative approach highlights the importance of creative solutions in addressing healthcare challenges.

The Growing Threat of Melanoma and the Importance of Early Detection

Skin melanoma, identified by the High Authority for Health (HAS) as the most serious of all skin cancers, demands early detection due to its aggressive metastatic potential. Public health data from France indicates a critically important health challenge, with approximately 15,500 new cases diagnosed annually and 2,000 related deaths. These figures are part of a larger landscape of skin cancers, estimated between 141,200 and 243,500 cases each year.

Appointment Delays: A Barrier to Timely Treatment

A concerning trend is emerging: extended waiting times for dermatology appointments are deterring individuals from seeking necessary medical attention. A 2023 Ifop study,commissioned by Sanofi,revealed that nearly half of respondents abandoned their attempts to schedule a dermatologist appointment due to excessive wait times. This delay can have severe consequences, particularly in the context of melanoma, where early intervention is crucial.

Regional Disparities: The Situation in Occitania

While official figures may suggest an average wait time of 36 days,the reality in regions like Occitania paints a different picture. Patients in this area are reportedly facing waiting periods of at least six months, highlighting significant regional disparities in access to dermatological care.

The Dermatologist Shortage: A Contributing Factor

Addressing the Crisis: Potential Solutions

The challenges in accessing timely dermatological care require multifaceted solutions. These may include increasing the number of dermatology specialists, incentivizing practitioners to prioritize medical dermatology, and leveraging telemedicine to reach underserved populations. Public awareness campaigns emphasizing the importance of regular skin checks and early detection are also essential.

The Growing Shortage of Dermatologists in France

France is grappling with a significant shortage of dermatologists,raising concerns about access to crucial dermatological care for its citizens. With only 3.4 dermatologists per 100,000 inhabitants, the nation faces a challenge in meeting the growing demand for skin health services. This scarcity is further exacerbated by the aging demographic of practicing dermatologists, with over half being older than 55. The National Union of Dermatologists (SNDV) highlights that the past limitations on medical training slots, imposed by the numerus clausus, have contributed significantly to this shortage. While the quota has been gradually increased, the SNDV emphasizes that the long-term effects of these adjustments are yet to be fully realized.

SNDV Responds to Misconceptions About Aesthetic Dermatology

Following a recent report on France 2, the SNDV issued a press release on February 21st to address what it perceives as a misconception regarding the balance between medical/surgical dermatology and aesthetic dermatology. The union firmly asserts that medical/surgical dermatology constitutes over 95% of the activity of dermatologists in private practice, while aesthetic dermatology accounts for less than 10% of their overall work, even within hospital settings.

This prejudice harms the image and credit of the whole of the profession.

Luc Sulimovic, National President of the SNDV

The SNDV also notes that the trend of general practitioners offering aesthetic medical treatments is growing, adding pressure to the already strained dermatology workforce.

Innovative Solutions: Tele-expertise and Collaborative Care

In response to the access crisis, innovative solutions are being implemented across France. One such initiative involves leveraging tele-expertise, allowing general practitioners to consult with dermatologists remotely for diagnosis and treatment advice. this approach aims to expedite the consultation process,with average consultation times for melanoma and carcinoma cases reduced to 8 and 18 days,respectively.

Furthermore, collaborative care models, such as specialized dermatology and venereology care teams (ESSDVs), are being established to improve access to dermatological services. These teams are currently operating in regions like Ile-de-France, Hauts-de-France, Brittany, corsica, and Center-Val de Loire.

physiotherapists as “Alert Launchers”: A Novel Approach in Occitania

An innovative initiative in occitania involves training physiotherapists to identify suspicious skin lesions and refer patients for dermatological evaluation. This program equips physiotherapists with the skills to capture images of questionable moles using smartphone-adapted dermatoscopes and transmit them securely to dermatologists for review. The goal is to provide a rapid response, with dermatologists expected to review the images within 48 hours and provide a report to the general practitioner and patient.

There is a real problem of access to dermatologists. Our patients can have a request, and, on our side, we can see things. Our role is to account, in a course which must be fluid.

François Marfraing, Physiotherapist at the Medical House of Clarensac (Gard)

François Marfraing, a physiotherapist participating in the program, sees his role as an alert launcher, emphasizing the importance of early detection in improving patient outcomes. Since completing the training, he has already referred several patients with suspicious lesions for further evaluation.

Looking Ahead: Addressing the Root Causes and Expanding Access

The SNDV is actively advocating for increased admissions to dermatology residency programs and the creation of more ESSDVs nationwide. These efforts aim to address the underlying causes of the dermatologist shortage and ensure that all citizens have access to timely and quality dermatological care. While dermatology was the third most popular specialty choice among medical students in 2024, sustained efforts are needed to attract and retain talent in the field.

The Rising Tide of Skin Cancer: A Public Health Concern

Skin cancer rates have been steadily climbing, presenting a significant challenge to public health. Recent data from Cancer Research UK indicates a concerning trend: skin cancer incidence has increased dramatically over the past few decades. Specifically, the number of new cases of skin cancer more than tripled between 1990 and 2023, according to cancer.fr. This surge underscores the urgent need for increased awareness, preventative measures, and early detection strategies.

Decoding Skin Cancer: Melanoma, Basal Cell Carcinoma, and squamous Cell Carcinoma

It’s crucial to understand that there is not one, but skin cancers, as the Foundation for Research on Cancer (ARC) emphasizes. the three primary types are melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC), each with distinct characteristics and risks.

Melanoma: The Most Aggressive Form

Melanoma, while the least common, is the most perilous form of skin cancer due to its propensity to metastasize. Melanoma causes metastases in around 20% of cases, making early detection and treatment paramount. Regular self-exams and professional skin checks are vital for identifying melanoma in its early stages.

Carcinomas: The Predominant Types

carcinomas, including basal cell carcinoma and squamous cell carcinoma, account for approximately 90% of all skin cancers.While generally less aggressive than melanoma, they can still cause significant damage if left untreated.

Basal Cell Carcinoma (BCC)

Basal cell carcinoma develops in the deepest layer of the epidermis. BCCs typically appear as pearly or waxy bumps and are often caused by prolonged sun exposure.

Squamous Cell Carcinoma (SCC)

Epidermoid carcinoma [develops] in the intermediate layer [of the epidermis]. SCCs can manifest as firm, red nodules or scaly, crusty patches. Like BCCs, they are strongly linked to UV exposure.

The Sun’s Shadow: UV Exposure and Skin Cancer Risk

A significant portion of skin cancer cases are directly attributable to excessive exposure to ultraviolet (UV) radiation. The ARC estimates that two-thirds of skin cancers are attributable to an exposure to the sun too large,or more generally to UV radiation from natural sunlight or artificial sources like tanning beds.minimizing UV exposure through sun protection measures is crucial for reducing skin cancer risk.

Identifying Your Risk Factors: Skin Type and Family History

Certain factors can increase an individual’s susceptibility to skin cancer. A light skin phototype (skin color) is a significant risk factor, as individuals with less melanin are more vulnerable to UV damage. Additionally, a family history of skin cancer can elevate your risk, highlighting the importance of genetic predisposition.

A Collaborative Approach to skin Health

Effective skin cancer prevention and management require a collaborative effort involving healthcare professionals and individuals. as Dr. Fraing notes,We send messages,we are in a chain of health professionals where everyone is bringing their stone to the building. This collaborative approach ensures thorough care and support for patients throughout their journey.