Dermatologists most qualified for skin cancer, cosmetic procedures

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Primary care physicians say dermatologists are better qualified than other specialists to perform skin cancer surgery as well as a variety of cosmetic procedures, according to a new study published in the October Dermatologic Surgery journal.

The study, supported by a Cutting Edge Research Grant from the American Society for Dermatologic Surgery (ASDS), found a majority of primary care physicians choose dermatologists as the best trained to do the following:

>>Perform skin cancer surgery.

>>Treat skin wrinkles with injectable neuromodulators such as Botox and Dysport

>>Rejuvenate skin with dermal filler injections such as Restylane, Juvederm and Radiesse.

>>Use lasers for cosmetic treatments as well as removal of hair and tattoos.

>>Evaluate and biopsy a worrisome lesion on the skin.

"The majority of primary care physicians recognize the expertise of dermatologists in these areas because of the large volumes of these procedures they perform," said lead author Dr. Omar A. Ibrahimi, director of the Connecticut Skin Institute in Stamford, Conn., and Visiting Assistant Professor at the Wellman Center for Photomedicine at Massachusetts General Hospital. "They also recognize the innovations that dermatologists have made in skin cancer surgery, laser procedures as well as injectable cosmetic treatments."

The study asked 561 physicians in primary care, family medicine and internal medicine residency programs in the United States to select who are the most qualified to perform different cutaneous cosmetic and surgical procedures: dermatologists, plastic surgeons, otolaryngologists (ear, nose and throat specialists) or ophthalmologists.

As suspected, study respondents said dermatologists are the best qualified to evaluate and biopsy a worrisome lesion on the skin (95 percent) and perform skin cancer surgery (56 percent). By almost a three to one margin, respondents said dermatologists also are the best trained to perform laser treatments for cosmetic treatments, hair removal, tattoo removal and birthmarks.

Almost two-thirds of respondents also chose dermatologists over plastic surgeons as the most qualified to perform cosmetic procedures for wrinkles (e.g., Botox, Dysport) and skin rejuvenation (eg, Restylane, Juvederm, Radiesse).

"Because primary care, family care and internal medicine physicians are trusted sources of information and referral for patients, it is important to understand their opinions on which specialist is the optimal provider for specific procedures," said Dr. Ibrahimi. "We also wanted to see how dermatologists compare in terms of their perceived expertise for cutaneous surgery and cosmetic procedures because of the overlap with other surgical subspecialties."

Confusion may arise in dermatology referrals because of that overlap and the diversity of dermatologic surgery procedures, Dr. Ibrahimi said. A 2011 ASDS Survey on Dermatologic Procedures reveals the range and scope of procedures performed by its members, including 2.6 million skin cancer treatments and more than five million cosmetic procedures ranging from wrinkle-relaxing injections, laser and light procedures, soft-tissue dermal fillers, vein treatments, body sculpting and laser hair removal.

"This is an important study because little was known about physician perceptions of dermatologists, and we know referring physicians want the best qualified specialist for their patients," said ASDS President Susan H. Weinkle, MD. "This study shows dermatologic surgeons understand the special needs of skin through every stage of life and are skilled providers of advanced surgical and non-surgical methods for both medical and cosmetic procedures."