A Status Report: Dermatological Surgery

T he American Society for Dermatologic Surgery recently released the results of its first ever survey on the “State of Dermatologic Surgery.” The organization surveyed its 2400 members and had a return rate of about 63%, according to spokeswoman Nadine Tosk. The survey found that ASDS members performed about 3.9 million procedures in 2001, with the five most common procedures being: 1. Skin cancer surgeries, 2. Laser and light-based procedures, 3. Resurfacing techniques, such as lasers, chemical peels and dermabrasion, 4. Botulinum toxin (Botox), and 5. Vein treatments. This survey was done to serve as an educational tool, says Stephen H. Mandy, M.D. “We thought it was important for ourselves and the public. We need to serve our members educationally,” Dr. Mandy, the incoming president of the ASDS, explains. He says it’s important that all dermatologists know more about what the profession is doing as a whole. He attributes the high return rate of the survey to the enthusiasm of the members of the organization. The average dermatologic surgeon, according to the ASDS, is 50 years old, with 48% younger than 50. Men make up 78% of the ASDS, but the proportion of women is increasing among younger members, according to the ASDS. Leading the Fight Against Skin Cancer Dr. Mandy was not surprised that skin cancer, accounting for more than 1.4 million of the 3.9 million procedures performed, remains the core of dermatologic surgery. Dr. Mandy says that although many dermatologists, such as himself, specialize in areas like cosmetic surgery, dermatologists across the board have patients needing to be treated for skin cancer. “Skin cancer is a big problem,” he says, adding that it’s not an elective treatment for patients the way a cosmetic procedure may be. With skin cancer patients, you aren’t depending on advertising or market-driven campaigns. These patients need treatment and look to you, the dermatologist, for it. The ASDS reports that skin cancer is the most common form of cancer in the United States with an estimated 1 million individuals affected by it in 2001. The good news is its high cure rate. Dermatologic surgeons are performing Mohs surgery, excisional surgery, sryosurgery and electrosurgery to help their patients fight the cancer. Of these, Mohs is the most popular, accounting for 37% of the surgeries performed by survey respondents. The ablative surgeries, syrosurgery and electrosurgery, follow closely behind at 31%. Cosmetic Procedures on the Rise On the other hand, cosmetic dermatology is driven by market demand, which is created by the patients and the companies. Cosmetic companies advertise and patients request these surgeries, says Dr. Mandy, adding that advances in this area have been rapid. Laser/light procedures, including nonablative technologies accounted for just under 0.8 million of the 3.9 million surgeries performed. The ASDS says this survey found that laser and light-based treatments make up about 15% of all procedures performed by its members. Resurfacing techniques are also on the rise. Respondents are mostly performing microdermabrasion, which makes up 35% all the resurfacing techniques being performed. Chemical peels make up 24%, lasers and others 21%, and liquid nitrogen is used 20% of the time. There are also a substantial number of respondents performing vein treatments and Botox injections. Dr. Mandy expects these areas to continue to grow, especially with the anticipated FDA approval for wrinkle reduction. Currently, sclerotherapy is the leading choice for treatment of leg veins for ASDS members. Laser and light sources are also being used to treat facial veins. “An increasing number of men are coming in for veins around their nose,” says Dr. Mandy. Men want these treated and taken care of. Harold J. Brody, M.D., immediate past president of the ASDS, points out that most of the laser/light based surgeries haven’t been around for longer than a few years, and dermatologic surgeons are the best equipped and trained to perform many of these procedures. Patients sometimes turn to non-physicians, but should feel much more confident going to a dermatologic surgeon who, as the statistics show, are the leaders in using many of these devices. Patient Demographics This survey also uncovered the trends in patients turning to dermatologists for surgery. Females represent 62% of the patients being treated, and almost 25% of these females are under the age of 40. Although the average age of the patients you’re treating is 55, the average age of women, 51, is much younger than that for men, 60. Other interesting statistics that arose from the survey: l Nearly 15% of all surgeries performed on women are laser/light based treatments. l Women comprise about 90% of bovine collagen, Botox, superficial chemical peels, microdermabrasion and sclerotherapy procedure patients. l Men mostly seek treatment for skin cancer. Of all procedures performed on men, 62% are cancer-related. On the other hand, skin cancer surgeries account for 27% of procedures for women. l Laser treatments of facial veins and chemical peel resurfacing are the most popular cosmetic procedures for men, which account for 18% of male related procedures. l Among the youngest patients—those under the age of 10—about 60% of all procedures were laser/light-based treatments. Looking to the Future Ms. Tosk says that the organization was not surprised by any of the results, but delighted and proud that the total number of procedures was so high. This is only the first survey of its kind that the ASDS plans to do. The results of this first survey will serve as a benchmark for future surveys—the next one is planned for 2003.