South Dakota Dermatology: Urban vs Rural Wait Times Survey and Dermatologist Density.

BACKGROUND: As of 2019, the state of South Dakota had only 32 registered dermatologists, one per 27,569 people. Wait times to be seen for dermatologic care are affected by factors such as socioeconomic status, provider distribution, and patient to provider ratios. This inaccessibility to care or prolonged wait times may lead to diagnosis and treatment delays, and disease progression. We hypothesized wait times to see a dermatologist would be longer in rural areas than urban areas in South Dakota. METHODS: Dermatology clinics throughout South Dakota were contacted to obtain wait times. An internet search was conducted to develop a list of dermatology providers. A population of 50,000 or greater defined an urban area and a ratio of 4 dermatologists per 100,000 people was used as an ideal patient to provider ratio. RESULTS: Overall, 75% of South Dakota's dermatology clinics participated with an equal rural to urban distribution. There was no statistically significant difference in wait times for new (p=0.787) or established patients (p=0.461) comparing rural and urban clinics. All South Dakota cities with clinics met the goal patient to dermatologist ratio except for Dakota Dunes (included as part of the Sioux City, Iowa metro population). CONCLUSIONS: The data does not support the hypothesis that wait times for dermatologists would be longer in rural locations than urban locations. Despite adequate dermatologist to patient ratios throughout most of South Dakota, wait times of over 6 weeks were found at both urban and rural locations, indicating the need for future studies to assess potential solutions for improving timely access to dermatologic care.

Comparing Travel Distance to Care and Staging of Parotid Gland Malignancies in South Dakota and Surrounding States.

BACKGROUND: Parotid gland malignancies are difficult to characterize in terms of incidence and risk factors due to their relatively rare occurrence. Common cancers often present more aggressively in rural areas, albeit occurring less frequently. Some previous studies have found increased distance to care has been linked to more advanced malignancies. This study hypothesized decreased access to parotid gland malignancy specialists (otolaryngologists or dermatologists), evaluated as longer travel distances, would be associated with more advanced staging of parotid gland malignancies. METHODS: A retrospective chart review of the Sanford Health system electronic medical record in South Dakota and surrounding states from 2008-2018 was conducted to obtain data of parotid gland malignancies, respective staging, and patient home addresses to assess distance, both driving and straight-line, to the nearest parotid gland malignancy specialist, including outreach clinics. Travel distance was categorized (0-20 miles, 20-40 miles, and 40+ miles) and compared to categorized tumor stage (early 0/I, late II/III/IV) using a Fisher's Exact test. RESULTS: Overall, chart review yielded 134 patients with parotid gland malignancies from 2008-2018 in the Sanford Health system and associated data was gathered. The malignancies were categorically organized as 52.3 percent in early stage (0/I) vs. 47.7 percent in late (II/III/IV). When comparing parotid malignancy stage to driving distance, no significant association was found when outreach clinics were excluded (p=0.938) or included (p=0.327). When comparing parotid malignancy stage to straight-line distance, no significant association was found when outreach clinics were excluded (p=0.801) or included (p=0.874). CONCLUSIONS: Although no association was established between travel distance and parotid gland malignancy staging, further studies are needed to evaluate at population levels the incidence of parotid gland malignancies in rural communities and if there are specific risk factors in these areas for these malignancies which is currently unknown.

High School Students' Knowledge and Attitudes on Tanning and Sun Exposure Before and After Educational Presentations.

BACKGROUND: Rising rates of skin cancer are a significant medical concern with a nearly 300 percent increase in new melanoma cases since the 1970s. There is a prominent lag time between UV radiation carcinogen exposure primarily in adolescence and pathology presentation primarily in the elderly. Teenagers spend the most time in the sun while paying the least attention to sun protective measures. A potential intervention method is primary prevention in the high school population. METHODS: A local high school was visited by medical student facilitators. Eligible participants of the IRB approved study were students in freshman physical education classes attending class in-person. Participants were given a prepresentation survey to assess behaviors, knowledge, and attitudes surrounding sun exposure and tanning. A 15-minute educational PowerPoint presentation was given. A post-presentation survey, identical to the pre-presentation survey, was given immediately after. RESULTS: Overall, 181 freshmen (75.4 percent) participated. Knowledge about sun exposure, UV radiation, and skin cancer was higher post-presentation. Additionally, students reported positive attitude changes regarding protecting oneself from UV radiation, perceived risks/benefits of tanning/sun exposure, and perceptions of their future likelihood/concern of developing skin cancer. CONCLUSIONS: Our study revealed brief educational presentations can increase knowledge and change attitudes in freshman high school students regarding UV radiation associated with tanning and sun exposure. Given the current rising rates of skin cancer, easy interventions such as the one demonstrated in this study should be part of a likely multi-factorial public health response. Future steps include additional analysis of changes to participants' behavior.

A Case-Based Review of Cutaneous CD30-Positive Lymphoproliferative Disorders.

CD30-positive lymphoproliferative disorders are a group of diseases which represent the second most common (30 percent) subgroup of cutaneous T-cell lymphomas. They present a challenging diagnosis given their similar findings histologically and clinically in comparison to other cutaneous pathologies. Use of immunohistochemical staining to identify CD30 positivity facilitates a more rapid development of the appropriate management plan. Here we present two cases of CD30-positive lymphoproliferative disorders (lymphomatoid papulosis and anaplastic large cell lymphoma), analyze the spectrum of CD30-positive lymphoproliferative disorders, and review potential mimics of these pathologies to ensure the proper workup, diagnosis, and management of such diseases.

Travel Distance for Rural South Dakota Dermatology Care.

BACKGROUND: Nearly 40 percent of dermatologists in the U.S. practice in the 100 most population dense areas, with less than 10 percent practicing in rural areas. Rurality, delayed detection time, and increased travel distance have been associated with worse malignancy outcomes. Without their local rural dermatologist, we hypothesized patients would face significantly increased travel distance and be less likely to receive dermatological care. METHODS: A survey was created to assess travel distance, likelihood to travel further for care, and use of primary care providers for dermatologic care. Eligible participants of the IRB approved study were patients of the only dermatology clinic in Yankton, South Dakota. Yankton is a town in southeastern South Dakota with a population of 14,687. RESULTS: Overall, 100 surveys were completed. Most patients (53.5 percent) did not know where they would receive dermatologic care if the dermatology clinic was not available. The average patient would travel 42.6 miles further to the closest non-outreach dermatology clinics. Over 25 percent of patients were unlikely or not willing to travel further for care. As patient's age increased, so did their likelihood to travel further. CONCLUSIONS: The data supports the hypothesis that without their local rural dermatologist, patients would face significantly increased travel distance and be less likely to receive dermatological care. Given the barriers to care in rural areas, it is imperative to proactively confront these challenges. Further studies are needed to assess for confounding factors in this dynamic and develop innovative solutions.

Netherton Syndrome in a Mother and Her Two Children.

Netherton syndrome (NS) is a rare autosomal recessive condition caused by mutations in the serine peptidase inhibitor, Kazal type 5 (SPINK5) gene which encodes for a serine protease inhibitor, lymphoepithelial Kazal-typerelated inhibitor (LEKT1). NS is characterized by a triad of ichthyosiform erythroderma, trichorrhexis invaginata, and atopic diathesis with elevated IgE levels. The syndrome typically presents in infancy, where life-threatening complications are frequent, and evolves into a less severe condition with milder clinical symptoms in adulthood. This case report details the clinical history and genetic testing of a mother and two children with clinically symptomatic and genetically proven NS.