Botox May Beat Cancer Concern in Race to Dermatologist

One patient is worried about wrinkles in her forehead. Another is concerned about a mole that she thinks may be showing signs of developing into skin cancer. Both make calls to their respective dermatologists for an appointment.

So who gets to see a doctor first?

According to a study published in the Journal of the American Academy of Dermatology on Tuesday, it's likely be the patient with the wrinkle woes — by a long shot.

In the survey, researchers called every board-certified dermatological practice in 12 metropolitan areas and posed as patients interested in botulinum toxin injections.

Lead study author Dr. Jack Resneck, an assistant professor of dermatology at the medical school of the University of California, San Francisco, and his colleagues found that the median wait time for a botulinum toxin jab appointment was eight days.

The researchers then compared this finding with previous research, which had found that the median wait time for an appointment to check a suspicious mole was 26 days.

Boston's 55-Day Wait

Practices in Boston led the pack in terms of the discrepancy between wait times. Researchers found that a wrinkle-injection patient would see a dermatologist 55 days earlier than a patient with a suspicious mole. In Little Rock, Ark., however, the difference amounted to only half a day though the wrinkle-injection patients still came out ahead.

"Wait times for this cosmetic treatment appear to be substantially shorter than those previously reported for patients with medical skin symptoms," the authors of the study wrote. "Even when patients report a changing mole [a potentially urgent indicator of malignancy] and are willing to pay out-of-pocket for a dermatology visit, the median wait time was 18 days longer than for botulinum toxin in these [cities]."

"Clearly a changing mole is more important than injections of Botox," said Dr. Alice Pentland, chair of the department of dermatology at the University of Rochester in Rochester, N.Y., who added that she felt the study was "well executed."

"It's an unfortunate finding," said Dr. Jeffrey Weinberg, assistant clinical professor of dermatology at Columbia University in New York. "Certainly cosmetic is a part of dermatology, and obviously we have to respect that. But my feeling is that this should be a wake-up call to dermatologists."

But not all dermatologists agreed that the study could be used to draw such a conclusion.

"For assessing access and wait times for Botox, the survey seems fine," said Dr. David Sawcer, assistant professor of dermatology at the University of Southern California. But he added, "In the comparisons it makes it is fraught with questions of poor reliability."

For one, he said, two different studies means two different sets of dermatologists. The studies were also done at different times, he said, further complicating a head-to-head comparison.

"Most simply, there may be more practitioners — dermatologists or physician assistants — who do Botox than check moles," he said.

However, Weinberg said regardless of these concerns the research still exposes an important issue for the field.

"Qualitatively the study still demonstrates that there's a problem," he said.

Reasons for the Wait

While the study delineated the differing wait times between these two categories of treatments, it was not designed to explain why these differences occurred.

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