PCP Support, Community Outreach Help Close Rural Dermatology Access Gaps

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Rural dermatology faces major access challenges, but virtual triage, primary care provider (PCP) support, and mobile clinics are helping bridge care gaps, experts explained during a Friday afternoon session at the 2026 American Academy of Dermatology (AAD) Annual Meeting in Denver, Colorado.¹

Current State of Rural Dermatology Care

Sancy A. Leachman, MD, PhD, FAAD, melanoma program director at the Knight Cancer Institute at Oregon Health and Science University, opened the session, “Reducing Rural Health Disparities in Skin Cancer,” with an overview of the issue.

She highlighted that 68% of US counties lack a dermatologist, leaving patients, particularly those in rural areas, with limited access to care and long travel distances. These barriers are further compounded by extended wait times, leading to delayed diagnoses and deferred treatment.

Brandon R. Litzner, MD, FAAD, a dermatologist at Heartland Dermatology in Kansas, built on Leachman’s points by focusing on melanoma, noting that many Midwestern rural states have very low dermatologist density and high melanoma mortality. North Dakota, however, is an outlier, with lower melanoma mortality and higher dermatologist density than the recommended threshold of 4 per 100,000 people. While this pattern may suggest that a better dermatologist supply reduces mortality, he explained that conclusions cannot be drawn due to several limitations.

Despite multiple database studies showing higher melanoma incidence and mortality in rural vs urban counties, the true incidence is likely even higher, especially in rural areas, because melanoma in the US is underreported by approximately 20% to 30%.

Looking more broadly, most databases do not capture thin or superficial melanomas, basal cell carcinoma, squamous cell carcinoma, or melanoma in situ. Litzner also emphasized that data accuracy may be compromised in areas without dermatology providers, as it is unclear who is diagnosing and reporting these cases.

Barriers and Solutions in Rural Dermatology

In addition to rural areas being dermatology deserts with long wait times, John R. Durkin, MD, FAAD, residency program director and associate professor of dermatology at the University of New Mexico (UNM) School of Medicine, explained that what distinguishes rural patient populations from others in the US is lower screening awareness, more outdoor and high-exposure jobs, and higher uninsured or underinsured rates.

He added that rural health systems also face limitations, including very limited specialty cancer care and Mohs surgery capacity, poor clinical trial access, and fragmented referral pathways, especially for solo or rural practices that do not know where to send patients.

Based on his experience at UNM, Durkin highlighted that adding more dermatologists is ideal, but the process is too slow to make a significant impact on the current rural dermatology crisis. He also noted that dermatologists cannot rely on patients traveling long distances, as many will not or cannot. While teledermatology is valuable, Durkin added that it is not a “silver bullet.”

He highlighted several challenges with direct-to-consumer teledermatology, noting that poor image quality often leads to in-person follow-up, doubling dermatologists’ workload. Teledermatology can also disrupt busy clinic workflows and put dermatologists at risk of forgetting calls or follow-ups.

In addition, teledermatology carries a hidden time burden due to patient messaging, administrative tasks, setup, and electronic medical record (EMR) management. Durkin explained that reimbursement may also vary and is generally less favorable than in-person visits. While often thought of as quicker and more convenient, teledermatology is still bottlenecked by limited dermatologist time.

Strategies that are improving care in New Mexico and can be applied more broadly include remote triage using photos and electronic consultations to prioritize patients who truly need tertiary care and centralizing only complex cases at university centers. Whenever safe, he suggested treating patients locally by empowering PCPs with education, backup, and training.

Durkin also promoted the use of interprofessional consults, in which PCPs and other clinicians send images and a question to dermatology, and dermatologists respond with written advice that is incorporated into the patient’s chart. These consults help keep care local, build PCP and clinician capacity, and enable them to become the “derm person” in their community. Consequently, dermatologists can give guidance in about 5 minutes without assuming full ongoing management.

“At the end of the day, there are going to be some things that patients need to come to specialized centers for, but the more we can do to improve the referral network, the better,” he concluded.

Amy Snow, PA-C, founder of Project Happy Face, followed Durkin’s presentation with another method for increasing rural dermatology access that meets people where they are: a mobile dermatology clinic.

Founded in 2009, Project Happy Face provides free dermatologic care in exchange for patients agreeing to smile at strangers. Snow launched a 24-foot mobile dermatology clinic in spring 2023 to reach rural and frontier communities. The clinic is fully equipped with liquid nitrogen, biopsy capability, and a full EMR (Modmed), enabling comprehensive care and follow-up, not just quick screenings.

Snow explained that Project Happy Face partners with the “connective tissue” of rural life to deliver care: rural clinics, first responders, schools, churches, and community organizations. The program’s ecosystem includes the community host, academic and cancer center partners, pathology services, volunteer clinical teams, industry partners, and EMR infrastructure. She stressed that every piece is essential for successful, sustainable community outreach.

To date, every outreach event has identified at least one skin cancer, helping underserved patients in rural areas of Oregon, Idaho, and Illinois.² Project Happy Face is actively expanding to Texas, Alabama, and northern Arizona.¹ Snow emphasized that a broader impact will require more dermatologists to engage with rural medicine and inspire other specialties to do the same.

“I really encourage all of you to step outside the exam room, step outside your clinic, and give back,” she said. “…It will remind you why you went into medicine, it will warm your heart, it will refire your energy, it will lower your cortisol, and it totally combats burnout…. We can really change the trajectory and inspire other specialties to do the same, so I think with showing up, with presence, and with collaboration, dermatology can really be the leader.”

References

1. Leachman SA, Brodell RT, Durkin JR, Litzner BR, Snow A. Reducing rural health disparities in skin cancer. Presented at: 2026 AAD Annual Meeting; March 27-31, 2026; Denver, CO.
2. Mobile outreach. Project Happy Face. Accessed March 28, 2026. https://www.projecthappyface.org/mobile-outreach