Kristen Evans decided the time had come for her to see a dermatologist.

A family member had been treated for skin cancer, and Evans thought she should have her own skin checked. So last December the Mount Joy resident called Dermatology Associates of Lancaster and asked for an appointment with Dr. Patrick Feehan. Her appointment was scheduled for July 1, nearly seven months later.

"I've never had the experience of it taking that long to get into any other kind of doctor," Evans said.

James Costello, of East Earl Township, also called Dermatology Associates in December at the urging of his daughters, who were concerned about a discolored patch of skin on his back. He didn't request a particular doctor. His appointment was scheduled for July 5.

"I was astounded," Costello said. "I expected maybe five weeks — maybe two months at the outside. I just couldn't conceive of seven months."

Whether you're seeking a dermatology appointment for yourself, perhaps to have a mole checked, or for a teen who is wrestling with acne, chances are you're going to have to wait. And your wait may be measured in months, not weeks.

Doctors say there are simply too few dermatologists to meet the demand from a public made keenly aware of the dangers of skin cancer.

The dermatology profession has "put the fear of God" into people, and now is telling would-be patients to wait to be seen, said Dr. Feehan, chief of dermatology at Lancaster General Hospital. "It can be hard for patients to understand."

The reality is, he said, "we do have quite a few dermatologists, compared to other counties, but there's definitely a manpower shortage, both locally and nationally."

Dr. Paul Conslato, director of clinical affairs for Lancaster General Medical Group and an internist with Lancaster General Health's Adult Medicine Specialists, said that when he has to refer a patient to a dermatologist, the wait is longer than that for most other specialists.

If it's a medical emergency, he can have a patient seen by a dermatologist within 24 hours. Dermatologists "clearly do accommodate for acute illness," Conslato said.

But "if I refer you to a dermatologist because I think you have a nonacute dermatitis, you may not be satisfied with the time it takes you to [be seen]," Conslato said.

Feehan said dermatologists are victims of their own success. Three decades ago, when he started practicing in Lancaster County, some people didn't even know what a dermatologist — a physician who specializes in treating the skin — was.

In recent years, however, there's been a concerted effort to make people more aware of skin cancer, which is diagnosed in more than 2 million Americans each year and is the most common of all cancers, according to the Skin Cancer Foundation.

Now "people are knocking on the door wanting to get skin exams," Feehan said. And it is impossible, he said, for everyone to have an annual skin exam with a dermatologist.

"As dermatologists, we try to triage people. ... We encourage people to come in, have baseline [screening], and then we look for risk factors," he said.

These risk factors include: a family history of melanoma, the most dangerous kind of skin cancer; freckled or fair skin; sun-damaged skin; and a proliferation of moles, which may signal an increased risk of melanoma.

If patients have no significant risk factors, they may not need annual return appointments (though they will be encouraged to do self-exams).

If "at some time, they do see a changing or new suspicious growth, they are welcome to call our office for an appointment," Feehan said. "They are now in the loop, so to speak, and will be seen in a timely manner."

According to a study for the American Academy of Dermatology, there are only 3.6 dermatologists available for every 100,000 U.S. residents. Training slots for would-be skin specialists are scarce, largely because of a cap on federal funding — through the Medicare program — for medical residencies.

The number of dermatology resident positions nationwide "has been holding at 300 for the past 40 years," said AAD spokeswoman Jennifer Allyn.

Dermatology is a highly sought-after residency, open to only high-achieving medical students, Feehan said.

Penn State College of Medicine graduates just three dermatologists a year, said Dr. James G. Marks Jr., chair of the dermatology department at the Penn State Milton S. Hershey Medical Center. "There's clearly a funding issue for supporting these residents as they get trained."

Dermatologists have hired "physician extenders" — physicians' assistants and nurse practitioners — but this has had little impact, Marks said. "We haven't been able to train up enough dermatologists or dermatology extenders to meet the demand."

A recent story in the Orlando Sentinel suggested that dermatologists are being diverted from medical cases by the surging demand for lucrative cosmetic procedures, such as Botox injections for wrinkled skin and laser treatments for the removal of sun spots and tattoos.

But Feehan said cosmetic procedures are not to blame for the backlog in dermatology appointments.

Ninety percent of the dermatology services his practice performs are medical, as opposed to cosmetic, Feehan said. The percentages may be different, he noted, in dermatology practices in major metropolitan areas, where cosmetic procedures are more popular.

At Feehan's practice, a person with a bleeding mole, for instance, will be seen right away, as would any patient with an acute dermatological problem — such as severe psoriasis or eczema — who is referred by a family physician, he said.

Still, those who have to wait can find it wearing — even if it's not a serious skin disease they're worrying about. Try telling a teenager dealing with a terrible case of acne that he needs to wait months before he can see a specialist who can treat him.

Marks, at Hershey, said he understands this. He said he knows that for acne sufferers, the emotional scars may last just as long as the physical scars.

Marks said Hershey started an "access clinic" six years ago to try to meet the demand for dermatology appointments.

A physician seeking a dermatology referral for a patient with an acute problem can have that patient seen at the weekly access clinic, or, if the problem warrants it, sooner in an office visit, Marks said. But patients with routine skin issues will wait for several months.

Even as Hershey has doubled the number of dermatologists on staff in the past 10 years, "our wait time has doubled. It used to be a six-week wait. Now, it's a 12-week wait," Marks said.

The wait time is frustrating for dermatologists, too.

"We get these calls from patients [saying] they can't get in any place," Marks said. "I remember a guy a few years ago — he was in that situation. I said, 'Add him on to my schedule.'!\p"

As it turned out, the man had a melanoma, so time was of the essence. He had surgery and survived.

Marks said he sympathizes with patients who have, for instance, a worrisome mole. "If it were me, personally, I wouldn't want to wait three months to have it checked."

Basal cell carcinoma, the most common skin cancer, rarely metastasizes and tends to be very slow growing.

But if a patient has a melanoma, "we wouldn't delay at all," Marks said. "We would put [that patient] in the front of the queue."

Earlier this month, Hershey added a third surgeon who is qualified to perform Mohs micrographic surgery, a technique used to remove some skin cancers by tracing out a tumor and removing only the diseased skin.

By renovating its surgery suite, adding a third Mohs surgeon and revamping procedures so that a patient who has a biopsy-proven skin cancer is referred directly to a Mohs surgeon, Hershey has reduced its wait time for skin-cancer surgery from three months to two weeks.

With the shortage of dermatologists, primary care physicians play an important role in the triaging of patients with skin issues, said Conslato, the internist.

He said primary care doctors are able to perform skin exams and assess the cancer risks of patients. "I don't just see someone with a mole and just reflexively send them to a dermatologist."

Still, Conslato said, something as simple as a rash or a mole can constitute an emergency in the mind of a patient. "We try to put ourselves in the shoes of patients and not demean their concerns," he said.

James Costello, who has fair skin with some freckles, worked in construction for many years and was exposed to the sun on a daily basis. "And as a kid back in the '50s and '60s, we played outside all of the time" without the protection of sunscreen, he recalled.

Waiting seven months for a dermatology appointment was "somewhat disconcerting," he said, "because you do hear so much about sun exposure and skin cancer."

Costello said he was seen, at long last, by Dr. Feehan, who gave him a careful exam and a totally clean bill of health.

To his daughters' delight, the questionable patch on his back turned out to be a discoloration of the skin not related to cancer. "It's always good to get an answer that it's nothing to be concerned about," Costello said.

Kristen Evans said her long-awaited dermatology appointment turned out fine, too. She said the doctor did a thorough job, but "waiting that many months to have a 10-minute appointment, it's a little crazy."

Evans said her biggest problem was locking down her schedule. "When you need to schedule an appointment that far out, you need to know that you can't change it."

Contact Sunday News staff writer Suzanne Cassidy scassidy@lnpnews.com.