Regional differences in medical needs and care for skin cancer across Bavaria: confronting the gap



The management of keratinocyte carcinoma (KC) and actinic keratosis (AK) as well as the number of dermatologists differ across the Bavarian counties in Germany.


To determine regions with low utilization rates of dermatological care and a high medical need due to AK and KC burden.

Materials and Methods

A cross-sectional study of 2,483 people was carried out during the Munich Oktoberfest in September 2016. Participants from urban, semi-urban and rural areas completed a questionnaire and received a medical examination on site by dermatologists.


The rate of previous skin cancer screening and previous treatment by dermatologists ranged from 18.8% to 58.6% and from 34.3% to 75.4% for all regions, respectively. Over 60% of people living in the environs or rural areas would consult a dermatologist first if they found a visible skin condition. Thus, people living in urban areas were twice as likely as people living in rural areas to consult a dermatologist first (odds ratio = 2.16; 95% CI: 1.38–3.39). Comparing the three different locations, dermatologists detected the highest AK burden among people living in rural areas (27.3% of the participants) and the highest KC burden among people living in urban areas (3.4% of the participants).


In rural areas, a high AK burden coupled with a low utilization rate of dermatological care was observed. To effectively address these problems, a broader implementation of alternative medical resources, such as teledermatology, might improve access to health care.

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Corresponding author

Correspondence to Alexander Zink.

Additional information


Financial support: This work was supported by unrestricted research grants from Beiersdorf Dermo Medical GmbH and Novartis Pharma GmbH. Conflicts of interests: none.

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Tizek, L., Schielein, M.C., Berger, U. et al. Regional differences in medical needs and care for skin cancer across Bavaria: confronting the gap. Eur J Dermatol 30, 119–126 (2020).

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Key words

  • keratinocyte carcinoma
  • actinic keratosis
  • dermatologists
  • Bavaria
  • Germany
  • care
  • burden
  • urban
  • rural