Skin Therapy Letter HOME
Written for dermatologists by dermatologists. Indexed by the US National Library of Medicine.
Skin Information
NETWORK
Skin Therapy Letter About STL Subscribe Today SkinCareGuide Network Site Map
CUSTOM DERMATOLOGY SEARCH:
Loading

Derm News: 2007.17(5)

Melanoma Outcomes for Medicare Patients: Association of Stage and Survival With Detection by a Dermatologist vs a Nondermatologist

Archives of Dermatology, 143(4):488-494
Michelle L. Pennie, Seaver L. Soon, Jessica B. Risser, Emir Veledar, Steven D. Culler, Suephy C. Chen
ABSTRACT

Objectives

To determine whether a difference in melanoma outcomes exists in the United States between tumors detected by dermatologists vs those detected by nondermatologists.

Design

Retrospective analysis of linked data from the Medicare enrollment and claims files from the Centers for Medicare and Medicaid Services and the National Cancer Institute's Surveillance, Epidemiology, and End Results program database from 1991 to 1996. The registries are from 12 US sites.

Patients

A study sample comprised of 2020 subjects.

Main Outcome Measures

Tumor characteristics (Breslow thickness and histologic ulceration), stage at diagnosis, and survival and mortality rates.

Results

Tumor detection by a dermatologist vs nondermatologist was associated with an earlier stage melanoma (stage 0, stage I, and stage II vs stage III and stage IV; 2 test, P<.01) and a thinner tumor (Breslow thickness, 0.86 mm vs 1.00 mm; P<.05). At all time points (6 months, 2 years, and 5 years), patients whose melanoma was detected by dermatologists had better survival rates (98%, 87%, and 74%, respectively, for those whose melanoma was detected by dermatologists vs 95%, 79%, and 69%, respectively, for nondermatologists; P<.05). Non-cancer-related mortality was similar for the 2 groups, but the patients whose tumors were detected by dermatologists had lower cancer-related mortality (13% vs 21%; P<.01) and overall mortality (29% vs 37%; P<.01). Multivariate analysis showed that age, sex, stage at diagnosis, and melanoma detection by a dermatologist were all significantly predictive of survival.

Conclusions

Earlier stage melanoma and improved survival are associated with detection by a dermatologist rather than by a nondermatologist. Increasing access to dermatologists, particularly for older patients, may represent one approach to improving melanoma-related health outcomes.


    Back to Current Volume:   Dermatology News 2007.17


The Derm News service provided by the Editorial Consultants of Skin Therapy Letter© and its founding editor Dr. Stuart Maddin.