Original Article

Late-Stage Melanoma: Be Sure to Screen Uninsured, Unmarried Men

Authors: Virginia L. Valentin, DrPH, PA-C, Wayne Sanderson, PhD, MS, Susan Westneat, MA, Eric Durbin, DrPH, MS

Abstract

Objective: The purpose of this study was to assess for any associations between individual and social factors and late-stage melanoma in Kentucky from 1995 to 2013.

Methods: The study combines three datasets: individual-level data from the Kentucky Cancer Registry, census tract–level data from the US Census, and county-level physician licensure data from the Kentucky Department for Public Health. The study population is described by all cases, early stage, and late stage. Logistic regression was used to evaluate the unadjusted associations between each covariate and early-stage and late-stage disease groups. All of the significant variables were assessed for interaction effect, and the significant interaction terms were used in the final model. Multiple logistic regression provided the final model of late-stage disease.

Results: In this study population, a dramatic increase in melanoma incidence is seen from 1995 to 2013 with a threefold increase in the number of cases per year. Of the 10,109 cases reported, 13.6% have late-stage disease, with a mean age for all cases at 56.9 years and the majority being men. Late-stage cases are more commonly uninsured or insured with Medicaid or Medicare compared with cases with early-stage lesions. Having a spouse or partner is clearly protective from being diagnosed as having late-stage melanoma, whereas being uninsured or having Medicaid increases the odds of late-stage melanoma.

Conclusions: The incidence of melanoma is increasing dramatically. With no screening recommendation for the general population from the US Preventive Task Force, clinicians should focus on those at increased risk of late-stage melanoma: unmarried men who are uninsured or receiving Medicaid.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Pollack LA, Li J, Berkowitz Z, et al. Melanoma survival in the United States, 1992 to 2005. J Am Acad Dermatol 2011;65(5 suppl 1):S78-S86.
 
2. Singh SD, Ajani UA, Johnson CJ, et al. Association of cutaneous melanoma incidence with area-based socioeconomic indicators-United States, 2004-2006. J Am Acad Dermatol 2011;65(5 suppl 1):S58-S68.
 
3. Reyes-Ortiz CA, Goodwin JS, Freeman JL. The effect of socioeconomic factors on incidence, stage at diagnosis and survival of cutaneous melanoma. Med Sci Monit 2005;11:RA163-RA172.
 
4. Hu S, Sherman R, Arheart K, et al. Predictors of neighborhood risk for late-stage melanoma: addressing disparities through spatial analysis and area-based measures. J Invest Dermatol 2014;134:937-945.
 
5. Youl PH, Baade PD, Parekh S, et al. Association between melanoma thickness, clinical skin examination and socioeconomic status: results of a large population-based study. Int J Cancer 2011;128:2158-2165.
 
6. Eriksson H, Lyth J, Månsson-Brahme E, et al. Low level of education is associated with later stage at diagnosis and reduced survival in cutaneous malignant melanoma: a nationwide population-based study in Sweden. Eur J Cancer 2013;49:2705-2716.
 
7. Reyes-Ortiz CA, Freeman JL, Kuo Y, et al. The influence of marital status on stage at diagnosis and survival of older persons with melanoma. J Gerontol A Biol Sci Med Sci 2007;62:892-898.
 
8. McLaughlin JM, Fisher JL, Paskett ED. Marital status and stage at diagnosis of cutaneous melanoma: results from the Surveillance Epidemiology and End Results (SEER) program, 1973-2006. Cancer 2011;117:1984-1993.
 
9. Roetzheim RG, Pal N, van Durme DJ, et al. Increasing supplies of dermatologists and family physicians are associated with earlier stage of melanoma detection. J Am Acad Dermatol 2000;43( 2 Part 1 ):211-218.
 
10. Association of American Medical Colleges. The complexities of physician supply and demand projections from 2013 to 2025. Final report. https://www.aamc.org/download/426248/data/thecomplexitiesofphysiciansupplyanddemandprojectionsfrom2013to2.pdf. Published March 2015. Accessed September 5, 2018.
 
11. Harris Williams & Co. Dermatology market overview. http://www.harriswilliams.com/system/files/industry_update/dermatology_market_overview.pdf. Published August 2013. Accessed August 17, 2017.
 
12. US Preventive Services Task Force. Final recommendation statement. Skin cancer: screening. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/skin-cancer-screening2. Published July 2016. Accessed February 5, 2018.
 
13. US Census Bureau. https://www.census.gov/topics.html. Accessed August 23, 2017.
 
14. Surveillance and Health Data Branch, Department for Public Health. Kentucky licensed physicians by specialty. http://chfs.ky.gov/nr/rdonlyres/307d34c5-e944-4ff4-ac55-3e96a3f96578/0/kentuckylicensedphysicians.pdf. Published August 2006. Accessed August 16, 2017.
 
15. Kentucky Cancer Registry. http://cancer-rates.info/ky/index.php. Accessed August 20, 2017.
 
16. Coker AL, DeSimone CP, Eggleston KS, et al. Smoking and survival among Kentucky women diagnosed with invasive cervical cancer: 1995-2005. Gynecol Oncol 2009;112:365-369.
 
17. US Census Bureau. State intercensal tables: 2000-2010. https://www.census.gov/data/tables/time-series/demo/popest/intercensal-2000-2010-state.html. Revised November 30, 2016. Accessed August 18, 2017.
 
18. Edge S, Byrd DR, Compton CC, et al. , eds. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2011.
 
19. Siegel R, Ma J, Zou Z, et al. Cancer statistics, 2014. CA Cancer J Clin 2014;64:9-29.
 
20. Mandalà M, Imberti GL, Piazzalunga D, et al. Association of socioeconomic status with Breslow thickness and disease-free and overall survival in stage I-II primary cutaneous melanoma. Mayo Clin Proc 2011;86:113-119.
 
21. Ward EM, Fedewa SA, Cokkinides V, et al. The association of insurance and stage at diagnosis among patients aged 55 to 74 years in the national cancer database. Cancer J 2010;16:614-621.
 
22. HealthInsurance.org. Kentucky health insurance marketplace: history and news of the state’ exchange. https://www.healthinsurance.org/kentucky-state-health-insurance-exchange. Accessed February 5, 2018.