Melanoma outcomes for Medicare patients - Association of stage and survival with detection by a dermatologist vs a nondermatologist

Objective: To determine whether a difference in melanoma outcomes exists in the United States between tumors detected by dermatologists vs those detected by non-dermatologists. 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 non-dermatologist was associated with an earlier stage melanoma (stage 0, stage I, and stage II vs stage III and stage IV; chi(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.