Article Figures & Data
Figures
- Figure 1.
Melanoma-specific survival. PCP, primary care physician.
Tables
Characteristics Patients No. % Prior physician visits Neither PCP nor dermatologist 2,419 12.8 PCP only 9,551 50.6 Dermatologist only 994 5.3 Both PCP and dermatologist 5,920 31.3 Age at diagnosis (years) 67–75 8,676 45.9 76–85 7,847 41.6 ≥86 2,361 12.5 Sex Male 11,283 59.7 Female 7,601 40.3 Race/ethnicity Non-Hispanic white 17,866 94.6 Bon-Hispanic black 115 0.6 Hispanic 308 1.6 Asian/American Indian/Pacific Islander 110 0.6 Other 485 2.6 Marital status Single (never married) 1,129 6.0 Married 9,500 50.3 Separated/divorced 671 3.6 Widowed 3,640 19.3 Unknown 3,944 20.9 MSA of residence Large metropolitan 10,570 56.0 Metropolitan 5,552 29.4 Urban 1,117 5.9 Less urban 1,294 6.9 Rural 350 1.9 Unknown 1 0.0 Year of diagnosis 1994–1997 3,359 17.8 1998–2000 3,802 20.1 2001–2005 11,723 62.1 Histologic type Melanoma NOS 8,911 47.2 Nodular melanoma 1,764 9.3 Superficial spreading 4,579 24.2 Lentigo maligna 2,220 11.8 Acral melanoma 266 1.4 Other 1,144 6.1 Stage at diagnosis* Local, thin 8,981 47.6 Local, intermediate 3,242 17.2 Local, thick 2,006 10.6 Regional 2,766 14.6 Distant 907 4.8 Unknown 982 5.2 Charlson Comorbidity Index 0 11,324 60.0 1 4,317 22.9 ≥2 3,243 17.2 Influenza vaccination 8,017 42.5 No 10,867 57.5 Yes Surgery Surgery with wide margin 10,893 57.7 Surgery without wide margin 6,471 34.3 No surgery 1,454 7.7 Unknown surgery 66 0.3 Lymph nodes removed Yes 4,213 22.3 No 14,328 75.9 Unknown 343 1.8 Radiation Yes 488 2.6 No 18,135 96.0 Unknown 261 1.4 ↵* Thin lesions are defined as Breslow thickness <1 mm, intermediate are 1 to 2 mm, and thick are >2 mm.
MSA, metropolitan statistical area; NOS, not otherwise specified; PCP, primary care physician.
- Table 2. Predictors of Thin Melanoma Diagnosis in Patients Using Multivariable Logistic Regression (n = 17,902)*
Thin Melanomas Adjusted Odds Ratio 95% Wald CL n/N % Prior physician visits Neither PCP nor dermatologist 1,025/2,271 45.1 1.00 Referent PCP only 4,420/9,122 48.5 1.08 0.98–1.21 Dermatologist only 479/929 51.6 1.17 0.98–1.38 Both PCP and dermatologist 3,057/5,580 54.8 1.26 1.12–1.41 Age at diagnosis (years) 67–75 4,543/8,266 55.0 1.00 Referent 76–85 3,560/7,434 47.9 0.78 0.73–0.84 ≥86 878/2,202 39.9 0.58 0.52–0.65 Sex Male 5,407/10,717 50.5 1.00 Referent Female 3,574/7,185 49.7 1.06 0.99–1.14 Race/ethnicity Non-Hispanic white 8,500/16,954 50.1 1.00 Referent Non-Hispanic black 29/108 26.9 0.53 0.33–0.85 Hispanic 99/290 34.1 0.63 0.49–0.83 Asian/American Indian/Pacific Islander 31/98 31.6 0.51 0.32–0.82 Other 322/452 71.2 1.79 1.43–2.26 Marital status at diagnosis Married 4,394/9,108 48.2 1.00 Referent Never married 449/1,060 42.4 0.86 0.74–0.98 Separated/divorced 272/640 42.5 0.81 0.68–0.97 Widowed 1,306/3,415 38.2 0.80 0.72–0.88 Unknown 2,560/3,679 69.6 2.22 2.02–2.43 Education level of residence Quintile 1 (lowest) 1,607/3,637 44.2 1.00 Referent Quintile 2 1,786/3,668 48.7 1.06 0.95–1.18 Quintile 3 1,741/3,476 50.1 1.14 1.01–1.29 Quintile 4 1,871/3,560 52.6 1.18 1.04–1.35 Quintile 5 (highest) 1,909/3,446 55.4 1.25 1.08–1.46 Median income of residence Quintile 1 (lowest) 1,734/3,795 45.7 1.00 Referent Quintile 2 1,817/3,699 49.1 1.04 0.94–1.17 Quintile 3 1,715/3,461 49.6 1.01 0.89–1.14 Quintile 4 1,813/3,530 51.4 1.01 0.89–1.15 Quintile 5 (highest) 1,835/3,302 55.6 1.11 0.94–1.29 MSA residence Large metropolitan 5,037/10,002 50.4 1.00 Referent Metropolitan 2,688/5,299 50.7 0.95 0.86–1.05 Urban 508/1,058 48.0 0.92 0.78–1.09 Less urban 596/1,212 49.2 1.05 0.88–1.24 Rural 152/330 46.1 0.98 0.75–1.29 Year of diagnosis 1994–1997 1,465/3,155 46.4 1.00 Referent 1998–2000 1,758/3,569 49.3 1.16 1.04–1.29 2001–2005 5,758/11,178 51.5 1.30 1.18–1.44 Histologic type Melanoma NOS 3,894/8,148 47.8 1.00 Referent Nodular melanoma 180/1,732 10.4 0.14 0.12–0.17 Superficial spreading 2,932/4,514 65.0 2.09 1.93–2.26 Lentigo maligna 1,588/2,145 74.0 3.25 2.90–3.63 Acral melanoma 78/260 30.0 0.61 0.46–0.80 Other 309/1,103 28.0 0.44 0.38–0.51 Charlson Comorbidity Index 0 5,633/10,756 52.4 1.00 Referent 1 1,977/4,086 48.4 0.87 0.80–0.94 ≥2 1,371/3,060 44.8 0.80 0.73–0.88 Influenza vaccination No 3,586/7,577 47.2 1.00 Referent Yes 5,395/10,325 52.3 1.13 1.05–1.21 Note: The Surveillance Epidemiology and End Results registry was adjusted for, but results are not presented.
↵* Excluding people with unknown stage at diagnosis. Thin lesions are defined as Breslow thickness <1 mm.
CL, confidence limits; MSA, metropolitan statistical area; NOS, not otherwise specified; PCP, primary care physician.
Characteristics Unadjusted Model Multivariable Model 1† Multivariable Model 2‡ Prior physician visits Neither PCP nor dermatologist 1.00 (referent) 1.00 (referent) 1.00 (referent) PCP only 0.82 (0.73–0.93) 0.84 (0.74–0.95) 0.87 (0.77–0.99) Dermatologist only 0.69 (0.55–0.86) 0.79 (0.63–1.00) 0.80 (0.64–1.01) Both PCP and dermatologist 0.59 (0.51–0.67) 0.66 (0.57–0.76) 0.72 (0.62–0.83) Age at diagnosis (years) 67–75 1.00 (referent) 1.00 (referent) 1.00 (referent) 76–85 1.29 (1.17–1.42) 1.21 (1.10–1.33) 1.08 (0.98–1.19) ≥86 1.94 (1.71–2.21) 1.76 (1.53–2.02) 1.38 (1.20–1.59) Sex Male 1.00 (referent) 1.00 (referent) 1.00 (referent) Female 0.79 (0.72–0.87) 0.71 (0.65–0.79) 0.70 (0.63–0.77) Race/ethnicity Non-Hispanic white 1.00 (referent) 1.00 (referent) 1.00 (referent) Non-Hispanic black 2.33 (1.59–3.41) 1.22 (0.82–1.82) 1.11 (0.75–1.65) Hispanic 1.67 (1.26–2.20) 1.21 (0.91–1.62) 1.01 (0.76–1.35) Asian/American Indian/Pacific Islander 1.71 (1.09–2.69) 1.53 (0.95–2.44) 1.37 (0.85–2.20) Other 0.11 (0.05–0.24) 0.16 (0.07–0.36) 0.22 (0.10–0.49) Marital status Married 1.00 (referent) 1.00 (referent) 1.00 (referent) Never married 1.51 (1.29–1.77) 1.33 (1.13–1.56) 1.31 (1.11–1.54) Separated/divorced 1.22 (0.98–1.51) 1.25 (1.00–1.55) 1.21 (0.97–1.51) Widowed 1.45 (1.31–1.61) 1.30 (1.16–1.46) 1.24 (1.10–1.39) Unknown 0.36 (0.30–0.42) 0.40 (0.34–0.47) 0.55 (0.46–0.65) Education level of residence Quintile 1 (lowest) 1.00 (referent) 1.00 (referent) 1.00 (referent) Quintile 2 0.79 (0.70–0.90) 0.93 (0.81–1.07) 0.96 (0.83–1.11) Quintile 3 0.85 (0.75–0.97) 0.91 (0.78–1.06) 0.97 (0.83–1.13) Quintile 4 0.79 (0.69–0.90) 0.98 (0.83–1.16) 1.00 (0.85–1.18) Quintile 5 (highest) 0.69 (0.60–0.79) 0.91 (0.75–1.12) 1.00 (0.82–1.23) Median income of residence Quintile 1 (lowest) 1.00 (referent) 1.00 (referent) 1.00 (referent) Quintile 2 0.87 (0.76–0.99) 0.91 (0.79–1.04) 0.94 (0.81–1.08) Quintile 3 0.91 (0.80–1.03) 0.97 (0.83–1.14) 1.03 (0.88–1.21) Quintile 4 0.91 (0.80–1.04) 1.04 (0.87–1.23) 1.10 (0.93–1.30) Quintile 5 (highest) 0.69 (0.60–0.79) 0.86 (0.70–1.07) 0.90 (0.73–1.11) MSA residence Large metropolitan 1.00 (referent) 1.00 (referent) 1.00 (referent) Metropolitan 1.09 (0.99–1.21) 0.99 (0.87–1.13) 1.01 (0.88–1.15) Urban 1.18 (0.98–−1.40) 1.15 (0.93–1.42) 1.14 (0.93–1.41) Less urban 1.18 (1.00–1.39) 1.13 (0.91–1.40) 1.09 (0.88–1.36) Rural 0.88 (0.61–1.25) 0.78 (0.53–1.16) 0.83 (0.56–1.23) Year of diagnosis 1994–1997 1.00 (referent) 1.00 (referent) 1.00 (referent) 1998–2000 0.90 (0.80–1.02) 0.86 (0.76–0.98) 0.93 (0.81–1.05) 2001–2005 0.94 (0.84–1.05) 0.85 (0.75–0.97) 0.90 (0.79–1.03) Histology type Melanoma, NOS 1.00 (referent) 1.00 (referent) 1.00 (referent) Nodular melanoma 1.74 (1.55–1.95) 1.90 (1.68–2.14) 1.14 (1.00–1.29) Superficial spreading 0.35 (0.31–0.40) 0.51 (0.44–0.59) 0.72 (0.63–0.83) Lentigo maligna 0.14 (0.10–0.19) 0.21 (0.16–0.28) 0.39 (0.29–0.53) Acral melanoma 1.11 (0.82–1.50) 1.05 (0.77–1.44) 0.93 (0.68–1.27) Other 0.98 (0.83–1.16) 1.05 (0.88–1.25) 0.76 (0.64–0.91) Stage at diagnosis§ Local, thin 1.00 (referent) 1.00 (referent) Local, intermediate 3.00 (2.43–3.70) 2.70 (2.18–3.35) Local, thick 8.62 (7.11–10.45) 6.65 (5.43–8.14) Regional/distant 26.82 (22.81–31.55) 16.48 (13.79–19.70) Unknown 12.68 (10.31–15.60) 6.03 (4.81–7.56) Charlson Comorbidity Index 0 1.00 (referent) 1.00 (referent) 1.00 (referent) 1 1.20 (1.08–1.34) 1.15 (1.03–1.28) 1.18 (1.06–1.31) 2+ 1.48 (1.32–1.66) 1.42 (1.26–1.61) 1.29 (1.15–1.45) Influenza vaccination No 1.00 (referent) 1.00 (referent) 1.00 (referent) Yes 0.79 (0.72–0.86) 0.91 (0.83–0.99) 0.97 (0.89–1.07) Surgery Surgery without wide margin 1.00 (referent) 1.00 (referent) 1.00 (referent) Surgery with wide margin 0.95 (0.85–1.05) 0.75 (0.67–0.83) 0.75 (0.67–0.84) No/unknown surgery 6.52 (5.79–7.35) 4.50 (3.94–5.13) 2.51 (2.19–2.88) Lymph node removal No/unknown 1.00 (referent) 1.00 (referent) 1.00 (referent) Yes 1.42 (1.28–1.56) 1.31 (1.18–1.45) 0.78 (0.70–0.87) Radiation therapy No/unknown 1.00 (referent) 1.00 (referent) 1.00 (referent) Yes 10.12 (8.88–11.54) 3.65 (3.15–4.22) 2.16 (1.87–2.50) ↵* After excluding people with in situ lesions but including those with unknown stage. Mortality refers to melanoma specific mortality, not all-cause mortality.
↵† Model 1 adjusted for all factors shown in table plus Surveillance Epidemiology and End Results registry but did not adjust for stage at diagnosis.
↵‡ Model 2 further adjusted model 1 for stage at diagnosis.
↵§ Thin lesions are defined as Breslow thickness <1 mm, intermediate are 1 to 2 mm, and thick are >2 mm.
MSA, metropolitan statistical area; NOS, not otherwise specified; PCP, primary care physician.
