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Association of Stage and Survival With Detection by a Dermatologist vs a Nondermatologist

Michelle L. Pennie, MD; Seaver L. Soon, MD; Jessica B. Risser, MD, MPH; Emir Veledar, PhD; Steven D. Culler, PhD; Suephy C. Chen, MD, MS

Arch Dermatol. 2007;143(4):488-494.

Objective  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.

Author Affiliations: Departments of Dermatology (Drs Pennie, Soon, Risser, and Chen) and Medicine, Division of Cardiology (Dr Veledar), Emory University School of Medicine; and Rollins School of Public Health (Dr Culler), Atlanta, Ga; and Department of Health Services Research and Development and Division of Dermatology, Atlanta Veterans Affairs Medical Center, Decatur, Ga (Dr Chen). Dr Soon is now with Scripps Clinic, Division of Dermatology and Cutaneous Surgery, La Jolla, Calif.

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