Association between melanoma thickness, clinical skin examination and socioeconomic status: Results of a large population‐based study

Abstract

Survival from melanoma is inversely related to tumour thickness and is less favorable for those in lower socioeconomic (SES) strata. Reasons for this are unclear but may relate to a lower prevalence of skin screening. Our aim was to examine the association between melanoma thickness, individual-level SES and clinical skin examination (CSE) using a population-based case-control study. Cases were Queensland (Australia) residents aged 20-75 years with a histologically confirmed first primary invasive cutaneous melanoma diagnosed between January 2000 and December 2003. Telephone interviews were completed by 3,762 cases (77.7%) and 3,824 (50.4%) controls. Thickness was dichotomized to thin ( 2 mm) and thick (>2 mm). Compared with controls, the risk of thick melanoma was significantly increased among men [relative risk ratio (RRR) 5 1.56, 95% CI 5 1.22-2.00], older participants (RRR 5 1.76, 95% CI 5 1.10-2.82), those educated to primary level (RRR 5 1.70, 95% CI 5 1.08-2.66), not married/living as married (RRR 5 1.47, 95% CI 5 1.15-1.88), retired (RRR 5 1.39, 95% CI 5 1.01-1.94) and not having a CSE in past 3 years (RRR 5 1.45, 95% CI 5 1.12-1.86). There was a significant trend to increasing prevalence of CSE with higher education (p < 0.01) and the benefit of CSE in reducing the risk of thick melanoma was most pronounced among that subgroup. There were no significant associations between cases with thin melanoma and controls. Melanoma thickness at presentation is significantly associated with educational level, other measures of SES and absence of CSE. Public health education efforts should focus on identifying new avenues that specifically target those subgroups of the population who are at increased risk of being diagnosed with thick melanoma.

Clinical-epidemiological studies on cutaneous malignant melanoma : A register approach

“…National guidelines for CMM diagnosis, treatment and follow-up have been implemented to minimise variation in the primary management. Despite this, in the present study, patients with lower education had more advanced disease at diagnosis, corroborating previous studies (40,41,44,46,47,(59)(60)(61). This finding explains in part the lower CMM-specific survival among low-educated groups in the After adjusting for clinical stage at diagnosis and for other prognostic factors, patients with low education still had a13% higher risk of CMM death compared to patients with high education.…”

Is Skin Self-Examination for Cutaneous Melanoma Detection Still Adequate? A Retrospective Study

“…Because the current mortality for melanoma is still stable, we are convinced that we should introduce a new message to encourage the high-risk patients, such as noneducated men over 50 years old, to have an annual skin examination as a rule [15]. This message could be helpful to further increase the prognosis of all kinds of melanomas.…”

Cutaneous malignant melanoma show geographic and socioeconomic disparities in stage at diagnosis and excess mortality

“…Excess mortality rates were also influenced by age (2.5-fold higher for age 70 vs. 30-49 years) and sex (1.8-fold higher for men) ( Table 3). Melanoma outcome has also been demonstrated to relate to ethnicity and marital/cohabitation status [23][24][25][26].…”

“…Stage III and IV were combined due to low numbers. More precisely, for all stages (total incidence) and stage I, II and III-IV, respectively, the expected number of cases in each residential area was calculated from the year, sex and age (15)(16)(17)(18)(19)(20)(21)(22)(23)(24), . .…”