Differences in the diagnosis of primary cutaneous melanoma in the public and private healthcare systems in Joinville, Santa Catarina State, Brazil

Abstract

BackgroundCutaneous melanoma accounts for up to 80% of deaths caused by skin cancer. Diagnostic suspicion and access to medical care and early intervention in suspected cases is vital to the patient’s prognosis.ObjectivesTo compare demographic and histopathological characteristics of primary cutaneous melanoma diagnosed in the public healthcare system (Sistema Único de Saúde SUS) and the private system in Joinville, Santa Catarina State, Brazil.MethodsThis cross-sectional retrospective study analyzed primary cutaneous melanoma cases recorded from 2003 to 2014 in the resident population of Joinville. Ethical approval was obtained from the local Research Ethics Committee.Results893 cases of primary cutaneous melanoma were identified. Patients in the private system were mostly younger, while there were more elderly patients in the public healthcare system (p <0.001). There was no statistically significant association between type of care (public/private) and gender or presence of multiple primary cutaneous melanomas. Histological diagnosis of superficial spreading melanoma was more common in patients treated in private healthcare, while nodular melanoma was more frequent in patients in the public healthcare system (p <0.001). Mean Breslow depth in patients treated in private healthcare was 1.35mm, compared to 2.72mm in the public system (p <0.001).Study limitationsThis was a retrospective study using secondary databases.Conclusionsthin cutaneous melanoma (in situ cutaneous melanoma and Breslow T1) showed the strongest association with the private healthcare system, while thick cutaneous melanoma was more frequent in the public system (Breslow category T3 and T4) (p <0.001).

Incidence of hospitalization and mortality due to stroke in young adults, residents of developed regions in Brazil, 2008-2018

“…Moreover, the number of private health plans in developed regions of Brazil has increased in the past years, particularly in São Paulo [28], which contrasts to lower socioeconomic groups, more often covered by the public health system. It demonstrates that access to the private system in Brazil is a key to the prognosis of the disease [29], what could explain why mortality rates for IS did not increase in developed regions in Brazil.…”

Perfil epidemiológico de pacientes com melanoma cutâneo em uma cidade do sul de Santa Catarina

“…O diagnóstico precoce do melanoma cutâneo também diminui os custos do tratamento, gerando uma economia considerável tanto para a rede pública de saúde, quanto para a rede privada, além de ser benéfico para o prognóstico do paciente. Em virtude disso, ressalta-se a importância da continuidade da realização de campanhas e da educação aos pacientes acerca do assunto não só em épocas específicas, mas durante todo o ano, bem como a conscientização dos profissionais das redes pública e privada sobre a importância da procura ativa por lesões que possam ser consideradas suspeitas, já que se trata de um rastreamento fácil, rápido e sem custos, tornando não só possível como também muito viável sua implementação nas rotinas de atendimento aos pacientes17,18 .…”