Melanoma Outcomes for Medicare Patients

Pennie, Michelle L.; Soon, Seaver L.; Risser, Jessica; Veledar, Emir; Culler, Steven D.; Chen, Shuo

doi:10.1001/archderm.143.4.488

Cited by 80 publications

(19 citation statements)

References 37 publications

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“…41 Our study did not find any difference in stage at diagnosis for subjects having ambulatory visits to only dermatologists compared with those having visits only to PCPs. The best outcomes, however, were seen among patients who had previous ambulatory visits to both dermatologists and PCPs, suggesting that these services can complement one another.…”

Section: Discussioncontrasting

confidence: 73%

The Influence of Dermatologist and Primary Care Physician Visits on Melanoma Outcomes Among Medicare Beneficiaries

Roetzheim

Lee

Ferrante

et al. 2013

The Journal of the American Board of Family Medicine

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Background Ambulatory visits to dermatologists and primary care physicians (PCPs) may improve melanoma outcomes through early detection. We sought to measure the effect of dermatologist and PCP visits on melanoma stage at diagnosis and mortality. Methods We used data from the database linking Surveillance Epidemiology and End Results (SEER) and Medicare data (1994 to 2005) to examine patterns of dermatologist and PCP ambulatory visits before diagnosis for 18,884 Medicare beneficiaries with invasive melanoma or unknown stage at diagnosis. Visits were assessed during the 2-year time interval before the month of diagnosis. We examined whether dermatologist and PCP visits were associated with diagnosis of thinner melanomas (defined as local stage tumors having Breslow thickness <1 mm) and lower melanoma mortality. Results Medicare beneficiaries visiting both a dermatologist and PCP before diagnosis had greater odds of diagnosis of a thin melanoma (adjusted odds ratio, 1.26; 95% confidence interval, 1.12–1.41) and lower melanoma mortality (adjusted hazard ratio 0.66, 95% confidence interval, 0.57–0.76) compared with those without such visits. The mortality findings were attenuated once stage at diagnosis was adjusted for in the multivariable model. Conclusion Improved melanoma outcomes among Medicare beneficiaries may depend on adequate access and use of dermatologist and PCP services.

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Section: Discussioncontrasting

confidence: 73%

The Influence of Dermatologist and Primary Care Physician Visits on Melanoma Outcomes Among Medicare Beneficiaries

Roetzheim

Lee

Ferrante

et al. 2013

The Journal of the American Board of Family Medicine

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“…Overall survival was worse among the group >50 and age was a significant prognostic variable in multivariate analysis13. Data from the SEER database and Medicare enrollment and claims files, showed that increasing age after 65 years and melanoma detection by a dermatologist were significantly predictive of survival on multivariate analysis in a population of over 2000 patients 14. In a large dataset of 17,600 melanoma patients, age was an independent prognostic factor for overall survival which was consistent within each thickness subgroup9.…”

Section: Discussionmentioning

confidence: 87%

Malignant Melanoma in the Elderly: Different Regional Disease and Poorer Prognosis

Macdonald

Dueck²,

Gray³

et al. 2011

J. Cancer

104

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Purpose: Age is a poor prognostic factor in melanoma patients. Elderly melanoma patients have a different presentation and clinical course than younger patients. We evaluated the impact of age ≥70 years (yrs) on the diagnosis and natural history of melanoma.Methods: Retrospective review of 610 patients with malignant melanoma entered into a prospective sentinel lymph node (SLN) database, treated from June 1997 to June 2010. Disease characteristics and clinical outcomes were compared between patients ≥70 yrs vs. <70 yrs of age.Results: 237 patients (39%) were ≥70 yrs. Elderly patients had a higher proportion of head and neck melanomas (34% vs. 20%, p<0.001), and greater mean tumor thickness (2.4mm vs. 1.8mm, p<0.001). A greater proportion of T3 or T4 melanoma was seen in the elderly (p<0.001) as well as a greater mean number of mitotic figures: 3.6/mm2 vs. 2.7/mm2 (p=0.005). Despite greater mean thickness, the incidence of SLN metastases was less in the ≥70 yrs group with T3/T4 melanomas (18% vs. 33%, p=0.02). The elderly had a higher rate of local and in-transit recurrences, 14.5% vs. 3.4% at 5 yrs (p<0.001). 5 yr disease-specific mortality and overall mortality were worse for those ≥70 yrs: 16% vs. 8% (p=0.004), and 30% vs. 12% (p<0.001), respectively.Conclusions: Elderly (≥70 yrs) melanoma patients present with thicker melanomas and a higher mitotic rate but have fewer SLN metastases. Melanoma in the elderly is more common on the head and neck. Higher incidence of local/in-transit metastases is seen among the elderly. Five-year disease-specific mortality and overall mortality are both worse for these patients.

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“…In addition to the stage of melanoma at diagnosis, previous surveys (3)(4)(5)(6) have found that other prognostic factors such as age, sex, histology, and location are related to melanoma survival. In this investigation, we analyzed the data from the Cancer Registry to research melanoma-specific one-year, five-year, and ten-year survival dependent on the demographic and clinical factors.…”

Section: Introductionmentioning

confidence: 99%

Analysis of prognostic factors for melanoma patients

Lideikaitė¹,

Mozūraitienė²,

Letautienė³

2017

AML

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Introduction. Melanoma is the most dangerous form of skin cancer. Morbidity from melanoma is increasing every year. Previous studies have revealed that there are some demographic and clinical factors having effect on melanoma survival prognosis.Aim of the study. Purpose of our study was to assess melanoma survival depending on prognostic factors, such as age, sex, stage, depth, histology and anatomical site.Materials and methods. We investigated melanoma-specific survival up to 10 years in 85 primary cases of melanoma from diagnosis at the National Cancer Institute in 2006. Analysis was performed for one-, five-, and ten-year survival. The data were processed with Microsoft Excel, data analysis was conducted using SPSS® software.Results. Melanomas diagnosed at stage IV or thicker than 4.00 mm had lower survival (five-year survival: 12.5% and 26.66%, respectively). A significant survival difference was observed among the different stages (p = 0.003) and different depths (p = 0.049) of melanoma. Ten-year survival was 32% for men and 61% for women, but melanoma-specific survival dependent on sex did not have a statistically significant difference (p = 0.121). In persons diagnosed at the age of 65 or older, ten-year survival was lower than in those of 40-64 years of age and in the age group of 15-39 years (44.44% and 26.66%, respectively), but melanoma-specific survival in different age groups did not have a statistically significant difference (p = 0.455). Back/breast skin melanoma had lower ten-year survival (37.03%) than other anatomic sites. Nodular melanoma had the poorest five-year and ten-year melanoma-specific survival among histological subtypes (51.67% and 38.75%). The differences between melanoma localizations (p = 0.457) and histological types (p = 0.364) were not statistically significant.Conclusions. Lower melanoma-specific survival rates were observed among patients diagnosed at a late stage, older age, and when melanomas were thicker than 4.00 mm. Female and younger patients had better melanoma-specific survival than men and older people, and these differences were statistically significant. Melanoma diagnosed at an early stage and of a small depth had higher survival rates. Back/breast skin melanoma had poorer prognosis than other anatomic sites. Nodular melanoma had the lowest melanoma-specific survival, while superficial spreading or lentigo maligna had the best prognosis among histological subtypes. However, differences in melanoma survival in different sex and age groups, localizations and histological types were not statistically significant.

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Melanoma Outcomes for Medicare Patients

Cited by 80 publications

References 37 publications

The Influence of Dermatologist and Primary Care Physician Visits on Melanoma Outcomes Among Medicare Beneficiaries

The Influence of Dermatologist and Primary Care Physician Visits on Melanoma Outcomes Among Medicare Beneficiaries

Malignant Melanoma in the Elderly: Different Regional Disease and Poorer Prognosis

Analysis of prognostic factors for melanoma patients

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