Regional Disparities in Socioeconomic Factors and Advanced-stage Presentation in Melanoma: A National Cancer Database Analysis (2004-2020)
TL;DR
Substantial geographic variation exists in the demographic and socioeconomic profile of patients with melanoma, which may correlate to meaningful differences in stage at diagnosis and, given melanoma’s strongly stage-dependent prognosis, potentially survival outcomes as well.
Abstract
Background/Aim: Although melanoma represents only approximately 1% of skin cancers, it causes the majority of skin-cancer deaths. In its early stages, melanoma can be treated successfully with surgery alone, yet a meaningful proportion of patients still present with advanced disease. Geographic variation in demographic and socioeconomic profiles of patients with melanoma across U.S. regions remains poorly characterized. Assessment of regional disparities in patient composition and stage at diagnosis is necessary for the advancement of targeted public health strategies. This study examined geographic variation in demographic, socioeconomic, and clinical characteristics among U.S. patients with melanoma. Patients and Methods: We conducted a cross-sectional analysis of patients diagnosed with melanoma between 2004 and 2020 using the National Cancer Database (NCDB). Patients were assigned to one of six U.S. geographic regions based on reporting facility location. Descriptive analyses were performed to evaluate age, sex, race and ethnicity, insurance type, income, urban-rural residence, and American Joint Committee on Cancer (AJCC) stage at diagnosis. Results: Among 986,555 patients (mean age, 65.3 years; 60.1% male), substantial socioeconomic variation was identified across regions. Uninsured rates were highest in the Southwest (3.4%) and Southeast (2.4%). Lower-income households (<$63,000) predominated in the Southwest (75.9%) and Southeast (67.9%). Advanced-stage (III-IV) disease at diagnosis was most common in the Southwest (13.0%) and least common in the Northeast (7.6%). The cohort was predominately White (99.1%). Conclusion: Substantial geographic variation exists in the demographic and socioeconomic profile of patients with melanoma, which may correlate to meaningful differences in stage at diagnosis and, given melanoma’s strongly stage-dependent prognosis, potentially survival outcomes as well. These disparities likely reflect structural inequities in screening access, insurance coverage, and healthcare infrastructure. Region-specific interventions, including Medicaid expansion, increased access to dermatologic care, public awareness campaigns, and targeted screening, are warranted to improve outcomes nationwide.