Neighborhood-Level Socioeconomic Predictors of Melanoma Thickness, Ulceration, and Metastasis at a Rhode Island Academic Center.

Malignant melanoma (MM) represents less than 2% of skin cancer incidence, but accounts for twice as many skin cancer-related deaths as non-melanoma skin cancers ( Aggarwal et al., 2021 Aggarwal P. Knabel P. Fleischer A.B. United States burden of melanoma and non-melanoma skin cancer from 1990 to 2019. J. Am. Acad. Dermatol. 2021; 85: 388-395 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar ). Lower socioeconomic status (SES) has been linked to poor outcomes in MM, though the mechanisms underlying this association are not entirely clear ( Jiang et al., 2015 Jiang A.J. Rambhatla P.V. Eide M.J. Socioeconomic and lifestyle factors and melanoma: a systematic review. Br. J. Dermatol. 2015; 172: 885-915 Crossref PubMed Scopus (98) Google Scholar ). Prior US studies investigating the relationship between neighborhood-level SES and high-risk MM presentations, such as increased Breslow thickness ( Eide et al., 2009a Eide MJ, Weinstock MA, Clark MA. Demographic and Socioeconomic Predictors of Melanoma Prognosis in the United States. J. Health Care Poor Underserved. Johns Hopkins University Press; 2009a;20(1):227–245 Google Scholar ; Escobedo et al. 2017; Pollitt et al. 2011; Pollitt et al. 2008; Stitzenberg et al. 2007) and advanced metastasis/stage ( Eide et al., 2009b Eide M.J. Weinstock M.A. Clark M.A. The association of physician-specialty density and melanoma prognosis in the United States, 1988 to 1993. J. Am. Acad. Dermatol. 2009; 60: 51-58 Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar ; Feigelson et al., 2019 Feigelson H.S. Powers J.D. Kumar M. Carroll N.M. Pathy A. Ritzwoller D.P. Melanoma incidence, recurrence, and mortality in an integrated healthcare system: A retrospective cohort study. Cancer Med. 2019; 8: 4508-4516 Crossref PubMed Scopus (31) Google Scholar ; Geller et al., 1996 Geller A.C. Miller D.R. Lew R.A. Clapp R.W. Wenneker M.B. Koh H.K. Cutaneous melanoma mortality among the socioeconomically disadvantaged in Massachusetts. Am. J. Public Health. 1996; 86: 538-544 Crossref PubMed Google Scholar ; Harvey et al. 2017; Hu et al. 2014; Van Durme et al. 2000), variably adjusted for potentially relevant clinicopathologic factors, such as patient demographics (Eide et al. 2009b; Escobedo et al. 2017; Feigelson et al. 2019; Geller et al. 1996; Pollitt et al., 2008 Pollitt R.A. Clarke C.A. Shema S.J. Swetter S.M. California Medicaid Enrollment and Melanoma Stage at Diagnosis: A Population-Based Study. Am. J. Prev. Med. 2008; 35: 7-13 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar ; Stitzenberg et al. 2007; Van Durme et al. 2000), individual behavior (Van Durme et al. 2000), insurance status ( Escobedo et al., 2017 Escobedo L.A. Crew A. Eginli A. Peng D. Cousineau M.R. Cockburn M. The role of spatially-derived access-to-care characteristics in melanoma prevention and control in Los Angeles county. Health Place. 2017; 45: 160-172 Crossref PubMed Scopus (7) Google Scholar ; Hu et al., 2014 Hu S. Sherman R. Arheart K. Kirsner R.S. Predictors of Neighborhood Risk for Late-Stage Melanoma: Addressing Disparities through Spatial Analysis and Area-Based Measures. J. Invest. Dermatol. 2014; 134: 937-945 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar ; Pollitt et al., 2011 Pollitt R.A. Clarke C.A. Swetter S.M. Peng D.H. Zadnick J. Cockburn M. The expanding melanoma burden in California hispanics. Cancer. 2011; 117: 152-161 Crossref PubMed Scopus (69) Google Scholar ; Van Durme et al., 2000 Van Durme D.J. Ferrante J.M. Pal N. Wathington D. Roetzheim R.G. Gonzalez E.C. Demographic predictors of melanoma stage at diagnosis. Arch. Fam. Med. 2000; 9: 606-611 Crossref PubMed Scopus (47) Google Scholar ), and tumor characteristics ( Stitzenberg et al., 2007 Stitzenberg K.B. Thomas N.E. Dalton K. Brier S.E. Ollila D.W. Berwick M. et al. Distance to Diagnosing Provider as a Measure of Access for Patients With Melanoma. Arch. Dermatol. 2007; 143: 991-998 Crossref PubMed Scopus (77) Google Scholar ). Furthermore, there is a paucity of US data examining SES and tumor ulceration, despite the known prognostic significance of the latter ( Boczar et al., 2020 Boczar D. Sisti A. Restrepo D.J. Huayllani M.T. Manrique O.J. Lu X. et al. National Analysis of Patients With Ulcerated Melanoma in the United States. Anticancer Res. 2020; 40: 1055-1058 Crossref Scopus (4) Google Scholar ). We aimed to describe relationships between neighborhood-level SES and MM thickness, ulceration, and metastasis at an academic center in Rhode Island (RI), USA while accounting for relevant clinicopathological factors.