Factors Associated with Advanced Presentations of Melanoma in the United States from 2004-2015: A National Cancer Database Analysis Cohort Study

Purpose: Significant advances have been made in the diagnosis and treatment of melanoma, but mortality remains high. The primary aim of this study was to identify risk factors associated with advanced presentations of melanoma in the US. Methods and Materials: Stage III and IV melanoma were identified in the National Cancer Database (NCDB) with appropriate staging and pathologic confirmation from 2004-2015. Patient-specific variables were analyzed using chi square and binary logistic regression multivariate analyses to elucidate factors associated with advanced stage melanoma at diagnosis. Results: There were 477,914 patients meeting inclusion criteria, 63,291 (13.2%) presenting with advanced stage. Factors associated with advanced presentation included lower income, non-Hispanic white race, Medicaid/uninsured insurance, greater distance to treatment centers, male gender, younger age, more medical comorbidities, and southeast U.S. location (p < 0.05, each). All factors were statistically significant on multivariate analysis. Conclusion: Age, gender, race/ethnicity, geographic location, socioeconomic factors, and distance to treatment center are associated with advanced melanoma diagnosis. Melanoma screening and education should target these groups, and more research is necessary to elucidate causes of the disparities that may preventing the early diagnosis of melanoma for these patients.