Greater distance to an academic medical center is associated with poorer melanoma prognostic factors: The University of Colorado Experience

Author(s): Snyder, Blake M; Mounessa, Jessica S; Fazzari, Melissa; Caravaglio, Joseph V; Kretowicz, Alexandra; Braunberger, Taylor; Wells, Keith; Dunnick, Cory A; Dellavalle, Robert P; Alkousakis, Theodore | Abstract: Introduction: Numerous studies report a correlation between distance to diagnostic provider in an academic medical center and poorer prognosis ofdisease. Limited research on this topic exists with respect to melanoma.Methods: This was a retrospective chart review of 1,463 adults (≥18 years) initially diagnosed with melanoma between 2006-2016. Associations between distance traveled and Breslow depth and presence of metastatic disease were assessed via cumulative and binary logistic regression models, adjusting for patient and tumor characteristics.Results: Subjects traveling ≥50 miles had 58% greater odds of having an increased Breslow depth than those traveling less than that distance (OR: 1.58; 95% CI: 1.24-2.01; pl0.0001), and had four times the odds of presenting with metastatic disease (OR: 4.04; 95% CI: 3.00-5.46; pl0.0001).Discussion: We highlight the correlation between increased distance to our academic medical center with greater Breslow depths and the presence ofmetastatic disease at presentation.Conclusion: Future studies assessing other factors and regional differences that limit access to diagnosis might help improve screening efforts to prevent poorer prognosis for patients in these areas.