National Analysis Of Patients Diagnosed With Melanoma At Autopsy Alone
Daniel Boczar, MD1, Maria T. huayllani, MD1, Gabriela Cinotto, MD1, Aaron C. Spaulding, PhD1, Sanjay Bagaria, MD1, Brian D. Rinker, MD1, Oscar J. Manrique, MD2, Antonio J. Forte, MD. PhD1.
1Mayo Clinic Florida, Jacksonville, FL, USA, 2Mayo Clinic, Rochester, MN, USA.
PORPUSE: While the vast majority of patients affected with malignant melanoma are diagnosed prior to life, there remains a substantial number who go undiagnosed until autopsy. The aim of this study was to identify disparities in treatment between those who received the diagnosis of melanoma prior to death and those who did not. Predictive factors analyzed included patient demographics such as gender and ethnicity, as well as socioeconomic and insurance status.
METHODS: National Cancer Database (NCDB) was used to select patients with melanoma from 2004 to 2015. We excluded patients who unknown information about the moment of diagnosis. We categorized patients in 2 groups [1-Autposy diagnosis (AD); 2-Diagnosis during life (DDL)]. Chi-Square and Mann-Whitney test were used to estimate statistical significance. Moreover, we performed multivariate logistic regression to find independent associations adjusted for confounders.
RESULTS: A total of 525,001 patients met the criteria of the study. Among them, 26,434 diagnosed only at autopsy (5.0%) and 498,567 diagnosed during life (95.0%). Regarding the patients with AD, the mean age was 64.01 years (SD 15.31). Most of the patients with AD were male (65.5%), with private insurance (40.0%) or Medicare (46.0%), lived in metropolitan counties (79.6%), had tumors with invasive behavior (94.7%), and Stage 4 (58.6%). Multivariate logistic regression demonstrated higher odds for AD among Non-Caucasians [AOR 1.969 (1.812–2.140), P < 0.001] compared to Caucasians. Moreover, lower odds for AD were found among female patients [AOR 0.716 (0.697–0.736), P < 0.001] compared to males; private insurance [AOR 0.382 (0.357–0.408), P < 0.001] compared to no insurance; Higher income (>$63,000) [AOR 0.812 (0.769–0.858), P < 0.001] compared to lower income (<$38,000); higher education [AOR 0.705 (0.667–0.745), P < 0.001] compared to lower education.
CONCLUSION: This nationwide study on melanoma diagnosis reveals significantly greater odds of being diagnosed only after death in patients who were male, non-Caucasian, without insurance coverage, and had lower income, and lower education. These findings identify a troubling disparity that must be addressed with heightened efforts to effectively diagnose and treat malignant melanoma earlier in these at-risk populations.
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