Pennie Michelle L, Soon Seaver L, Risser Jessica B, Veledar Emir, Culler Steven D, Chen Suephy C
Department of Dermatology, Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USA.
Arch Dermatol. 2007 Apr;143(4):488-94. doi: 10.1001/archderm.143.4.488.
To determine whether a difference in melanoma outcomes exists in the United States between tumors detected by dermatologists vs those detected by nondermatologists.
Retrospective analysis of linked data from the Medicare enrollment and claims files from the Centers for Medicare and Medicaid Services and the National Cancer Institute's Surveillance, Epidemiology, and End Results program database from 1991 to 1996. The registries are from 12 US sites.
A study sample comprised of 2020 subjects.
Tumor characteristics (Breslow thickness and histologic ulceration), stage at diagnosis, and survival and mortality rates.
Tumor detection by a dermatologist vs nondermatologist was associated with an earlier stage melanoma (stage 0, stage I, and stage II vs stage III and stage IV; chi(2) test, P<.01) and a thinner tumor (Breslow thickness, 0.86 mm vs 1.00 mm; P<.05). At all time points (6 months, 2 years, and 5 years), patients whose melanoma was detected by dermatologists had better survival rates (98%, 87%, and 74%, respectively, for those whose melanoma was detected by dermatologists vs 95%, 79%, and 69%, respectively, for nondermatologists; P<.05). Non-cancer-related mortality was similar for the 2 groups, but the patients whose tumors were detected by dermatologists had lower cancer-related mortality (13% vs 21%; P<.01) and overall mortality (29% vs 37%; P<.01). Multivariate analysis showed that age, sex, stage at diagnosis, and melanoma detection by a dermatologist were all significantly predictive of survival.
Earlier stage melanoma and improved survival are associated with detection by a dermatologist rather than by a nondermatologist. Increasing access to dermatologists, particularly for older patients, may represent one approach to improving melanoma-related health outcomes.
确定在美国皮肤科医生检测出的黑色素瘤与非皮肤科医生检测出的黑色素瘤在预后方面是否存在差异。
对1991年至1996年医疗保险和医疗补助服务中心的医疗保险参保及理赔档案以及美国国立癌症研究所的监测、流行病学和最终结果计划数据库中的关联数据进行回顾性分析。这些登记处来自美国12个地点。
研究样本包括2020名受试者。
肿瘤特征（ Breslow厚度和组织学溃疡）、诊断时的分期以及生存率和死亡率。
皮肤科医生与非皮肤科医生检测出的肿瘤相比，黑色素瘤分期更早（0期、I期和II期与III期和IV期；卡方检验，P<0.01），肿瘤更薄（Breslow厚度，0.86毫米对1.00毫米；P<0.05）。在所有时间点（6个月、2年和5年），皮肤科医生检测出黑色素瘤的患者生存率更高（皮肤科医生检测出黑色素瘤的患者分别为98%、87%和74%，而非皮肤科医生检测出黑色素瘤的患者分别为95%、79%和69%；P<0.05）。两组的非癌症相关死亡率相似，但皮肤科医生检测出肿瘤的患者癌症相关死亡率较低（13%对21%；P<0.01），总体死亡率也较低（29%对37%；P<0.01）。多变量分析表明，年龄、性别、诊断时的分期以及皮肤科医生检测出黑色素瘤均显著预测生存率。
黑色素瘤分期更早和生存率提高与皮肤科医生而非非皮肤科医生的检测有关。增加皮肤科医生的可及性，尤其是对老年患者而言，可能是改善黑色素瘤相关健康结局的一种方法。
