Receipt of sentinel lymph node biopsy for thin melanoma is associated with distance traveled for care.

BACKGROUND

Sentinel lymph node biopsy (SLNB) is not routinely recommended for thin melanoma. However, it is considered when high-risk features, clinicopathological, or sociodemographic, are present. It was our objective to evaluate the impact of travel distance on decision-making for SLNB in thin melanoma.

METHODS

We used the National Cancer DataBase (1998-2011) to identified patients with thin melanoma (≤1 mm thickness). The primary exposure was distance traveled for care, categorized as short (<12.5 miles), intermediate (12.5-49.9 miles), or long (≥50 miles). The primary outcome was receipt of SLNB.

RESULTS

We identified 21 124 cases of thin melanoma; 48.8%, 38.2%, and 13.0% traveled short, intermediate, and long distances, respectively. Overall, SLNB was performed in 32.8% of patients. Traveling farther was associated with a step-wise increase in the likelihood of undergoing a SLNB (P-trend < 0.001). Even after adjusting for patient, disease, and facility factors, we found that patients who traveled an intermediate distance were 18% more likely to undergo a SLNB (OR:1.18; 95%CI: 1.10,1.27), and those who traveled a long distance were 24% more likely (OR:1.24; 95%CI: 1.11,1.39) compared with those who traveled a short distance.

CONCLUSIONS

The distance patients travel for surgical care appears to be an independent factor influencing the receipt of SLNB.