Greater distance to an academic medical center is associated with poorer melanoma prognostic factors: The university of colorado experience

Introduction: Numerous studies report a correlation between distance to diagnostic provider in an academic medical center and poorer prognosis of disease. 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, p<0.0001), and had four times the odds of presenting with metastatic disease (OR: 4.04, 95% CI: 3.00-5.46, p<0.0001). Discussion: We highlight the correlation between increased distance to our academic medical center with greater Breslow depths and the presence of metastatic 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.