Higher Socioeconomic Status and Physician Accessibility Linked to More Early-stage but Not Fewer Late-Stage Melanoma Diagnoses

BACKGROUND: Socioeconomic status (SES) and physician accessibility, key proxies for skin cancer screening uptake, can influence melanoma diagnosis, but their impact on reducing advanced-stage diagnoses remains unclear. We examined how these indicators relate to the incidence of early- and late-stage melanoma across neighborhoods in Ohio, USA.

METHODS: This cross-sectional study analyzed newly diagnosed cancer cases from the Ohio Incidence Surveillance System (2011-2020), aggregated into 259 neighborhoods (derived from 2,952 census tracts), and estimated neighborhood-level, stage-specific incidence rates. Correlation and geospatial analyses explored dose-response relationships between SES, physician accessibility, and stage-specific melanoma incidence. Classification and regression tree and logistic regression further examined these associations.

RESULTS: Higher SES and physician accessibility were significantly associated with increased early-stage melanoma incidence but not with late-stage incidence. Affluent city suburbs with high physician accessibility had the highest early-stage incidence (median: 20.2 per 100,000), whereas disadvantaged rural areas with low physician accessibility had the lowest (median: 14.4 per 100,000). CART identified five neighborhood profiles of early-stage melanoma. A nearly 100-fold difference in the odds of high early-stage incidence was observed between the high-risk and low-risk neighborhoods. No significant results were observed for late-stage incidence in correlation analysis, CART, or logistic regression.

CONCLUSIONS: Areas with high healthcare access measures experience increased early-stage melanoma incidence. However, this does not correspond to a reduction in late-stage cases. The absence of a clear association between late-stage incidence and these screening proxies highlights the need for further research into the biology and progression of advanced-stage melanoma tumors, as well as the effectiveness of current screening methods in detecting these cases.