The role of accessibility policies and other determinants of health care provision in the initial prognosis of malignant melanoma: a cross-sectional study

Abstract

Background: The prognostic benefit of health care service provision and delivery policies for patients with malignant melanoma (MM) is not yet clear.

Objective: To analyze the role of health care provision determinants in the initial prognosis of MM.

Methods: A multicenter cross-sectional study was conducted at 14 public hospitals and recruited 3550 patients with MM between 2000 and 2009. The study variables were analyzed using univariate and multivariate models to identify their role in the variations observed.

Results: In a 10-year period, the number of patients with MM increased by 78.54%, with primary in situ MM (Tis) or MMs with a Breslow thickness <1 mm (T1) representing 51.72% of the total number of MMs in 2000, increasing to 62.23% by the end of the study period (P = .005). Among the variables that explained the variation in MM frequency the year of diagnosis after 2004 (univariate odds ratio [OR], 1.43 [P < .001]; multivariate OR, 1.36 [P = .005]) and diagnosis in centers with specific fast-track referral systems (univariate OR, 1.24 [P = .01]; multivariate OR, 1.59 [P = .025]) were shown to explain the increasing frequency of Tis-T1 MM.

Limitations: The primary potential limitation of this study is its retrospective nature.

Conclusion: Health care provision policies and interventions aimed at improving accessibility to specialized care appear to explain the increasing frequency of Tis-T1 MM.

Keywords: health care service provision; malignant melanoma; primary prevention; prognosis; secondary prevention; skin cancer; teledermatology.