People with melanoma who live in states with the highest number of melanoma diagnoses tend to have better survival rates, according to recent research that examined data on a state-by-state basis.

Researchers from the University of Utah (U of U) Health in Salt Lake City, UT, set out to determine if there were any differences in survival rates for people with melanoma depending on where they live. As it turns out, the answer may be yes.

The study, now available in the Journal of the American Academy of Dermatology, indicates a number of differences. For example, in areas where doctors make fewer overall diagnoses, a person's survival rate is lower. The researchers also observed that in areas where there were more practicing physicians, mortality from melanoma was also higher.

"Finding a significant relationship between more physicians and mortality was certainly surprising," says Dr. Zachary Hopkins, resident in internal medicine at U of U Health and the paper's first author.

Melanoma rates parallel better outcomes

Dr. Hopkins adds, "This study is a bird's eye view of melanoma survival in [the] US. We are interested in finding disparities in state health care systems to target specific states to improve care for people."

To find these differences, the researchers looked at survival data found in the US Cancer Database from the Centers for Disease Control and Prevention (CDC). They were looking at the mortality-to-incidence ratio for each state, which helped them approximate survival by relating mortality to the frequency of its diagnosis.

The team also looked at other health-care variables, such as how many dermatologists and primary care physicians there were relative to the area's population, how much the region spends on health care per capita, and how many National Cancer Institute-designated cancer centers there were. The researchers also considered other demographics, such as average household income, education level, and health insurance status.

The study also indicated that people who live in states with a high incidence of melanoma, including Oregon, Washington, Utah, Minnesota, Vermont, and New Hampshire, had a better survival rate. On the other hand, in states where there are fewer cases of melanoma, such as Texas, Louisiana, Alabama, Indiana, Illinois, and Nevada, the survival rates were lower.

Melanoma rates and risk factors

According to the American Cancer Society, skin cancer is the most common form of cancer, and while melanoma only makes up a very small percentage of skin cancer cases (around 1%), it is the deadliest type. The American Cancer Society expects that about 96,000 people will develop melanoma in the US in 2019. It also estimates that about 7,200 people will die from the disease.

Melanoma is a type of cancer that starts in skin cells called melanocytes. If doctors do not detect it early, it can spread easily. Exposure to ultraviolet light, including sunlight, is a significant risk factor for melanoma. Also, people who have a lot of moles on their skin are more at risk than people who have fewer moles. Fair-skinned people are also more at risk than their darker-skinned peers, and those with blue or green eyes or light hair also have an increased risk of developing melanoma.

Treatment for melanoma can include a number of different strategies based on the cancer staging and the individual's health. Treatments include surgery, immunotherapy, targeted therapy, chemotherapy, and radiation, which doctors can tailor to each person. While survival rates vary, ongoing research aims to find new and better treatment.

What does this study mean going forward?

This study revealed that there is a definite disparity in outcomes for those with melanoma based on where they live. The study authors believe their findings might help improve care in areas where survival rates are the lowest.

Aaron Secrest, PhD, assistant professor in the Departments of Dermatology and Population Health Sciences at U of U Health and senior author on the paper says:

"The analysis is telling us that two people with similar melanomas could have very different outcomes based on where they live and the care they receive. We can use this information to improve care to help more people survive."

—Aaron Secrest, PhD