Assessing rural–urban disparities in the use of sentinel lymph node biopsy for melanoma

Abstract Background We hypothesized that patients in urban areas with intermediate thickness cutaneous melanoma would have higher rates of sentinel lymph node biopsy (SLNB) relative to their rural-dwelling counterparts. Methods The Surveillance, Epidemiology, and End Results database was queried for...

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Bibliographic Details
Published in:The Journal of surgical research 2013-10, Vol.184 (2), p.1157-1160
Main Authors: Shah, Dhruvil R., MD, Yang, Anthony D., MD, Maverakis, Emanual, MD, Martinez, Steve R., MD, MAS
Format: Article
Language:English
Subjects:
Disparities
Female
Hospitals, Rural - statistics & numerical data
Hospitals, Urban - statistics & numerical data
Humans
Male
Melanoma
Melanoma - diagnosis
Melanoma - pathology
Multivariate Analysis
Neoplasm Staging
Regression Analysis
Retrospective Studies
Rural
SEER Program - statistics & numerical data
Sentinel lymph node biopsy
Sentinel Lymph Node Biopsy - utilization
Skin Neoplasms - diagnosis
Skin Neoplasms - pathology
Surgery
United States
Urban
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Summary:Abstract Background We hypothesized that patients in urban areas with intermediate thickness cutaneous melanoma would have higher rates of sentinel lymph node biopsy (SLNB) relative to their rural-dwelling counterparts. Methods The Surveillance, Epidemiology, and End Results database was queried for patients who underwent surgery for intermediate thickness cutaneous melanoma from 2004–2008. Patients were categorized as coming from urban or rural counties based on a nine-point scale. We used multivariate logistic regression models to predict use of SLNB. Covariates examined included sex, race/ethnicity, age, T stage, tumor histology, tumor location, and ulceration. The likelihood of undergoing SLNB was reported as OR with 95% CI. Results Of 8441 patients, 8382 (99.3%) had complete information regarding use of SLNB. On multivariate analysis, patients from rural counties had a decreased likelihood of receiving a SLNB (OR 0.87, CI 0.78–0.97; P = 0.014). Additional factors associated with a decreased likelihood of receiving a SLNB included increasing age, Asian/Hispanic/Unknown race, and head and neck or overlapping primary tumor site. Conclusions Patients in rural areas are less likely to receive a SLNB for intermediate thickness cutaneous melanoma than their urban-dwelling counterparts.
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2013.04.091