Geographic and patient variation in receipt of surveillance procedures after local excision of cutaneous melanoma.
Little is known about variation in surveillance practices following the diagnosis of invasive melanoma. The objective of this study was to characterize geographic, patient, and tumor variation in the use of follow-up surveillance testing in patients with local or regional stage melanoma. A cohort of Medicare beneficiaries > or =65 y diagnosed with invasive melanoma during 1992 to 1996 living in a Surveillance, Epidemiology, and End Results registry area was studied. Outpatient and inpatient Medicare claims 3 mo following diagnosis were examined for up to 2 y for surveillance procedures of interest. Use of chest X-ray, chest computed tomography scan, abdominal and/or pelvic computed tomography scan, abdominal ultrasound, head computed tomography scan, head magnetic resonance imaging, laboratory testing, and skin examinations were compared between patient groups and geographic regions. A total of 3389 patients were identified for the analysis. Surveillance testing was relatively common, ranging from 13% for abdominal ultrasound to 80% for laboratory testing. Follow-up skin examinations were performed in 70% to 90% of patients. The use of most surveillance procedures was associated (p<0.01) with younger age, male gender, regional stage tumors, and geographical area, with up to 2-fold differences observed. In contrast, there was much less variability in the receipt of skin examinations. Further studies are needed to determine the etiology and impact of such disparities, and the influence of surveillance procedures on morbidity and mortality.
Department of Epidemiology and Biostatistics and Skin Disease Research Center, University Hospitals of Cleveland, and Case Western Reserve University, Cleveland, Ohio 44106, USA. david.barzilai@case.edu
David A
DA
Barzilai
Kevin D
KD
Cooper
Duncan
D
Neuhauser
Alfred A
AA
Rimm
Gregory S
GS
Cooper
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008545:Melanoma / Q000401:mortality*; D015999:Multivariate Analysis; D010045:Outpatients / Q000706:statistics & numerical data; D012307:Risk Factors; D018426:SEER Program; D012878:Skin Neoplasms / Q000401:mortality*; D014481:United States / Q000453:epidemiology