Geographic variation in utilization of sentinel lymph node biopsy for intermediate thickness cutaneous melanoma.
OBJECTIVE
Sentinel lymph node biopsy (SLNB) is the standard for evaluation of the draining lymphatic basin for intermediate thickness melanoma. Despite this, SLNB has not been uniformly adopted. We hypothesized that there are geographic areas of the United States where patients are less likely to receive SLNB.


METHODS
The Surveillance, Epidemiology, and End Results database was queried for patients who underwent surgery for intermediate thickness cutaneous melanoma (Breslow thickness 1.00-4.00 mm) from 2004 to 2008. Patients were categorized according to geographic area based on the reporting registry. Multivariate logistic regression models predicted use of SLNB.


RESULTS
Entry criteria were met by 8957 patients. On multivariate analysis, patients from the South were less likely (OR 0.54, CI 0.48-0.62; P < 0.001) to receive a SLNB. Additional factors associated with a decreased likelihood of receiving a SLNB included head and neck primary tumor site, high or unknown serum LDH, Asian, Hispanic, Native American or unknown race, and increasing age.


CONCLUSIONS
Patients from the South were less likely to receive a SLNB for an intermediate thickness cutaneous melanoma. This report of geographic disparities on a national level should be confirmed locally to better guide interventions aimed at eliminating these disparities.
Division of Surgical Oncology, Department of Surgery, University of California at Davis, Sacramento, California 95817, USA. steve.martinez@ucdmc.ucdavis.edu
Steve R
SR
Martinez
Dhruvil R
DR
Shah
Emanual
E
Maverakis
Anthony D
AD
Yang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000473:pathology*; D008875:Middle Aged; D018579:Patient Selection; D012111:Residence Characteristics / Q000706:statistics & numerical data; D018426:SEER Program; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult