title: 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 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.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of California at Davis, Sacramento, California.
authors.forename: Dhruvil R
authors.initials: DR
authors.lastname: Shah
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Yang
authors.forename: Emanual
authors.initials: E
authors.lastname: Maverakis
authors.forename: Steve R
authors.initials: SR
authors.lastname: Martinez
mesh_terms: D005260:Female; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D012044:Regression Analysis; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014481:United States
keywords: Disparities; Melanoma; Rural; Sentinel lymph node biopsy; Urban