title: The influence of dermatologist and primary care physician visits on melanoma outcomes among Medicare beneficiaries.
abstract: BACKGROUND
  Ambulatory visits to dermatologists and primary care physicians (PCPs) may improve melanoma outcomes through early detection. We sought to measure the effect of dermatologist and PCP visits on melanoma stage at diagnosis and mortality.
  
  
  METHODS
  We used data from the database linking Surveillance Epidemiology and End Results (SEER) and Medicare data (1994 to 2005) to examine patterns of dermatologist and PCP ambulatory visits before diagnosis for 18,884 Medicare beneficiaries with invasive melanoma or unknown stage at diagnosis. Visits were assessed during the 2-year time interval before the month of diagnosis. We examined whether dermatologist and PCP visits were associated with diagnosis of thinner melanomas (defined as local stage tumors having Breslow thickness <1 mm) and lower melanoma mortality.
  
  
  RESULTS
  Medicare beneficiaries visiting both a dermatologist and PCP before diagnosis had greater odds of diagnosis of a thin melanoma (adjusted odds ratio, 1.26; 95% confidence interval, 1.12-1.41) and lower melanoma mortality (adjusted hazard ratio 0.66, 95% confidence interval, 0.57-0.76) compared with those without such visits. The mortality findings were attenuated once stage at diagnosis was adjusted for in the multivariable model.
  
  
  CONCLUSIONS
  Improved melanoma outcomes among Medicare beneficiaries may depend on adequate access and use of dermatologist and PCP services.
authors.affiliation: the Department of Family Medicine, University of South Florida, Tampa, FL; the H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; the Department of Family Medicine and Community Health, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ; the Cancer Institute of New Jersey, Trenton, NJ; and the Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Roetzheim
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Lee
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Ferrante
authors.forename: Eduardo C
authors.initials: EC
authors.lastname: Gonzalez
authors.forename: Ren
authors.initials: R
authors.lastname: Chen
authors.forename: Kate J
authors.initials: KJ
authors.lastname: Fisher
authors.forename: Kymia
authors.initials: K
authors.lastname: Love-Jackson
authors.forename: Ellen P
authors.initials: EP
authors.lastname: McCarthy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003880:Dermatology / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D058007:Physicians, Primary Care; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018426:SEER Program; D012878:Skin Neoplasms; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D000096142:Cutaneous Malignant Melanoma
keywords: Dermatology; Medicare; Melanoma; Primary Care Physicians; SEER Program