title: The role of accessibility policies and other determinants of health care provision in the initial prognosis of malignant melanoma: a cross-sectional study.
abstract: BACKGROUND
  The prognostic benefit of health care service provision and delivery policies for patients with malignant melanoma (MM) is not yet clear.
  
  
  OBJECTIVE
  To analyze the role of health care provision determinants in the initial prognosis of MM.
  
  
  METHODS
  A multicenter cross-sectional study was conducted at 14 public hospitals and recruited 3550 patients with MM between 2000 and 2009. The study variables were analyzed using univariate and multivariate models to identify their role in the variations observed.
  
  
  RESULTS
  In a 10-year period, the number of patients with MM increased by 78.54%, with primary in situ MM (Tis) or MMs with a Breslow thickness <1 mm (T1) representing 51.72% of the total number of MMs in 2000, increasing to 62.23% by the end of the study period (P = .005). Among the variables that explained the variation in MM frequency the year of diagnosis after 2004 (univariate odds ratio [OR], 1.43 [P < .001]; multivariate OR, 1.36 [P = .005]) and diagnosis in centers with specific fast-track referral systems (univariate OR, 1.24 [P = .01]; multivariate OR, 1.59 [P = .025]) were shown to explain the increasing frequency of Tis-T1 MM.
  
  
  CONCLUSIONS
  The primary potential limitation of this study is its retrospective nature.
  
  
  CONCLUSIONS
  Health care provision policies and interventions aimed at improving accessibility to specialized care appear to explain the increasing frequency of Tis-T1 MM.
authors.affiliation: Hospital Universitario Virgen Macarena, Seville, Spain. Electronic address: david.moreno.ramirez.sspa@juntadeandalucia.es.
authors.forename: David
authors.initials: D
authors.lastname: Moreno-Ramírez
authors.affiliation: Hospital Universitario Virgen Macarena, Seville, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Ojeda-Vila
authors.affiliation: Hospital Universitario Virgen Macarena, Seville, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Ríos-Martín
authors.affiliation: Complejo Hospitalario de Jaén, Jaén, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ruiz-Villaverde
authors.affiliation: Hospital Costa del Sol, Marbella-Málaga, Spain.
authors.forename: Magdalena
authors.initials: M
authors.lastname: de-Troya
authors.affiliation: Hospital Regional de Málaga, Málaga, Spain.
authors.forename: Andres
authors.initials: A
authors.lastname: Sanz-Trelles
authors.affiliation: Hospital Costa del Sol, Marbella-Málaga, Spain.
authors.forename: Rafael Fúnez
authors.initials: RF
authors.lastname: Liébana
authors.affiliation: Complejo Hospitalario de Jaén, Jaén, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Martínez-de-Victoria
authors.affiliation: Hospital San Cecilio, Granada, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Aneiros-Fernández
authors.affiliation: Hospital San Cecilio, Granada, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Naranjo-Sintes
authors.affiliation: Hospital Torrecárdenas, Almeria, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Amérigo
authors.affiliation: Hospital Torrecárdenas, Almeria, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Alcalde
authors.affiliation: Hospital Universitario Virgen del Rocío, Seville, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Zulueta
authors.affiliation: Hospital Universitario Virgen del Rocío, Seville, Spain.
authors.forename: Javier J
authors.initials: JJ
authors.lastname: Domínguez-Cruz
authors.affiliation: Hospital Infanta Margarita, Cabra-Córdoba, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Solís-García
authors.affiliation: Hospital Infanta Margarita, Cabra-Córdoba, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Tejera-Vaquerizo
authors.affiliation: Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: Aurelio M
authors.initials: AM
authors.lastname: Martín-Castro
authors.affiliation: Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: Valentín
authors.initials: V
authors.lastname: García-Mellado
authors.affiliation: Hospital Regional de Málaga, Málaga, Spain.
authors.forename: Silvestre
authors.initials: S
authors.lastname: Martínez-García
authors.affiliation: Hospital Universitario Virgen de la Victoria, Málaga, Spain.
authors.forename: Araceli
authors.initials: A
authors.lastname: Martínez-García
authors.affiliation: Hospital Universitario Virgen de la Victoria, Málaga, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Herrera-Acosta
authors.affiliation: Hospital Infanta Elena, Huelva, Spain.
authors.forename: Pilar Jurado
authors.initials: PJ
authors.lastname: Escámez
authors.affiliation: Hospital de Jerez de la Frontera, Cádiz, Spain.
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Rodríguez-Fernández
authors.affiliation: Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Salvatierra-Cuenca
authors.affiliation: Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: José C
authors.initials: JC
authors.lastname: Moreno-Giménez
authors.affiliation: Hospital Punta de Europa, Algeciras-Cádiz, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Guerrero-Cauqui
authors.affiliation: Hospital Punta de Europa, Algeciras-Cádiz, Spain.
authors.forename: Jose C
authors.initials: JC
authors.lastname: Armario-Hita
authors.affiliation: Department of Preventive Medicine and Public Health, University of Seville, Spain.
authors.forename: Adoración
authors.initials: A
authors.lastname: Nieto-Garcia
authors.affiliation: Hospital Universitario Virgen Macarena, Seville, Spain.
authors.forename: Lara
authors.initials: L
authors.lastname: Ferrándiz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000473:pathology; D008875:Middle Aged; D011322:Primary Prevention; D011379:Prognosis; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
keywords: health care service provision; malignant melanoma; primary prevention; prognosis; secondary prevention; skin cancer; teledermatology