INTRODUCTION
Melanoma is one of the most common malignancies in the United States (US) and has the highest mortality rate of any skin cancer.1 A study exploring the effects of dermatologist density on melanoma mortality rate (MMR) between 1988 and 1993 found that higher dermatologist geographic density was associated with improved prognosis.2
An analysis of MMR between 2002 to 2006 suggested that the presence of up to 2 dermatologists/100,000 people significantly lowered MMR by 53% when compared to no dermatologists.3 The overall density of US dermatologists has increased over the past several decades, yet the present density (3.66/100,000) remains below the recommended for adequate care (>4/100,000).4 In this study, we utilize current data to explore the relationship between MMR and dermatologist density.
An analysis of MMR between 2002 to 2006 suggested that the presence of up to 2 dermatologists/100,000 people significantly lowered MMR by 53% when compared to no dermatologists.3 The overall density of US dermatologists has increased over the past several decades, yet the present density (3.66/100,000) remains below the recommended for adequate care (>4/100,000).4 In this study, we utilize current data to explore the relationship between MMR and dermatologist density.
MATERIALS AND METHODS
A cross-sectional analysis including 659 section codes with a total population of 306,658,964 was performed. Dermatologist density was calculated using 2023 AAD membership data per US postal section codes (first 3 digits of zip codes) and population and median income data for section codes from the 2020 US Census Bureau.4 MMR for US counties was obtained from the NCI for 1/2016-12/2020.5 All ages, sexes, and races were included. Per NCI guidelines, counties were excluded if they had insufficient data for calculation of MMR.5 Counties were matched to section codes using HUD Crosswalk Files. Urban areas were defined as >250,000 population based on SEER Rural-Urban Continuum coding. Multivariable linear regression was used to assess significance of relationships.
RESULTS
Overall age-adjusted MMR was 2.1/100,000 with a significant inverse correlation to dermatologist density (r=-0.263, P<0.001). MMR directly improved with increasing dermatologist density (0-4/100,000 MMR=2.39, 4-7/100,000 MMR=2.10, 7-10/100,000 MMR=1.98, >10/100,000 MMR=1.81; Figure 1). Section codes with dermatologist density less than the recommended value for adequate coverage of 4/100,000 had significantly higher MMR compared to those with a density of >4/100,000 (2.39 vs 2.01, P<0.001).
