Better access to dermatologic care enables earlier melanoma detection at the population level, suggests a US study, noting an association between greater dermatologist density and a lower proportion of melanoma cases diagnosed at a late stage.
“Cutaneous melanoma with regional or distant metastases (late-stage) is associated with worse survival than localized disease,” the researchers said. “Access to dermatologic care varies widely across the US and may influence the stage at which melanoma is diagnosed.”
Data from the State Cancer Profiles and Area Health Resource File were used in this national ecological study to analyse the proportions of late-stage melanoma and dermatologist counts per 100,000 population across National Cancer Institute Health Service Areas (HSAs) from 2017 to 2021.
A total of 557 HSAs met the eligibility criteria. Multivariable analysis revealed the association between higher dermatologist density and significantly lower proportions of late-stage melanoma diagnosis. [J Am Acad Dermatol 2026;95:662-669]
The likelihood of being diagnosed with late-stage melanoma was lower by 11 percent for >0‒1 dermatologists per 100,000 population (odds ratio [OR], 0.89; p=0.034), 11 percent for >1‒2 (OR, 0.89; p=0.020), 16 percent for >2‒4 (OR, 0.84; p<0.001), and 20 percent for >4 (OR, 0.80; p<0.001) when compared with HSAs with no dermatologists.
“These findings suggest that increased dermatologist availability may play a meaningful role in facilitating earlier melanoma detection at the population level,” the researchers said.
Multifactorial
Several factors may help explain the observed association. For instance, regions with greater dermatologist density are more likely to benefit from better access to care and shorter wait times. Earlier studies showed that patients in areas with lower density experience longer delays in securing appointments. [Cancer 2015;121:113-122; PLoS One 2016;11:e0162767]
Dermatologists are also more likely to perform routine skin examinations, which results in the detection of thinner, earlier-stage melanomas. [Arch Dermatol 2011;147:39-44]
A study by Watts and colleagues further shows how skin-check‒identified tumours display more favourable clinicopathologic features than patient- or nonspecialist-identified lesions. [JAMA Dermatol 2021;157:1425-1436]
“This is further supported by evidence that dermatologists routinely use advanced diagnostic tools such as dermoscopy, which enhances accuracy in differentiating malignant from benign lesions and improves early detection,” the researchers said. [Br J Dermatol 2008;159:669-676]
“Together, these factors may explain the population-level benefits observed in regions with higher dermatologist availability,” they added. [J Invest Dermatol 2021;141:1699-1706.e7]
Education level
Similarly, educational attainment is associated with earlier melanoma detection. Specifically, individuals with higher education levels tend to engage more in skin self-examinations, utilize preventive services, and seek earlier evaluation of concerning lesions. [Cancer 2012;118:3725-3734; Eur J Cancer 2013;49:2705-2716; Acta Oncol 2016;55:993-1000; J Am Acad Dermatol 1996;34:962-970]
Another study involving insured adults found that socioeconomic status could be predictive of melanoma-specific mortality. This finding stressed the interaction between education, insurance, and healthcare system structure, according to the researchers. [J Am Acad Dermatol 2023;88:560-567]