178 Association of melanoma mortality rates and geographic density of dermatology and hematology-oncology specialists

Abstract

Melanoma is one of the most lethal forms of skin cancer, with a poor prognosis following metastasis. The field of melanoma treatment has advanced greatly with the introduction of checkpoint inhibitor and targeted therapies. As a result, in the US, care involving both dermatology and hematology/oncology (heme/onc) specialists is instrumental in the prevention, diagnosis, and treatment of early-stage to advanced melanoma patients. We correlated population density of both specialist types with age-adjusted mortality of cutaneous melanoma. Data on melanoma mortality was collected from the Surveillance, Epidemiology, and End Results (SEER) database. Data on the density of specialists was collected from the CMS National Plan and Provider Enumeration System, and was sorted by specialty and county of practice location for each physician listed. Patients in counties with at least one dermatologist or at least one heme/onc specialists had higher 5-year survival rates compared to those in counties without these specialists. 5-year survival improved by 3.69% (75.56% vs 71.87%) in a county with any number of dermatologists (p < 0.0001). 5-year survival improved by 2.33% (74.76% vs 72.43%) for counties with any number of heme/onc specialists (p = 0.0003). Each additional dermatologist per 100,000 in a county improves 5-year melanoma survival by 0.496% (p = 0.0015). Having greater numbers of heme/onc specialists per 100,000 was not significantly associated with change in mortality rates. Notably, many areas in the US lack county-level immediate access to either specialist type. Regions for which SEER data is available only have a total of only 3080 dermatologists and 2062 heme/onc specialists, very few of whom localized to rural areas. Overall, these data suggest that a higher density of dermatologists is associated with better survival rates for patients with melanoma.