Differential melanoma outcomes in a regional Veterans Affairs center and a tertiary care center with shared physician staffing: A cohort study.

BACKGROUNDMelanoma outcomes vary by subgroups.

OBJECTIVEIdentify institutional/systemic factors contributing to outcome differences.

METHODSRetrospective cohort study of melanoma patients seen from January 1987 to May 2023 at a Veterans Affairs (VA) center and nearby tertiary care center sharing providers. Outcomes include melanoma-specific survival and mortality.

RESULTSCompared to the tertiary center (n = 9,682, 5564 males), VA patients (n = 638, 612 males) were older and had a greater proportion of melanoma in situ (P < .0001). When comparing VA males to males treated at the tertiary center, melanoma-specific survival was increased for localized melanoma (P = .003) but decreased for regional (P = .0002) and distant disease (P = .02). When comparing VA males to VA-insured males at the tertiary center, melanoma-specific survival remained increased for localized disease (P < .0001), but differences for regional or distant disease were no longer significant. Within the tertiary center, publicly insured patients had increased melanoma-specific mortality compared to privately insured (Medicare, hazard ratio [95% confidence interval]: 1.46 [1.22-1.75]; Medicaid, 1.67 [1.28-2.18]; Military/VA 1.92 [1.15-3.20]).

LIMITATIONSSmaller number of VA-insured patients.

CONCLUSIONDifferences in preventative screening and selective referrals may contribute to increased survival at the VA for early-stage melanoma. Insurance type within and between institutions is associated with differential mortality outcomes for advanced melanoma stages, indicating a need for additional care standardization.

Abstract from PubMed