C. E. Sharon1, A. J. Sinnamon1, M. E. Ming2, E. Y. Chu2, R. R. Kelz1, R. E. Roses1, D. L. Fraker1, G. C. Karakousis1 2Hospital Of The University Of Pennsylvania,Dermatology,Philadelphia, PA, USA 1Hospital Of The University Of Pennsylvania,Endocrine And Oncologic Surgery,Philadelphia, PA, USA
Introduction:
Early detection of melanoma is associated with improved patient outcomes. There is data to suggest that spouses or partners may facilitate detection of melanoma prior to the onset of regional and distant metastases. Less well known is the influence of marital status on the detection of early clinically localized melanoma. We sought to evaluate the impact of marital status on T stage at time of presentation for early stage disease and decision for SLN biopsy in appropriate patients.
Methods:
Patients at least 18 of age without evidence of regional or distant metastases were identified using Surveillance Epidemiology and End Results (SEER 2010-2014). The main independent variable of interest was marital status, categorized as married, never married, divorced, and widowed. Separate analysis dichotomizing patients as married or unmarried was also performed. Chi square test was used to evaluate for significant differences in distribution of T stage at presentation by marital status. Multivariable analysis using ordered logistic regression was performed to adjust for additional patient factors.
Results:
A total of 56,718 patients were identified for study. Most patients were married (n=39,448, 70%). Others were never married (n=8,374, 15%), divorced (n=4,024, 7%), or widowed (n=4,872, 9%). Distribution of T stage at diagnosis was significantly different by marital status (p<0.001). Forty-three percent of married patients presented with T1a disease, compared to 40% of never married patients, 36% of divorced patients, and 30% of widowed patients (p<0.001). Conversely, 10% of widowed patients presented with T4b disease compared to only 4% of married patients (p<0.001). The association between marital status and higher T stage at presentation remained significant among all non-married groups after adjustment for income, age, gender, state of residence, urban versus rural, and high school education level. There was no observed effect modification between marital status and gender (p=0.17). Independent of T stage and other patient factors, never married and widowed patients were also less likely to undergo sentinel lymph node biopsy (SLNB) in lesions over 1mm in thickness, for which SLNB is routinely recommended (p<0.001).
Conclusion:
Married status is associated with earlier presentation of localized melanoma, which has important implications on prognosis and extent of surgery. Moreover, patients who are never married or widowed are less likely to undergo SLNB for lesions where it is routinely recommended. Marital status should be considered when counseling patients for melanoma procedures and when recommending frequency of screening and follow-up to optimize patient care.
