Author Affiliations: Robert Wood Johnson Clinical Scholars Program and Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut.
Hypothesizing that geographic variation in the county-level density of dermatologists may affect melanoma-associated mortality, Aneja et al,1 in a recent issue of the Archives, show that the presence of 1 or more dermatologists per 100 000 people is associated with an approximately 30% or greater reduction in the corresponding age-adjusted mean melanoma mortality rate compared with counties with no dermatologists. Accordingly, they argue that this result “reflects that access to a dermatologist allows for an accurate and earlier diagnosis of melanoma, more appropriate therapy, or a combination of these factors.”1(p176) The magnitude of this effect size—in concert with the reported lack of significant association with sociodemographic parameters that have hitherto repeatedly been linked with worse outcomes across many diseases, including melanoma2—should prompt reconsideration of potentially unrecognized confounders.
Lott JP. On Dermatologist Density and Melanoma Mortality. Arch Dermatol. 2012;148(9):1092-1093. doi:10.1001/archdermatol.2012.1500