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Original Investigation
May 2018

Association of Marital Status With T Stage at Presentation and Management of Early-Stage Melanoma

Author Affiliations
  • 1Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia
  • 2Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
JAMA Dermatol. 2018;154(5):574-580. doi:10.1001/jamadermatol.2018.0233
Key Points

Question  What is the association of marital status with T stage at presentation and management of early-stage melanoma?

Findings  In this analysis of 52 063 patients from the Surveillance, Epidemiology, and End Results database, married patients more commonly presented with T1a tumors, whereas widowed patients were more likely to present with T4b tumors. In addition, married patients were more likely to undergo sentinel lymph node biopsy for lesions with Breslow thickness greater than 1 mm.

Meaning  These findings support increased consideration of spousal training for partner skin examination and perhaps more frequent screening for unmarried patients.

Abstract

Importance  Early detection of melanoma is associated with improved patient outcomes. Data suggest that spouses or partners may facilitate detection of melanoma before the onset of regional and distant metastases. Less well known is the influence of marital status on the detection of early clinically localized melanoma.

Objective  To evaluate the association between marital status and T stage at the time of presentation with early-stage melanoma and the decision for sentinel lymph node biopsy (SLNB) in appropriate patients.

Design, Setting, and Participants  This retrospective, population-based study used the Surveillance, Epidemiology, and End Results database of 18 population-based registered cancer institutes. Patients with cutaneous melanoma who were at least 18 years of age and without evidence of regional or distant metastases and presented from January 1, 2010, through December 31, 2014, were identified for the study. Data were analyzed from September 27 to December 5, 2017.

Exposure  Marital status, categorized as married, never married, divorced, or widowed.

Main Outcomes and Measures  Clinical T stage at presentation and performance of SLNB for lesions with Breslow thickness greater than 1 mm.

Results  A total of 52 063 patients were identified (58.8% men and 41.2% women; median age, 64 years; interquartile range, 52-75 years). Among married patients, 16 603 (45.7%) presented with T1a disease, compared with 3253 never married patients (43.0%), 1422 divorced patients (39.0%), and 1461 widowed patients (32.2%) (P < .001). Conversely, 428 widowed patients (9.4%) presented with T4b disease compared with 1188 married patients (3.3%) (P < .001). The association between marital status and higher T stage at presentation remained significant among never married (odds ratio [OR], 1.32; 95% CI, 1.26-1.39; P < .001), divorced (OR, 1.38; 95% CI, 1.30-1.47; P < .001), and widowed (OR, 1.70; 95% CI, 1.60-1.81; P < .001) patients after adjustment for various socioeconomic and patient factors. Independent of T stage and other patient factors, married patients were more likely to undergo SLNB in lesions with Breslow thickness greater than 1 mm, for which SLNB is routinely recommended, compared with never married (OR, 0.59; 95% CI, 0.53-0.65; P < .001), divorced (OR, 0.87; 95% CI, 0.76-0.99; P = .03), and widowed (OR, 0.69; 95% CI, 0.62-0.76; P < .001) patients.

Conclusions and Relevance  Marital status is associated with earlier presentation of localized melanoma. Moreover, never married, divorced, and widowed patients are less likely to undergo SLNB for appropriate lesions. Marital status should be considered when counseling patients for melanoma procedures and when recommending screening and follow-up to optimize patient care.

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