Married Melanoma Patients Present at an Earlier Stage

Melanoma patients who are married tend to present at earlier stages of the disease than those who are not married, divorced, or widowed, according to a new analysis. Marital status was also associated with the likelihood of undergoing sentinel lymph node biopsy (SLNB) for appropriate lesions.

“Early detection of melanoma is critical because it is associated with improved patient outcomes,” wrote study authors led by Cimarron E. Sharon, BS, of the Hospital of the University of Pennsylvania in Philadelphia. Marital status has previously been shown to be associated with the risk of regional and/or distant metastases at diagnosis, but “whether any association exists between marital status and T stage at presentation among patients with clinically localized disease has not been determined.”

The new study used the Surveillance, Epidemiology, and End Results (SEER) database to assess associations between marital status and disease stage at presentation. In total, it included 52,063 patients (58.8% men, 41.2% women) with a median age of 64 years. The results were published in JAMA Dermatology.

Most of the cohort was married (69.7%); 14.5% were never married, 7.0% were divorced, and 8.7% were widowed. The married patients were more likely to present with T1a tumors (45.7% of married patients), compared with never-married patients (43.0%), divorced patients (39.0%), and widowed patients (32.2%; P < .001).

Widowed patients were more likely than others to present with T4 disease, with 5.6% presenting with T4a and 9.4% presenting with T4b disease. Married patients (2.6% T4a, 3.3% T4b), never-married patients (2.9% T4a, 4.8% T4b), and divorced patients (3.1% T4a, 5.1% T4b) had lower rates of such late-stage presentation (P < .001).

A multivariate analysis confirmed these results. After adjustment for age, gender, primary tumor site, income level, and education level, never-married patients had an odds ratio (OR) to present with a later T stage than married patients of 1.32 (95% CI, 1.26–1.39; P < .001). For divorced patients, the OR was 1.38 (95% CI, 1.30–1.47; P < .001), and for widowed patients it was 1.70 (95% CI, 1.60–1.81; P < .001).

SLNB is recommended for lesions with Breslow thickness greater than 1 mm, and marital status was associated with rates of this procedure as well. Widowed patients were the least likely to undergo SLNB (48.8%), compared with divorced patients (74.9%), married patients (74.0%), or never-married patients (73.6%). After adjustment for various factors, married patients were more likely to undergo SLNB than any of the other three groups.

“This study has important implications for counseling patients and recommending frequency of follow-up surveillance,” the authors wrote. “Clinicians may, for instance, recommend that unmarried patients initiate regular skin examinations at an earlier age and continue them more frequently to detect lesions at an earlier stage.”