1. ^*Department of Epidemiology and Biostatistics, University Hospitals of Cleveland, and Case Western Reserve University, Cleveland, Ohio, USA
2. ^†Skin Disease Research Center, University Hospitals of Cleveland, and Case Western Reserve University, Cleveland, Ohio, USA
3. ^‡Department of Medicine and Comprehensive Cancer Center, University Hospitals of Cleveland, and Case Western Reserve University, Cleveland, Ohio, USA
4. ^§Department of Dermatology, University Hospitals of Cleveland, and Case Western Reserve University, Cleveland, Ohio, USA

Correspondence: David A. Barzilai, Department of Epidemiology & Biostatistics, Case Western Reserve University School of Medicine, 10900 Euclid Ave., SOM W-G57, Cleveland, OH 44106, USA. Email: david.barzilai@case.edu

¹Tables 4, 6, and appendix can be found at http://www.blackwellpublishing.com/products/journals/suppmat/jid/jid22238/jid22238sm.htm

Received 20 April 2003; Revised 1 July 2003; Accepted 4 September 2003; Published online 12 February 2004.

Abstract

Little is known about variation in surveillance practices following the diagnosis of invasive melanoma. The objective of this study was to characterize geographic, patient, and tumor variation in the use of follow-up surveillance testing in patients with local or regional stage melanoma. A cohort of Medicare beneficiaries 65 y diagnosed with invasive melanoma during 1992 to 1996 living in a Surveillance, Epidemiology, and End Results registry area was studied. Outpatient and inpatient Medicare claims 3 mo following diagnosis were examined for up to 2 y for surveillance procedures of interest. Use of chest X-ray, chest computed tomography scan, abdominal and/or pelvic computed tomography scan, abdominal ultrasound, head computed tomography scan, head magnetic resonance imaging, laboratory testing, and skin examinations were compared between patient groups and geographic regions. A total of 3389 patients were identified for the analysis. Surveillance testing was relatively common, ranging from 13% for abdominal ultrasound to 80% for laboratory testing. Follow-up skin examinations were performed in 70% to 90% of patients. The use of most surveillance procedures was associated (p<0.01) with younger age, male gender, regional stage tumors, and geographical area, with up to 2-fold differences observed. In contrast, there was much less variability in the receipt of skin examinations. Further studies are needed to determine the etiology and impact of such disparities, and the influence of surveillance procedures on morbidity and mortality.