Veterans present with later stage, thicker melanomas compared with general population

U.S. veterans were diagnosed with melanoma at later stages compared with those individuals included in the Surveillance, Epidemiology and End Results program, though both populations exhibited recent improvement, according to a study.

“Melanoma is the fifth most common cancer in the United States,” Michael S. Chang, BA, of Harvard Medical School and the department of dermatology at Brigham and Women’s Hospital in Boston, and colleagues wrote in the Journal of the American Academy of Dermatology. “The National Cancer Institute reports annual statistics on melanoma incidence and deaths using data from the Surveillance, Epidemiology and End Results (SEER) program. Although the SEER registry covers approximately a third of the U.S. population, it may not comprehensively capture patient information from different health care networks.”

The researchers identified patients with melanoma diagnosed between 2009 and 2017, including 15,334 from the Veterans Affairs Cancer Registry (VACR) and 166,265 from the SEER registry.

Veterans were predominantly aged 65 years and older, men and white. Also, 58.7% were from urban areas and 39% were from rural areas.

In comparison, SEER patients, who were diagnosed with invasive melanoma at 10-fold the rate of VACR patients, presented at a younger age and with fewer patients in the 65 years and older range. SEER patients were also mostly white, but the ratio of sex was nearly half and half in SEER compared with a majority of men in VACR (57.4% vs. 96.9%).

Chang and colleagues wrote that, compared with SEER data, a larger proportion of VACR patients were diagnosed with tumors that were ulcerated and very thick ( 4 mm: 10.4% in VACR vs. 6.4% in SEER). VACR patients were also more likely to present with advanced disease compared with SEER patients (regional or distant disease: 17.5% in VACR vs. 13% in SEER).

“We report an increased relative proportion of advanced disease and poorer [melanoma-specific survival] outcomes stratified by age and stage among veterans with initial invasive melanoma diagnoses compared with the general population in SEER,” the researchers wrote. “The higher rates of advanced melanoma among veterans highlight a need for awareness of this disease among Veterans Health Administration providers.”