Association of Neighborhood Deprivation With Breslow Thickness in Head and Neck Cutaneous Melanoma.

Abstract

To characterize the role of neighborhood-level disadvantage measured via Area Deprivation Index (ADI) in surgical melanoma management by understanding its association with melanoma thickness and other key clinical outcomes. This is a retrospective cohort study of 321 patients with primary head and neck cutaneous melanoma who were surgically treated at a single tertiary care center between 2012-2020. Clinicodemographic information was abstracted from patients' medical records. Patients' zip codes determined state-ranked ADI quartiles and rurality using Rural-Urban Commuting Area (RUCA) codes. Covariates included age, sex, race/ethnicity, and distance to hospital. Multivariable linear regression models assessed associations between ADI quartile and clinical outcomes, adjusting for demographic factors. This analysis included 321 patients. Patients in the most socioeconomically disadvantaged quartile (Q4) had, on average, 1.40 mm greater surgical Breslow thickness (95% CI 0.17-2.63, p = 0.026) and greater thickness discrepancy between biopsy and surgery (Estimate = +1.52 mm, 95% CI 0.54-2.50, p = 0.003) when compared to Q1 while adjusting for covariates. ADI Q4 was also independently associated with a 33% relative increase in time to surgery (95% CI 8%-65%, p = 0.008). The effect of ADI on tumor discrepancy persisted when adjusting for time to surgery and biopsy type (p = 0.006). Neighborhood socioeconomic disadvantage is associated with greater surgical tumor thickness, increased tumor discrepancy between biopsy and surgery, and modestly increased delay to definitive management. These findings suggest further biologic or access-related delays may be contributing to melanoma severity in socioeconomically disadvantaged populations.