The role of accessibility policies and other determinants of health care provision in the initial prognosis of malignant melanoma: a cross-sectional study.

Background The prognostic benefit of health care service provision and delivery policies for patients with malignant melanoma (MM) is not yet clear. Objective To analyze the role of health care provision determinants in the initial prognosis of MM. Methods A multicenter cross-sectional study was conducted at 14 public hospitals and recruited 3550 patients with MM between 2000 and 2009. The study variables were analyzed using univariate and multivariate models to identify their role in the variations observed. Results In a 10-year period, the number of patients with MM increased by 78.54%, with primary in situ MM (Tis) or MMs with a Breslow thickness P  = .005). Among the variables that explained the variation in MM frequency the year of diagnosis after 2004 (univariate odds ratio [OR], 1.43 [ P P  = .005]) and diagnosis in centers with specific fast-track referral systems (univariate OR, 1.24 [ P  = .01]; multivariate OR, 1.59 [ P  = .025]) were shown to explain the increasing frequency of Tis-T1 MM. Limitations The primary potential limitation of this study is its retrospective nature. Conclusion Health care provision policies and interventions aimed at improving accessibility to specialized care appear to explain the increasing frequency of Tis-T1 MM.