Impact of rurality on processes and outcomes in melanoma care

Rural patients tend to have poorer cancer outcomes, compared to those living in urban areas. The impact of rurality on setting of melanoma excision and mortality was investigated in this whole-nation cohort study in Scotland. Linked data was used for every individual in Scotland diagnosed with melanoma between 2005-2013, in both primary and secondary care. A total of 9,519 patients were included, with a mean age of 60.2 years. Of melanomas where setting of excision was known, 90.3% were in secondary care and 8.1% were in primary care. The odds of primary care excision increased with increasing rurality/remoteness. Compared with those in urban areas, those in the most remote locations had almost twice the odds of melanoma excision in primary care. However, melanoma specific mortality was significantly lower in individuals residing in accessible small towns than in large urban areas, with no trend towards poorer survival with increasing rurality. These findings suggest that current guidelines on melanoma management could be revised to recognise the role of primary care in the prompt and effective diagnosis and treatment of those in rural locations.

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