Melanoma is an increasingly common, and often fatal form of skin cancer for which the substantial prognostic advantages of early detection and treatment. Preliminary evidence suggests that people of low socioeconomic status may have particularly poor survival from melanoma, perhaps because there is a tendency for the cancer to be detected and treated at a more advanced stage in these people. We propose to study the relationship of socioeconomic status to melanoma detection, survival and mortality in a recent case-control study in Connecticut. This is a rich, unique data set for such analyses, because the study is population-based with rapid case ascertainment, includes a comprehensive assessment of risk factors as well as self-screening, health care use, and other factors related to detection of melanoma, and it has on-going follow-up of cases for vital status and recurrence of the cancer. With assignment of socioeconomic status based on education, occupation, and composite indices, we will determine whether cases of lower socioeconomic status have more late stage melanoma or thicker lesions at diagnosis and whether they have more recurrence of the cancer or poorer survival compared to cases of higher socioeconomic status. Subsequently, we will evaluate the extent to which such differences are related to patients' behavioral, medical, and other characteristics, including knowledge of melanoma, frequency of skin self- examinations or examinations by medical personnel, or access to and use of health care services. This research directly addresses several of the high priority research needs for cancer control science in Health People 2000. The results will have important implications for detection and control of cutaneous melanoma, and should help shape future efforts to limit melanoma mortality.
