Incidence and thickness of primary tumours and survival of patients with cutaneous malignant melanoma in relation to socioeconomic status

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Abstract
Objective: To study incidence of and survival from cutaneous malignant melanoma in relation to socioeconomic status. Design: Application of Carstairs deprivation score to all malignant melanoma patients diagnosed in a geographically defined area over a 15 year period. Setting: West of Scotland (area population 2 716 900). Subjects: 3142 patients first diagnosed with malignant melanoma in the period 1979-93. Interventions: Surgical excision of primary malignant melanoma with additional treatment as appropriate and follow up until December 1994. Main outcome measures: Malignant melanoma incidence, primary tumour thickness and five year survival by socioeconomic status Results: From 1979 to 1993, the age standardised incidence rate for cutaneous malignant melanoma was 9.1/100000 for the most affluent men and 2.4/100000 for the least affluent men and 16.1/100000 and 5.0/100000 respectively for most and least affluent women (PConclusion: Although the incidence of cutaneous malignant melanoma is higher among more affluent people, the prognosis is better in this group than for less affluent individuals. Early diagnosis campaigns should be targeted particularly to less affluent men and primary prevention campaigns should emphasise the greater risk in more affluent women. Key messages Paradoxically, five year disease free survival prospects are better for affluent people Variations in incidence could be explained by differences in sun exposure related to socio- economic status Variations in nutrition and possibly immune function by socioeconomic status could explain survival differences In public education campaigns, deprived men should be targeted to encourage earlier diagnosis Primary prevention campaigns should be tar- geted to more affluent socioeconomic groups