Urban-rural differences in survival from cutaneous melanoma in Queensland

Objective: To assess how much of the urban-rural disparity in melanoma survival in Queensland is due to later diagnosis. Methods: Data were obtained from the population-based Queensland Cancer Registry. We used incident cases for the six years 1996 to 2001 with follow-up to the end of 2002, so that all patients were followed for at least 12 months with a median follow-up time of 41 months. Cox regression models were used to compare urban versus rural case-fatality rates, after adjusting for thickness, level, subsite, age and sex. Results: The adjusted case-fatality rate was 20% higher in rural versus urban areas (hazard ratio 1.20, 95% Cl 1.02-1.43). Conclusions: There is some characteristic of living in an urban area, other than earlier diagnosis, that improves melanoma survival. In the first instance, differences in access to services and variation in management practices deserve investigation and exclusion.