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Area of Science:

  • Dermatology
  • Oncology
  • Public Health

Background:

  • Skin cancer incidence is increasing globally.
  • National treatment trends for skin cancer in lighter- and darker-skinned populations remain understudied.
  • Understanding disparities in skin cancer treatment is crucial for equitable care.

Purpose of the Study:

  • To analyze trends in procedural skin cancer treatments.
  • To compare treatment trends between lighter-skinned (Skin Color Ethnicity [SCE] I–III) and darker-skinned (SCE IVa–VI) patients.
  • To identify changes in the utilization of Mohs micrographic surgery (MMS), wide local excision (WLE), and destructive treatments.

Main Methods:

  • Utilized Optum's Clinformatics Data Mart Database (2011-2022).
  • Identified patients based on skin color ethnicity (SCE I–III for lighter, SCE IVa–VI for darker).
  • Analyzed treatment trends using Current Procedural Terminology codes for MMS, WLE, and destructive procedures, linked with ICD codes for basal cell carcinoma, squamous cell carcinoma, melanoma, and Merkel cell carcinoma. Employed Mann-Kendall and Joinpoint analyses to assess temporal trends and average annual percent changes (AAPCs).

Main Results:

  • Included 1,625,367 adult patients and 4,184,496 skin cancer treatments.
  • Annual MMS frequency increased significantly from 2011-2022 for both groups: 53.9% for darker-skinned (AAPC 3.89%) and 46.7% for lighter-skinned patients (AAPC 3.86%).
  • Rates of WLE and destructive skin cancer treatments decreased for both lighter- and darker-skinned populations (p < .001).

Conclusions:

  • Mohs micrographic surgery utilization is increasing over time for both lighter- and darker-skinned patients.
  • The trend suggests a growing preference for MMS across diverse skin tones.
  • Further research may explore reasons for these shifts and their impact on patient outcomes.