Marital status and its association with vulvar melanoma outcomes

To evaluate the association between marital status and clinical presentation, treatment, and survival in vulvar melanoma.

We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results Program (2000-2022). Overall survival and disease-specific survival were estimated using the Kaplan-Meier method. Multi-variable Cox and Fine-Gray models were used to assess the association between marital status and disease-specific survival.

A total of 1291 patients were included (645 married, 646 unmarried). Unmarried patients were more likely to present with distant-stage disease (9.4% vs 6.2%, p = .011), less likely to undergo surgery (89.2% vs 94.3%, p = .001), and more likely to receive radiation (10.5% vs 7.3%, p = .041). Five-year disease-specific survival was lower in unmarried patients (48.61% vs 62.42%; log-rank p < .001). In multi-variable analyses, unmarried status was associated with lower disease-specific survival (adjusted hazard ratio 1.24, 95% confidence interval 1.03 to 1.50, p = .026), with the poorest outcomes observed among widowed patients (adjusted hazard ratio 1.35, 95% confidence interval 1.06 to 1.72, p = .013).

Unmarried patients with vulvar melanoma were more likely to present with advanced disease and were less likely to undergo surgery. Unmarried status, particularly widowhood, was associated with lower disease-specific survival, suggesting disparities in the care pathway and the need to improve equitable access to care.