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Mohs Surgery for Skin Cancer: Impact of Insurance Type on Tumor Diameters

By: Jenna Carter, PhD
Posted: Thursday, August 18, 2022

Wait times, shortage of dermatologists, and cost and availability of insurance are just a few factors that may limit dermatologic care in patients with non-melanoma skin cancer. A recent article published in JAMA Dermatology reported findings from a study investigating the association of one of these factors—insurance type—on tumor and treatment characteristics among patients undergoing Mohs micrographic surgery. Emily L. Clarke, MD, of Dell Medical School at The University of Texas at Austin, and colleagues compared preoperative and postoperative tumor characteristics based on insurance type; they found that uninsured and underinsured patients had larger preoperative and postoperative tumor sizes compared with privately insured patients.

“Insurance type is associated with increased stage at presentation, differences in treatment, and delays in care for patients with melanoma and other noncutaneous cancers…. [Here, we] assess whether tumor and treatment characteristics differ based on insurance type…because there has been little research investigating this association,” stated Dr. Clarke and colleagues.

A total of 1,397 patients were included in this retrospective study. Mohs micrographic surgery was performed in 1,916 patients, 868 (45%) of whom had Medicare, 570 (30%) had private insurance, 299 (16%) had VA insurance, and 179 (9%) of whom were treated at a safety net clinic or were uninsured. Patient demographic information, tumor characteristics, and treatment details were collected and compared with treatment outcomes.

A multiple regression analysis revealed a significant association between insurance type and preoperative tumor bed diameter (P < .001) and postoperative defect size (P < .001), after controlling for tumor type, patient age, tumor location, and high-risk status. Additionally, uninsured and underinsured patients had significantly larger preoperative tumor bed diameters (difference, 28%; 95% confidence interval [CI] = 14%–43%; P < .001) and postoperative defect sizes (difference, 28%; 95% CI = 16%–41%; P < .001) compared with patients who had private insurance.

Disclosure: The study authors reported no conflicts of interest.


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