Demographic Characteristics and Management of Uninsured Patients with a History of Melanoma

Aims and Objectives: Patients diagnosed with malignant melanoma often undergo regular follow-up care and skin checks to reduce the likelihood of recurrence. Yearly exams are more inconsistent and likely to be missed due to a lack of healthcare access and resources among the uninsured population. This study determined demographic characteristics of uninsured patients with a history of malignant melanoma. Follow-up was assessed in order to improve and ensure the highest quality of long-term care. Methods: Demographics and chronic disease diagnoses were extracted from 8,857 patients managed at eight free-clinics from the Tampa Bay Area during 2016 and 2017. Patients diagnosed with malignant melanoma were specifically chosen for further chart review. A retrospective analysis of the follow-up care and health outcomes are reported. Results: A total of 200 of 8,857 reported a history of malignancy; ten patients (5%) were diagnosed with malignant melanoma. The average age of these patients was 52-years-old, 70% (N=7) of whom were female. Initial treatment for 2 patients (20%) was surgical excision. Remaining patients were either observed (N=2) or did not mention treatment to their free clinic provider (N=6). Postoperative follow-up for recurrent lesions varied between patients but a commonly cited reason that prevented proper follow-up with a dermatologist in eight of the ten patients (80%) was financial restraint. Conclusions: Free-clinics should be cognizant of local dermatologists who provide subsidized services to those in need due to the higher prevalence of melanoma among the uninsured. Patients should also be directed to free clinics immediately after surgery to receive recommended follow-up skin checks. With education, free-clinics can deliver higher quality dermatology management to patients by following recommended standard