Greater socioeconomic disadvantage associated with delays in Merkel cell carcinoma treatment

Summary: Abstract Body: Delayed surgery may worsen the prognosis for cutaneous Merkel cell carcinoma (MCC). The impact of socioeconomic (SE) status on treatment delays and survival has not been studied for MCC. We identified MCC patients treated at a single tertiary medical center (2006-2022). SE status was assessed using the Area of Deprivation Index (ADI), with higher scores correlating to more SE disadvantage. Patients were categorized into two groups using our cohort’s median ADI score (group 1: =<50th percentile, group 2: >50th percentile). The primary outcome was the impact of socioeconomic (SE) status on time to surgery (TTS), the number of days from diagnostic biopsy to surgical excision with wide local excision or Mohs micrographic surgery. Secondary outcomes were identifying factors affecting survival and recurrence. Wilcoxon Rank-Sum test assessed differences between the two ADI cohorts. Multivariate analysis evaluated characteristics associated with >4 week TTS, including gender, age, race, ethnicity, ADI group, stage of MCC, type of surgical treatment, and Sentinel Lymph Node Biopsy(SLNB). Cox multivariable hazard model included the same factors to find independent predictors for overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS). 190 MCC patients were included with a median follow-up of 3.62 years (SD:3.51). Median ADI was 31.5 (IQR:18.25-47). TTS was longer in patients with greater ADI (42 days, SD:35) than lower ADI (32 days, SD:14) (p=0.023). Female gender (OR:2.56, CI:1.20-5.65, p=0.017) and having ADI >50th percentile (OR:2.94, CI:1.42-6.34, p=0.005) predicted TTS >4 weeks on multivariate. Controlling for demographic factors, stage, and treatment, ADI was not an independent predictor of OS, DSS, or RFS. However, TTS >4 weeks (HR:1.65, CI:1.03-2.65, p=0.039) put patients at higher risk of recurrence. Greater SE disadvantage can delay MCC care by >a week. This delay in care may affect RFS. Further study is needed to better understand this relationship and address this disparity. Stephanie Y. Wang¹, Karla L. Valdes Morales¹, Emily R. Hunter¹, Jeremy R. Etzkorn¹, Christopher J. Miller¹, H. William Higgins 2nd¹ 1. Dermatology, University of Pennsylvania, Philadelphia, PA, United States. Minoritized Populations and Health Disparities Research