Early detection of melanoma is associated with improved prognosis, yet melanoma population screening is not routinely recommended in Australia. Instead, physician-led skin checks largely occur through opportunistic or patient-initiated pathways. Understanding which groups are less likely to undergo skin checks prior to diagnosis may help identify inequities in access to early detection.
We analysed data from a Queensland cohort of patients diagnosed with high-risk primary melanoma (T1b–T4b). Participants reported whether they had undergone a physician-led skin check in the five years prior to diagnosis. Sociodemographic, geographic, educational, occupational, and melanoma history factors were examined using logistic regression. Univariable and multivariable models were used to estimate odds ratios (OR).
Among 699 participants with available outcome data, 555 (79%) reported at least one physician-led skin check in the five years prior to diagnosis, while 144 (21%) reported none. The final multivariable model included 681 complete cases.
Participants aged ≥70 years had higher odds of physician-led skin checks compared with those aged <55 years (aOR 1.83, 1.03-3.27). Male participants had lower odds of reporting at least one physician-led skin check than female participants (aOR 0.76, 0.46-1.26). Participants residing in outer regional or remote areas had substantially lower odds of physician-led skin checks than those living in major cities (aOR 0.41, 0.23-0.70).
Educational attainment was also associated with physician-led skin checks. Compared with participants with school-only education, those with university education had significantly higher odds of ever undergoing physician-led skin checks prior to melanoma diagnosis (aOR 2.15, 95% CI 1.05–4.41). Participants with diploma or trade qualifications also had higher odds of skin checks than those with school-only education.
One in five participants with high-risk melanoma reported no physician-led skin examinations in the five years prior to diagnosis. Lower engagement was observed among people living in regional or remote areas and those with lower educational attainment, highlighting persistent geographic and socioeconomic inequities in access to early detection. Strategies to improve targeted skin surveillance in high-risk populations, including those outside major cities or with lower educational attainment, may help reduce disparities in melanoma screening and outcomes.