Date of Award

January 2018

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Suguru Imaeda

Second Advisor

Oscar Colegio


The overall melanoma mortality rate amongst whites (the population overwhelmingly affected by melanoma) has remained deceptively stable during the past 30 years. Population-based screening is one potential strategy for reducing melanoma mortality. We evaluated the need for a primary care (PCP)-based melanoma early detection program targeting those at greatest risk of melanoma death. Using Surveillance, Epidemiology and End Results (SEER) data, we collected detailed U.S. melanoma incidence and mortality rates. We analyzed health care utilization data from the National Ambulatory Care Medical Survey (NAMCS) and Medical Expenditure Panel Survey (MEPS) to explore opportunities to reduce mortality. We reviewed screening studies and mass media healthcare campaigns to identify necessary components for an early detection initiative. From 1983 to 2013, melanoma incidence rates more than tripled and mortality rates increased 57% among white men ≥50. White men diagnosed at age ≥50 made up 56% of all fatal melanoma cases from 2009-2013. The sharpest increase in mortality rates in men occurred around 50 years of age from all tumor thickness categories. Of the 38 million white men in the U.S aged ≥50, approximately 26 million made 76 million visits to a PCP in 2014. Recent skin cancer screening initiatives demonstrate improvements in early detection. This data suggests that there is an urgent need and ample evidence to initiate targeted melanoma screening programs in white men aged 50 and older.


This thesis is restricted to Yale network users only. It will be made publicly available on 06/25/2100