{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T11:25:52Z","timestamp":1787397952812,"version":"build-2736575974"},"reference-count":26,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To characterize the role of neighborhood\u2010level disadvantage measured via Area Deprivation Index (ADI) in surgical melanoma management by understanding its association with melanoma thickness and other key clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective cohort study of 321 patients with primary head and neck cutaneous melanoma who were surgically treated at a single tertiary care center between 2012\u20132020. Clinicodemographic information was abstracted from patients' medical records. Patients' zip codes determined state\u2010ranked ADI quartiles and rurality using Rural\u2013Urban Commuting Area (RUCA) codes. Covariates included age, sex, race\/ethnicity, and distance to hospital. Multivariable linear regression models assessed associations between ADI quartile and clinical outcomes, adjusting for demographic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This analysis included 321 patients. Patients in the most socioeconomically disadvantaged quartile (Q4) had, on average, 1.40\u2009mm greater surgical Breslow thickness (95% CI 0.17\u20132.63,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026) and greater thickness discrepancy between biopsy and surgery (Estimate\u2009=\u2009+1.52\u2009mm, 95% CI 0.54\u20132.50,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003) when compared to Q1 while adjusting for covariates. ADI Q4 was also independently associated with a 33% relative increase in time to surgery (95% CI 8%\u201365%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008). The effect of ADI on tumor discrepancy persisted when adjusting for time to surgery and biopsy type (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Neighborhood socioeconomic disadvantage is associated with greater surgical tumor thickness, increased tumor discrepancy between biopsy and surgery, and modestly increased delay to definitive management. These findings suggest further biologic or access\u2010related delays may be contributing to melanoma severity in socioeconomically disadvantaged populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>3<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70851","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T11:18:30Z","timestamp":1787397510000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Neighborhood Deprivation With Breslow Thickness in Head and Neck Cutaneous Melanoma"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8387-7321","authenticated-orcid":false,"given":"Evan A.","family":"Thomas","sequence":"first","affiliation":[{"name":"University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Dermatology University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaz L.","family":"Stucken","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly L.","family":"Harms","sequence":"additional","affiliation":[{"name":"Department of Dermatology University of Michigan Medical School  Ann Arbor Michigan USA"},{"name":"Rogel Cancer Center University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A.","family":"McLean","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly E.","family":"Heft Neal","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly M.","family":"Malloy","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W. A.","family":"Forner","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,22]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2022.06.1190"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000004135"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055\u20109965.EPI\u201022\u20101167"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.70069"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdin.2024.05.011"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.30832"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1802313"},{"key":"e_1_2_11_9_1","unstructured":"University of Wisconsin School of Medicine and Public Health \u201cArea Deprivation Index v4.0 \u201d2020 accessed October 22 2025 https:\/\/www.neighborhoodatlas.medicine.wisc.edu\/."},{"key":"e_1_2_11_10_1","unstructured":"U.S. Department of Agriculture Economic Research Service \u201c2020 Rural\u2010Urban Commuting Area Codes \u201dJuly 2025."},{"key":"e_1_2_11_11_1","unstructured":"\u201cUW RHRC Rural Urban Commuting Area Codes \u2013 RUCA \u201daccessed October 22 2025 https:\/\/depts.washington.edu\/uwruca\/?utm_source=chatgpt.com."},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2023.04.019"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2025.0311"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885\u2010015\u20101972\u20108"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph192214916"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.25540"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2018.0233"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26706"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.5457"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2024.42.16_suppl.1593"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.143.4.488"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/1203475419870177"},{"key":"e_1_2_11_23_1","unstructured":"S. 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