Disparity in Melanoma

Abstract

Main Outcome Measures: Age-adjusted melanoma incidence and stage at diagnosis. Results: Of 41 072 cases of melanoma, 39 670 cases were reported for white non-Hispanics (WNHs), 1148 for white Hispanics (WHs), and 254 for blacks. Melanoma incidence rates increased by 3.0% per year among WNH men (PϽ .001), 3.6% among WNH women (PϽ .001), 3.4% among WH women (P = .01), and 0.9% among WH men (P =.52), while remaining relatively stable among black men and women. Both WHs and blacks had significantly more advanced melanoma at presentation: 18% of WH and 26% of black patients had either regional or distant-stage melanoma at diagnosis compared with 12% of WNH patients. The proportion of distant-stage melanoma diagnosed among WHs and blacks changed little from 1990 to 2004, compared with a steady decrease in the percentage of melanoma cases diagnosed at distant stage among WNHs (PϽ .001). Such differences in the time trends of the proportion of distant-stage melanoma remained after excluding in situ cases. Conclusions: The rising melanoma incidence among WNHs and WHs emphasizes the need for primary prevention. The persistence of disparity in melanoma stage at diagnosis among WHs, blacks, and WNHs warrants closer examination of secondary prevention efforts in minority groups.

Disparities in the Presentation and Management of Cutaneous Melanoma That Required Admission

“…In the multivariate model, there was no significant disparity in nodal metastasis among the different racial groups. This underlines the disagreement between our study and most of the studies conducted on populations from United States in which there was minimal or no control for confounders [30, 31, 34]. However, a study by Cormier et al [36], using the SEER data, found that Hispanics and African-Americans were more likely to present with advanced stage melanoma compared to Whites [36].…”

Preliminary Evidence for Mediation of the Association Between Acculturation and Sun-Safe Behaviors

“…52, 53 A recent report revealed that between 1992–2004 melanoma incidence doubled across all SES strata, with the lowest SES groups exhibiting the highest increase and the sharpest rise in tumor thickness. 54 Because the number Latinos have risen, and Latinos have disproportionate representation among low SES strata, 42 and increased rates of advanced-stage melanoma at diagnosis, 6, 7, 55 the public health effect of their skin cancer-related behaviors is likely to intensify, especially as this population continues to expand. Our results, denoting variability in the mediation mechanisms for different sun-safe behaviors, could guide primary prevention program development for Latinos and future public health research.…”

“…5 In addition, Latinos exhibit persistently higher rates of thick melanoma at diagnosis compared with non-Latino whites. 6,7 …”

Rare Presentations of Primary Melanoma and Special Populations

“…92 Recently, Hu and colleagues found that 18% of Hispanics and 26% of African Americans presented with regional or distant disease, compared to 12% of Caucasian patients. 23 Additionally mean Breslow thickness for Caucasians was 1.62 mm versus 2.59 mm for non-Caucasians; while the acral lentiginous subtype comprised 6/33 (18.1%) of the non-Caucasian patients with melanoma. 93 Socioeconomic factors, language barriers, and health care system factors have also been surmised as contributing to delayed presentation and influencing survival in ethnic minorities.…”

“…23,24 Because of the general lack of accessibility and late presentation, prognosis is generally poor, with a 5-year survival rate of <50% for vulvar and <18% for vaginal melanomas. 25 Again noted is the extreme rare occurrence of BRAF mutations in the female genital tract variant.…”