ABSTRACT
Limited data describe the epidemiology and risk factors of acral lentiginous melanoma (ALM). In this retrospective analysis, we examined trends in incidence and mortality of ALM among racial and ethnic minoritized populations. We queried 22 Surveillance, Epidemiology, and End Results registries for cases of ALM among Hispanics, non-Hispanic Asians or Pacific Islanders (NHAPIs), non-Hispanic Blacks (NHBs), and non-Hispanic Whites (NHWs) from 2000 through 2020. Age-adjusted incidence and annual percentage changes (APCs) were estimated. Kaplan-Meier curves were stratified by race and ethnicity and compared with log-rank tests. Cox proportional hazard regression models were adjusted for age, sex, race, ethnicity, income, urban-rural residence, stage, and treatment. Of 4188 total cases of ALM with complete data, our study cohort was comprised of 792 (18.9%) Hispanics, 274 (6.5%) NHAPIs, 336 (8.0%) NHBs, and 2786 (66.5%) NHWs. The age-adjusted incidence of ALM increased by 2.48% (P < 0.0001) annually from 2000 to 2020, which was driven by rising rates among Hispanics (APC 2.34%, P = 0.001) and NHWs (APC 2.69%, P < 0.0001). Incidence remained stable among NHBs (APC 1.15%, P = 0.1) and NHAPIs (APC 1.12%, P = 0.4). From 2000 through 2020, 765 (18.3%) patients died from ALM. Compared to NHWs, Hispanics, NHAPIs, and NHBs had significantly increased ALM-specific mortality (all P < 0.0001). Unadjusted and adjusted cause-specific mortality modeling revealed significantly elevated risk of ALM-specific mortality among Hispanics (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.22-1.75; adjusted hazard ratio [aHR] 1.38, 95% CI 1.14-1.66), NHAPIs (HR 1.80, 95% CI 1.41-2.32; aHR 1.58, 95% CI 1.23-2.04), and NHBs (HR 1.98, 95% CI 1.59-2.47; aHR 2.19, 95% CI 1.74-2.76) (all P < 0.001). Our study finds rising incidence of ALM among Hispanics and NHWs along with elevated risk of ALM-specific mortality among racial and ethnic minoritized populations. Future strategies to mitigate health inequities in ALM are warranted.
Subject(s)
Melanoma , SEER Program , Skin Neoplasms , Humans , Incidence , Male , Female , SEER Program/statistics & numerical data , Middle Aged , Skin Neoplasms/mortality , Skin Neoplasms/ethnology , Skin Neoplasms/epidemiology , Retrospective Studies , Aged , United States/epidemiology , Adult , Melanoma/mortality , Melanoma/ethnology , Melanoma/epidemiology , Risk Factors , Hispanic or Latino/statistics & numerical data , Ethnicity/statistics & numerical data , Young Adult , Native Hawaiian or Other Pacific Islander/statistics & numerical data , Aged, 80 and overABSTRACT
Limited studies explore the role social determinants of health have on urban-rural health disparities, particularly for Skin of Color. To further evaluate this relationship, a cross-sectional study was conducted on data from five states using the 2018 to 2021 Behavior Risk Factor Surveillance Survey, a national state-run health survey. Prevalence of skin cancer history and urban/rural status were evaluated across these social determinants of health: sex, age, race, insurance status, number of personal healthcare providers, and household income. Overall, rural counterparts were significantly more likely to have a positive skin cancer history across most social determinants of health. Rural populations had a higher prevalence of skin cancer history across all races (P<.001). Rural non-Hispanic Whites had greater odds than their urban counterparts (OR=1.40; 95% CI 1.34 - 1.46). The odds were approximately twice as high for rural Black (OR=1.74; 95% CI 1.14 - 2.65), Hispanic (OR=2.31; 95% CI 1.56 - 3.41), and Other Race, non-Hispanic (OR=1.99; 95% CI 1.51 - 2.61), and twenty times higher for Asians (OR=20.46; 95% CI 8.63 - 48.54), although no significant difference was seen for American Indian/Alaskan Native (OR=1.5; 95% CI 0.99 - 2.28). However, when household income exceeded $100,000 no significant difference in prevalence or odds was seen between urban and rural settings. Despite increasing awareness of metropolitan-based health inequity, urban-rural disparities in skin cancer prevalence continue to persist and may be magnified by social determinants such as income and race. J Drugs Dermatol. 2024;23(6):480-484. doi:10.36849/JDD.8094.
Subject(s)
Health Status Disparities , Rural Population , Skin Neoplasms , Social Determinants of Health , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Cross-Sectional Studies , Healthcare Disparities/statistics & numerical data , Healthcare Disparities/ethnology , Prevalence , Rural Health/statistics & numerical data , Rural Population/statistics & numerical data , Skin Neoplasms/epidemiology , Skin Neoplasms/ethnology , United States/epidemiology , Urban Population/statistics & numerical data , Black or African American , Hispanic or Latino , WhiteSubject(s)
Leiomyosarcoma , Skin Neoplasms , Humans , Leiomyosarcoma/diagnosis , Leiomyosarcoma/pathology , Leiomyosarcoma/ethnology , Skin Neoplasms/diagnosis , Skin Neoplasms/ethnology , Skin Neoplasms/pathology , Male , Female , Middle Aged , Aged , Ethnicity/statistics & numerical data , Racial Groups/statistics & numerical data , Aged, 80 and overSubject(s)
Carcinoma, Basal Cell , Healthcare Disparities , Mohs Surgery , Skin Neoplasms , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma, Basal Cell/surgery , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/ethnology , Ethnicity/statistics & numerical data , Healthcare Disparities/ethnology , Healthcare Disparities/statistics & numerical data , Skin Neoplasms/surgery , Skin Neoplasms/ethnology , Skin Neoplasms/pathologySubject(s)
Carcinoma, Merkel Cell , Skin Neoplasms , Humans , Carcinoma, Merkel Cell/epidemiology , Carcinoma, Merkel Cell/pathology , Carcinoma, Merkel Cell/ethnology , Skin Neoplasms/epidemiology , Skin Neoplasms/pathology , Skin Neoplasms/ethnology , Retrospective Studies , Male , Female , Case-Control Studies , Aged , Middle Aged , Aged, 80 and overABSTRACT
INTRODUCTION: Melanoma guidelines stem largely from data on non-Hispanic White (NHW) patients. We aimed to identify features of melanoma within non-Hispanic Black (NHB) patients to inform strategies for earlier detection and treatment. METHODS: From 2004 to 2019 Surveillance, Epidemiology, and End Results (SEER) data, we identified nonmetastatic melanoma patients with known TN category and race. Kaplan-Meier cancer-specific survival (CSS) estimates and multivariable Cox proportional hazard modeling analyses were performed. RESULTS: Of 492 597 patients, 1499 (0.3%) were NHB, who were younger (21% vs. 17% age <50) and more commonly female (54% vs. 41%) than NHW, both p < 0.0005. For NHBs, lower extremity was the most common site (52% vs. 15% for NHWs, p < 0.0001), T category was higher (55% Tis-T1 vs. 82%; 27% T3-T4 vs. 8%, p < 0.0001) and stage at presentation was higher (19% Stage III, vs. 6%, p < 0.0001). Within the NHB cohort, males were older, and more often node-positive than females. Five-year Stage III CSS was 42% for NHB males versus 71% for females, adjusting for age and clinical nodal status (hazard ratio 2.48). CONCLUSIONS: NHB melanoma patients presented with distinct tumor characteristics. NHB males with Stage III disease had inferior CSS. Focus on this high-risk patient cohort to promote earlier detection and treatment may improve outcomes.
Subject(s)
Black or African American , Melanoma , SEER Program , Skin Neoplasms , Humans , Melanoma/pathology , Melanoma/mortality , Melanoma/therapy , Melanoma/ethnology , Male , Female , Middle Aged , Skin Neoplasms/pathology , Skin Neoplasms/mortality , Skin Neoplasms/therapy , Skin Neoplasms/ethnology , Survival Rate , Black or African American/statistics & numerical data , Aged , Adult , Prognosis , Follow-Up StudiesSubject(s)
Alaska Natives , Melanoma , SEER Program , Skin Neoplasms , Humans , Melanoma/epidemiology , Melanoma/ethnology , Female , SEER Program/statistics & numerical data , Skin Neoplasms/epidemiology , Skin Neoplasms/ethnology , Retrospective Studies , Male , Alaska Natives/statistics & numerical data , Middle Aged , United States/epidemiology , Aged , Sex Factors , Adult , Indians, North American/statistics & numerical data , Sex DistributionSubject(s)
Asian , Health Inequities , Melanoma , Native Hawaiian or Other Pacific Islander , Skin Neoplasms , Humans , Asian/statistics & numerical data , Melanoma/diagnosis , Melanoma/ethnology , Melanoma/mortality , Melanoma/pathology , Skin Neoplasms/diagnosis , Skin Neoplasms/ethnology , Skin Neoplasms/mortality , Skin Neoplasms/pathology , Native Hawaiian or Other Pacific Islander/statistics & numerical data , United States/epidemiology , Survival AnalysisABSTRACT
This cohort study investigates patterns in melanoma detection in racial and ethnic minority populations as part of a large, primary carebased screening initiative.
Subject(s)
Melanoma , Skin Neoplasms , Humans , American Indian or Alaska Native , Early Detection of Cancer , Hispanic or Latino , Melanoma/diagnosis , Melanoma/ethnology , Pacific Island People , Skin Neoplasms/diagnosis , Skin Neoplasms/ethnology , United States , Asian , Black or African AmericanABSTRACT
Syder NC, Elbuluk N. rising interest in sunscreen for skin of color: an analysis of Google trends. J Drugs Dermatol. 2023;22(7):712-713. doi:10.36849/JDD.7373.
Subject(s)
Skin Neoplasms , Sunscreening Agents , Humans , Search Engine , Skin , Skin Neoplasms/drug therapy , Skin Neoplasms/ethnology , Skin Neoplasms/prevention & control , Skin PigmentationABSTRACT
The various presentations of many dermatologic conditions among various skin types are slowly being elucidated throughout the recent years. These differences present as an issue as it leads to delayed diagnosis, treatment, and poorer quality of life. Herein, we present the characteristics of leukemia cutis in a skin of color patient with diagnosed chronic myelomonocytic leukemia. Adjei S, Temiz LA, Miller AC, et al. Leukemia cutis in skin of color. J Drugs Dermatol. 2023;22(7):687-689. doi:10.36849/JDD.7020.
Subject(s)
Leukemia , Skin Neoplasms , Humans , Leukemia/diagnosis , Quality of Life , Skin , Skin Neoplasms/diagnosis , Skin Neoplasms/ethnology , Skin Neoplasms/therapy , Skin PigmentationABSTRACT
BACKGROUND: Asian American and Pacific Islander (AAPI) melanoma patients have higher mortality than non-Hispanic White (NHW) patients. Treatment delays may contribute, but whether AAPI patients have longer time from diagnosis to definitive surgery (TTDS) is unknown. OBJECTIVES: Investigate TTDS differences between AAPI and NHW melanoma patients. METHODS: Retrospective review of AAPI and NHW melanoma patients in the National Cancer Database (NCD) (2004-2020). The association of race with TTDS was evaluated by multivariable logistic regression, controlling for sociodemographic characteristics. RESULTS: Of 354,943 AAPI and NHW melanoma patients identified, 1155 (0.33%) were AAPI. AAPI patients had longer TTDS for stage I, II, and III melanoma (P < .05 for all). Adjusting for sociodemographic factors, AAPI patients had 1.5 times the odds of a TTDS between 61 and 90 days and twice the odds of a TTDS >90 days. Racial differences in TTDS persisted in Medicare and private insurance types. Uninsured AAPI patients had the longest TTDS (mean, 53.26 days), while those with private insurance had the shortest TTDS (mean, 34.92 days; P < .001 for both). LIMITATION: AAPI patients comprised 0.33% of the sample. CONCLUSIONS: AAPI melanoma patients have increased odds of treatment delays. Associated socioeconomic differences should inform efforts to reduce disparities in treatment and survival.
Subject(s)
Asian , Health Services Accessibility , Melanoma , Pacific Island People , Skin Neoplasms , Time-to-Treatment , Aged , Humans , Asian/statistics & numerical data , Cross-Sectional Studies , Medicare/statistics & numerical data , Melanoma/epidemiology , Melanoma/ethnology , Melanoma/therapy , United States/epidemiology , Skin Neoplasms/epidemiology , Skin Neoplasms/ethnology , Skin Neoplasms/therapy , Health Services Accessibility/statistics & numerical dataABSTRACT
Cutaneous malignant melanomas of the head and neck (HNM) are proposed to have notable histological and clinical differences from those at other sites (other melanoma); however, HNMs among Asians have remained poorly understood. This study aimed to investigate the clinicopathological features and prognostic factors of HNM in Asians. Asian melanoma patients who underwent surgical treatment from January 2003 to December 2020 were retrospectively reviewed. The clinicopathological features and risk factors for local recurrence, lymph node metastasis, and distant metastasis were analyzed. Among 230 patients, 28 (12.2%) were diagnosed with HNM, and 202 (87.8%) with other melanoma. The histologic subtype significantly differed as the nodular type was predominant in HNM whereas the acral lentiginous type was predominant in other melanoma ( P â <â 0.001). HNM was significantly associated with higher local recurrence ( P â =â 0.045), lymph node metastasis ( P â =â 0.048), distant metastasis ( P â =â 0.023), and lower 5-year disease-free survival ( P â =â 0.022) than other melanoma. Ulceration was the risk factor for lymph node metastasis based on multivariable analysis ( P â =â 0.013). A high proportion of HNM present as the nodular subtype in Asians, leading to poor outcomes and low survival. Therefore, more cautious surveillance, evaluation, and aggressive treatment are required.
Subject(s)
Asian , Head and Neck Neoplasms , Melanoma , Skin Neoplasms , Humans , Asian/statistics & numerical data , Head and Neck Neoplasms/ethnology , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/surgery , Lymphatic Metastasis , Melanoma/ethnology , Melanoma/mortality , Melanoma/pathology , Melanoma/surgery , Neoplasm Staging , Prognosis , Retrospective Studies , Skin Neoplasms/ethnology , Skin Neoplasms/mortality , Skin Neoplasms/pathology , Skin Neoplasms/surgery , Skin Ulcer/ethnology , Skin Ulcer/etiology , Melanoma, Cutaneous MalignantABSTRACT
[We have not prepared an abstract for the editorial but we can do so if required.].
Subject(s)
Melanoma , Skin Neoplasms , Humans , Incidence , Melanoma/epidemiology , Melanoma/ethnology , Skin Neoplasms/epidemiology , Skin Neoplasms/ethnology , South Africa/epidemiology , White PeopleABSTRACT
PURPOSE: Acral lentiginous melanoma (ALM), a relatively rare subtype of cutaneous melanoma, has been reported to have a worse prognosis than other melanomas. We aimed to assess clinical findings in Caucasian ALM patients and compare the data with a matched cohort of superficial spreading melanoma (SSM) patients. METHODS: We studied 63 patients with ALM and 63 randomly stage- and limb-matched patients with SSM (non-ALM). In both cohorts, guideline-adjusted diagnosis, treatment and follow-up were performed. RESULTS: We did not observe differences in prognostic factors (e.g., tumor thickness, ulceration) between the two cohorts. Both in ALM and non-ALM patients positive sentinel lymph node was a significant independent predictor for disease relapse and melanoma-specific death. However, disease relapse and melanoma-specific death rates did not significantly differ between ALM and non-ALM patients. An overall 5-year melanoma-specific survival of 82.5% and 81% was observed in ALM and non-ALM patients, respectively. CONCLUSIONS: Our data confirm that patients with ALM have no worse outcome than non-ALM patients when correcting for significant prognostic factors. Hence, the reportedly high rates of fatal ALM cases should not be ascribed to pathobiological differences between ALM and non-ALM but are most likely are a consequence of a delay in diagnosis and thus advanced stage of ALM.