The ongoing racial disparities in melanoma: An analysis of the Surveillance, Epidemiology, and End Results database (1975-2016)

Abstract

Background: Although most patients with cutaneous melanoma are non-Hispanic whites (NHWs), minorities consistently suffer worse melanoma-specific survival (MSS). Much of the literature comes from analyses of registries from the 1990s and 2000s.

Objective: We sought to evaluate whether and to what degree racial disparity in MSS persists since 2010.

Methods: We analyzed 381,035 patients from the Surveillance, Epidemiology, and End Results registry. Race categories included Hispanic, NHW, non-Hispanic black (NHB), non-Hispanic Asian or Pacific Islander (NHAPI), and non-Hispanic American Indian/Alaska Native (NHAIAN). We evaluated the association between MSS and race in 3 time periods: before the year 2000, 2000 to 2009, and 2010 or later. NHW was the reference group for all analyses.

Results: Racial disparity worsened from before the year 2000 to 2010 or later for Hispanic (P < .001), NHB (P = .024), and NHAPI (P < .001) patients. Across all minority groups, patients with localized disease suffered increasing disparity (P = .010 for Hispanic, P < .001 for NHB, P = .023 for NHAPI, and P = .042 for NHAIAN patients). Among those with regional and distant disease, Hispanic patients were the only minority to experience worsening disparity (P = .001 and P = .019, respectively).

Limitations: Lack of immunotherapy and targeted treatment information.

Conclusions: Racial disparity in MSS is worsening. Improving postdiagnosis management for minorities with localized disease is imperative to mitigate disparity and improve survival.

Keywords: SEER; disparities; melanoma; race/ethnicity; survival.

Fig 1.

Estimated survival curves for melanoma-specific survival in different racial groups from the Surveillance, Epidemiology, and End Results cohort and stratified by year of diagnosis. P values were estimated by log-rank test comparing survival outcomes for each racial group in the diagnosis period. NHAIAN, non-Hispanic American Indian/Alaska Native; NHAPI, non-Hispanic Asian or Pacific Islander; NHB, non-Hispanic black; NHW, non-Hispanic white.

Fig 2.

Trend of adjusted hazard ratios (HRs) for melanoma-specific survival (MSS) of minorities to non-Hispanic whites along years of melanoma diagnosis in the Surveillance, Epidemiology, and End Results cohort. Adjusted HRs were calculated from multivariable Cox proportional hazard models, adjusting for racial groups, age, gender, primary site, histologic subtype, and stage. The same model was performed for samples of melanoma patients diagnosed in each year. The adjusted HRs of each minority group to non-Hispanic whites are presented on the Y axis and the diagnosis year is presented on the X axis (dots). Loess curves were estimated for the adjusted HRs along years of diagnosis for each racial group. NHAIAN, Non-Hispanic American Indian/Alaska Native; NHAPI, non-Hispanic Asian or Pacific Islander; NHB, non-Hispanic black.