Impact of Demographics on Early-Stage vs. Stage IV Diagnosis in Amelanotic Melanoma: An Analysis of the National Cancer Database

Abstract

Introduction Amelanotic melanoma (AM) is a rare form of melanoma that lacks pigment. Although curable when diagnosed early, it is often missed or mistaken for other benign conditions. There has not been a study investigating the impact of demographic features on the diagnosis of stage 0-I (early-stage) versus stage IV AM. Objective This study addresses a gap in knowledge regarding demographic factors that influence the odds of early-stage vs. stage IV diagnosis of AM. Methods This study identified 684 patients from the National Cancer Database who were diagnosed with early-stage AM or stage IV AM from 2004 to 2020 and compared them based on age, sex, race, insurance, income, education, insurance status, rurality, facility type, geographic region, and Charleson-Deyo score. Socioeconomic and demographic features of patients with early-stage and stage IV were compared using the chi-squared test, the independent t-test, and multivariate logistic regression. Statistical significance was set at α = 0.05. Results Most cases analyzed were White (98.5%), male (57.7%), and lived in a metropolitan setting (86.7%). Males made up most of the early-stage and stage IV groups (55.0% vs. 45% and 66.5% vs. 33.5%, respectively, p < 0.05). Younger age is associated with decreased odds of stage IV disease (OR = 0.973, 95% CI = 0.952-0.993, p < 0.05). In addition, the female sex is associated with decreased odds of stage IV disease (OR = 0.584, 95% CI = 0.381-0.897, p < 0.05). Conclusions Age and sex are two variables that influence the odds of stage IV diagnosis in patients with AM, which is strongly associated with worse survival outcomes.

Keywords: amelanotic melanoma; cutaneous malignant melanoma; demographic factors; early identification and diagnosis; health disparity; late diagnosis; metastatic skin cancer; ­skin cancer.