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Are There Racial Differences in Time to Treatment for Melanoma?


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Black patients with stage I to III melanoma are likely to experience a longer delay from diagnosis to surgery than non-Hispanic white patients, according to a study published by Tripathi et al in the Journal of the American Academy of Dermatology.

“We already knew that black patients with melanoma have a worse prognosis and that longer time to treatment is associated with worse survival, but we didn’t fully understand the relationship between race and time to treatment after controlling for various other factors,” said the study’s first author Raghav Tripathi, MPH, a medical student at Case Western Reserve University’s School of Medicine and a researcher at University Hospitals Cleveland Medical Center. “A more thorough understanding of the factors associated with worse outcomes for black patients is critical in reducing racial disparities in melanoma outcomes.”

Methods

The study was based on National Cancer Database statistics from 2004 to 2015. The research team identified nearly 234,000 people with melanoma, 1,221 (0.52%) of whom were black. Mr. Tripathi explained that although the incidence of melanoma in black populations is relatively low, using large health-care databases and sample sizes allowed researchers to include a sufficient number of black patients to investigate racial disparities in skin cancers.

Results

KEY POINTS

  • The time from diagnosis to definitive surgery for melanoma was 23.4 days on average for black patients, compared to 11.7 days for non-Hispanic white patients.
  • Racial differences in time from diagnosis to definitive surgery persisted in each insurance group, suggesting that insurance status doesn’t fully account for these disparities.

The time from diagnosis to definitive surgery for melanoma was 23.4 days on average for black patients, compared to 11.7 days for non-Hispanic white patients. Black patients were twice as likely to have a time from diagnosis to definitive surgery of 41 to 60 days, three times as likely to have a time from diagnosis to definitive surgery of 61 to 90 days, and five times as likely to have a time from diagnosis to definitive surgery of 91 days or longer.

The study also found that the disparities persisted despite controlling for various demographic characteristics, including insurance type and income level. Patients with Medicaid had the longest time from diagnosis to definitive surgery (an average of 60.4 days), and those with private insurance had the shortest (44.6 days). Racial differences in time from diagnosis to definitive surgery persisted in each insurance group, suggesting that insurance status doesn’t fully account for these disparities.

The precise nature of the association between time from diagnosis to definitive surgery and race is not known, said Mr. Tripathi. However, black patients typically develop more aggressive melanomas and require more complex surgeries that can take longer to arrange, particularly if they involve coordination among several clinicians. In addition, he said, awareness about skin cancer among black Americans is often limited because it is relatively rare in that population.

“Ultimately, we hope this study will draw attention to the importance of further understanding the various components of time from diagnosis to definitive surgery and worse outcomes for black [patients with] melanoma,” said Mr. Tripathi. “Additionally, this study suggests that targeted approaches to improve time from diagnosis to definitive surgery for black [patients with] melanoma are integral in reducing racial disparities in melanoma outcomes.”

Disclosure: For full disclosures of the study authors, visit jaad.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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