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 Among nearly 97,000 patients with melanoma - the rarest and
deadliest type of skin malignancy - white patients had the highest
likelihood of survival, followed by Hispanics, and then Asian
American, Native American and Pacific Islanders. African-American
patients had the worse survival odds of all.
"In general, white patients have higher overall survival than black
patients because the public and many physicians are not aware that
black patients can get melanoma," said senior study author Dr.
Jeremy Bordeaux of Case Western Reserve University in Cleveland.
Part of the problem may be that non-white patients get diagnosed
when the cancer is more advanced. But that doesn't entirely explain
the racial disparities in outcomes, Bordeaux said by email.
"What is more troubling to me is that even when black patients are
diagnosed at the same stage as white patients, they still have worse
outcomes," Bordeaux added. "Black patients may not be treated as
quickly as white patients or they may not be receiving the same
treatment, or another possibility is that melanoma in black people
may just be more aggressive in general."
The vast majority of skin cancers don’t result in death. But
melanoma – a rare form that accounts for less than 2 percent of
cases – has a much higher death rate.
This year, an estimated 76,400 people will develop melanoma in the
U.S. and 10,100 will die from the disease, according to a recent
report in JAMA.
For the current study, researchers analyzed national cancer registry
data collected from 1992 to 2009 on patients with melanoma.
They looked at how advanced cancer was at the time of diagnosis and
outcomes based on the severity of the disease at that point in time.
At the earliest stages, melanoma may be found only in the outer
layer of skin or epidermis, when it's unlikely to spread to other
parts of the body. As it progresses, melanoma gets thicker,
penetrates more layers of skin and becomes increasingly more likely
to spread or become fatal.
African-American patients had the worst overall survival rate, and
they were also the group most likely to be diagnosed with melanoma
in its later stages, when the disease is more difficult to treat,
researchers report in the Journal of the American Academy of
Dermatology.
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One limitation of the study is that researchers lacked data on some
factors that can influence melanoma outcomes, including family
history of the disease, follow-up time, income, insurance status,
and other medical problems, the authors note.
Even so, the findings should serve as a reminder that patients of
every skin color need to use sunscreen and take precautions like
staying in the shade during the brightest part of the day, said Dr.
Mona Gohara, a dermatology researcher at Yale School of Medicine who
wasn't involved in the study.
"There is a false sense of immunity amongst populations of color and
the doctors caring for us," Gohara said by email. "Cancer is cancer;
no population is fortunate enough to be exempt from this disease."
Doctors and patients may also need to get better at looking for
abnormalities on skin of color, whether in self-exams at home or
annual cancer screenings at a doctor's office, said Dr. Seemal
Desai, a researcher at the University of Texas Southwestern Medical
Center and president-elect of the Skin of Color Society.
"Darker skin tones can certainly be more challenging, and I do think
you have to see lots of patients with different skin tones to pick
up on clues," Desai, who wasn't involved in the study, said by
email. "There are dermatologists out there who specialize in skin of
color."
SOURCE: http://bit.ly/2b5kP8r Journal of the American Academy of
Dermatology, online July 28, 2016.
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