Study Highlights Presentation of Melanoma Among Black Patients to Improve Outcomes

Jessica A. Steadman, MBBS

Credit: Mayo Clinic Alumni Associatio

Patients with melanoma who are non-Hispanic Black (NHB) may present with distinct tumor characteristics, according to recent findings, and those with Stage 3 melanoma have inferior cancer-specific survival (CSS) rates.¹

These results represented the conclusion of new research into the features of melanoma observed among non-Hispanic Black individuals. The motivation for such research was to inform strategies for earlier detection as well as treatment of this population, given that melanoma guidelines typically stem from data regarding non-Hispanic White (NHW) patients.

This research was led by Jessica A. Steadman, MBBS, of the division of breast and melanoma surgical oncology at the Mayo Clinic. Steadman and colleagues noted the lack of available data on melanoma-specific characteristics among those in the non-Hispanic Black population, citing a single small retrospective study of 44 such melanoma patients.²

“Thus, the aims of the present study were to characterize distinguishing features of melanoma in the NHB population…with the goal of informing strategies for early diagnosis and improving cancer outcomes,” Steadman and colleagues wrote. “We hypothesized that the presentation, treatment, and outcomes of cutaneous melanoma within the cohort of NHB patients might be different from what is generally reported for cutaneous melanoma focused on nearly exclusively NHW patient cohorts.”

Background and Methods

The Surveillance, Epidemiology, and End Results (SEER) registry was utilized by the research team to identify all new diagnoses of nonmetastatic cutaneous melanoma done in the period from 2004 - 2019. Using SEER Stat information, the team were able to note the T, N, and M categories for all of the study subjects, with restaging based upon the American Joint Committee on Cancer (AJCC) system of staging.

The team’s research included individuals that had primary cutaneous melanoma and a range from Tis - T4—a noted N category—and metastatic disease (M0) signs at the point of diagnosis. The T category is given following the complete excision of a patient’s melanoma, and the N category is based upon the pathological assessment of regional lymph nodes after lymph node surgery or radiologic/clinical evaluation if pathological information is not accessible.

The investigators did not include subjects if the aforementioned variables were not visible or if the potential subjects were shown to have noncutaneous primary melanoma, had been diagnosed only at autopsy, or were given a diagnosis that was confirmed only on a death certificate.

The research team implemented the SEER “Race and Origin recode” variable to categorize the study participants by their ethnicity and race. The team looked at comparisons between NHB individuals to the NHW group, so subjects were stratified into either NHW and NHB cohorts, excluding others.

The investigators looked at data on participants’ sex, ages, and melanoma-specific elements. The latter elements included the primary tumor's Breslow depth, anatomical region, mitotic rate, histology, clinical T and N categories, status of ulceration, and surgical treatment details.

In addition to the demographic and melanoma-specific characteristics compared between both the NHW and NHB arms, variables and survival rates were also evaluated by the research team separately within the NHB patient cohort specifically.

Findings

Overall, there were 492,597 patients, with 0.3% being non-Hispanic Black. This cohort was noted by the research team as being younger, typically, with 21% of them being under the age of 50 as opposed to 17% of non-Hispanic Whites. Additionally, this arm was reported to be more frequently female, with 54% versus 41% in the White patient cohort, and with both differences being statistically significant (P < .0005).

For the Black patient cohort, the investigators found that the most common area of occurrence was the lower extremity (52% versus 15% for Whites, P < .0001). Black patients were additionally found to have presented with higher T categories (55% Tis–T1 versus 82%; 27% T3–T4 versus 8%, P < .0001).

Non-Hispanic Black subjects were also shown to be at higher stages at the time of their diagnoses (19% Stage 3 vs. 6%, P < 0.0001). Among the Black patient cohort, male subjects were noted by the investigators generally older and had a higher likelihood of being node-positive compared to females.

Among Black males with Stage 3 disease, the five-year rate of cancer-specific survival (CSS) was reported by the research team to be 42%. This was a rate noted as far lower than the 71% CSS rate found among females when adjusted for clinical nodal status and subject age, with a hazard ratio of 2.48.

“These data suggest areas of focus to achieve earlier detection of melanoma amongst this cohort, focusing on improved education on melanoma risk perception among racial minorities, increased awareness devoted to NHB patients by national organizations involved in skin cancer prevention and treatment, and greater transparency and inclusivity of NHB patients in melanoma research,” they wrote.

References

1. ^{Steadman JA, Glasgow AE, Neequaye NN, Habermann EB, Hieken TJ. Distinct presentation of melanoma in Black patients may inform strategies to improve outcomes. J Surg Oncol. 2024 May;129(6):1041-1050. doi: 10.1002/jso.27608. Epub 2024 Mar 4. PMID: 38436625.}
2. ^{Bellows CF, Belafsky P, Fortgang IS, Beech DJ. Melanoma in African-Americans: trends in biological behavior and clinical characteristics over two decades. J Surg Oncol. 2001; 78(1): 10-16.}