Black patients with one of the deadliest forms of skin cancer are likely to experience a longer delay from diagnosis to surgery than non-Hispanic white (NHW) patients, according to a new study published in the Journal of the American Academy of Dermatology.
The time from diagnosis to definitive surgery (TTDS) for melanoma was 23.4 days on average for black patients, compared to 11.7 days for NHW patients. Black patients were twice as likely to have a TTDS of 41 to 60 days, three times as likely to have a TTDS of 61 to 90 days and five times as likely to have a TTDS of 91 days or longer.
The study, led by researchers at Case Western Reserve University and University Hospitals Cleveland Medical Center (UH), was based on National Cancer Database statistics from 2004-15. It also found that the disparities persisted despite controlling for various demographic characteristics, including insurance type and income level.
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. A more thorough understanding of the factors associated with worse outcomes for black patients is critical in reducing racial disparities in melanoma outcomes."
Raghav Tripathi, study's first author, medical student at Case Western Reserve's School of Medicine and a researcher at UH
The study's principal investigator is Jeremy Bordeaux, director of the Multidisciplinary Melanoma Program at University Hospitals Cleveland Medical Center and a professor of dermatology at the medical school. The study's co-authors represent several disciplines and are from the medical school, UH, Case Comprehensive Cancer Center, the University of Minnesota Medical Center, the University of Maryland Medical Center and Johns Hopkins University School of Medicine.
The study builds on several research projects Bordeaux's team conducted in recent years involving different aspects of melanoma and racial disparities.
The current study identified nearly 234,000 people with melanoma-;1,221 (0.52%) of whom were black. Tripathi said that that because the incidence of melanoma in black populations is relatively low, using large health-care databases and sample sizes allows researchers to include a sufficient number of black patients to investigate racial disparities in skin cancers.
Patients with Medicaid had the longest TTDS (an average of 60.4 days), and those with private insurance had the shortest (44.6 days). Racial differences in TTDS persisted in each insurance group, suggesting that insurance status doesn't fully account for these disparities.
The precise nature of the association between TTDS and race is not known, Tripathi said. 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 TTDS and worse outcomes for black melanoma patients," Tripathi said. "Additionally, this study suggests that targeted approaches to improve TTDS for black melanoma patients are integral in reducing racial disparities in melanoma outcomes."
Tripathi, R., et al. (2020) Racial Differences in Time to Treatment for Melanoma. Journal of the American Academy of Dermatology. doi.org/10.1016/j.jaad.2020.03.094.