Improving Time from Diagnosis to Definitive Surgery in Black Patients with Melanoma

Targeted approaches to improving time from diagnosis to definitive surgery (TTDS) for black patients are essential in reducing racial disparities in melanoma outcomes according to a study published in the Journal of the American Academy of Dermatology.¹

In this study, black patients had greater TTDS for melanoma than non-hispanic white patients after controlling for other sociodemographic factors. Additionally, racial differences in TTDS persisted after stratifying by insurance type and melanoma stage. 

“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,” first author Raghav Tripathi, a medical student at Case Western Reserve’s School of Medicine and a researcher at University Hospitals Cleveland Medical Center, said in a press release.² “A more thorough understanding of the factors associated with worse outcomes for black patients is critical in reducing racial disparities in melanoma outcomes.” 

Using the National Cancer Database from 2004-2015, researchers retrospectively reviewed 233,982 patients with melanoma, 1,221 (0.52%) of which were black. According to Tripathi, using large healthcare databases and sample sizes such as this allows researchers to include a sufficient number of black patients to investigate racial disparities in skin cancers. 

Black patients were found to have longer TTDS for stage I-III melanoma (P < 0.001) and time to immunotherapy (P = 0.01), but not for TTDS for stage IV melanoma or time to chemotherapy (P > 0.05 for both). Moreover, after controlling for sociodemographic characteristics, black patients were still found to have over twice the odds of having TTDS between 41-60 days, over 3 times the odds of having TTDS between 61-90 days, and over 5 times the odds of having TTDS over 90 days. On average, the TTDS for melanoma was 23.4 days for black patients, compared to 11.7 days for non-hispanic white patients.

Patients with Medicaid had the longest TTDS (mean 60.4 days), while those with private insurance had the shortest TTDS (mean 44.6 days; P < 0.001 for both). Even further, racial differences in TTDS remained within each insurance type, indicating that insurance status does not fully account for these disparities.

According to the researchers, difference in disease characteristics by race may affect the TTDS for patients with melanoma. For instance, black patients more often present with aural lentiginous melanoma on lower extremities and have increased Breslow depth and stage at diagnosis for other melanoma subtypes, which generally predicts a worse prognosis. Additionally, it has been shown that black patients are less likely to receive immunotherapy for metastatic melanoma and other cancers after controlling for other sociodemographic findings.

Ultimately, Tripathi indicated that the precise nature of the association between TTDS and race is not known though. However, the study authors collectively highlighted the need to better understand the various components underlying worse outcomes for black patients with melanoma.

“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,” said Tripathi. “Additionally, this study suggests that targeted approaches to improve TTDS for black melanoma patients are integral in reducing racial disparities in melanoma outcomes.”

References:

1. Tripathi R, Archibald LK, Mazmudar RS, Conic R, Rothermel LD, Scott JF, Bordeaux JS. Racial Differences in Time to Treatment for Melanoma. Journal of the American Academy of Dermatology. doi:10.1016/j.jaad.2020.03.094.

2. Study finds racial differences in time it takes to treat melanoma [news release]. Cleveland. Published April 30, 2020. newswise.com/articles/study-finds-racial-differences-in-time-it-takes-to-treat-melanoma. Accessed May 7, 2020.