Study Underscores Need to Raise Awareness of Melanoma Risk in Nonwhites

A new study has found that overall survival is significantly worse for people of color who are diagnosed with melanoma, even though whites are diagnosed with this deadliest form of skin cancer at a higher rate.

Jeremy Bordeaux, MD, MPH

A new study has found that overall survival is significantly worse for people of color who are diagnosed with melanoma, even though whites are diagnosed with this deadliest form of skin cancer at a higher rate. In fact, blacks fared worse among all races in a stage-by-stage setting, a finding which may be closely related to when the disease is diagnosed.

The research, published online in the Journal of the American Academy of Dermatology, points to a need for better melanoma screening and awareness among nonwhite populations.

“If you take everybody who has melanoma, people with skin of color present at a later stage of diagnosis, so when they get to the doctor their melanoma is already advanced,” noted study author Jeremy Bordeaux, MD, MPH, director of the Melanoma Program at University Hospitals Case Medical Center.

“The more concerning part is that people with skin of color, if you look at them at the same stage as white patients diagnosed at similar times, the outcome is not the same. What we found was that a white person, who has very early melanoma, their likelihood of survival is significantly better than if a person with skin of color is diagnosed with a melanoma at the exact same stage.”

For this study, researchers at Case Western Reserve University reviewed nearly 97,000 patients diagnosed with melanoma from 1992 to 2009. They obtained the information from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database. Of the races examined in the study, white patients had the best overall survival, followed by Hispanic patients, and patients in the Asian American/Native American/Pacific Islander group

Bordeaux said he believes black patients present with disease at later stages because there is not enough awareness in the general public and the medical community.

“I think it has to do with lack of education or public perception that nonwhites can’t get skin cancer, and I think that also is a perception that may be held by many of my physician colleagues,” he explained.

In a 2011 study, researchers found that 47% of dermatologists and dermatology residents believed they did not receive adequate training in diagnosing conditions on black skin. This statistic does not surprise Bordeaux:

“The later diagnosis is really two parts. It’s the doctors, but it’s also the public, too,” Bordeaux said. “I think the first thing that has to happen is that a patient has to say, ‘I have a spot and it needs to be looked at.’ I think that in many cases that doesn’t happen or it happens much later within the black community.

“The second roadblock is when they finally make it to their primary care doctor—the likelihood that they are going to think it’s cancer is lower and then if they make it to the dermatologist I think it’s the same thing."

Bordeaux explained that though the stage-by-stage differences between white and nonwhite patients are a grey area, he does have a few hypotheses. The first is that nonwhites are not getting timely treatment or they’re getting different treatment than whites. He said this may be due to uneven access to healthcare, something he hopes to study next as he continues his research. Clinical trial participation rates may also be a factor, as well as possible genetic differences in melanoma in nonwhites.

Though melanoma can develop anywhere on the body, people of color often develop it on their hands and feet, white men on their back, and white women on their legs.

“For everyone, it’s important to be very aware of your skin,” Bordeaux stressed. “If you notice a spot that’s growing, changing, bleeding or anything out of the ordinary—raise concern with your dermatologist.”

Reference

Dawes SM, Tsai S, Gittleman H, Barnholtz-Sloan JS, Bordeaux JS. Racial disparities in melanoma survival [published online ahead of print July 23, 2016]. J Am Acad Dermatol.