Association Between Race/Ethnicity and Survival of Melanoma Patients in the United States Over 3 Decades: A Secondary Analysis of SEER Data

Medicine (Baltimore). 2016 Apr;95(17):e3315. doi: 10.1097/MD.0000000000003315.

Abstract

Melanoma is a treatable and preventable skin cancer. It is responsible for 75% of deaths among all skin cancers. Previous studies have found that race/ethnicity may play a role in survival among melanoma patients. However, there are no studies that cover 30 years and take race into account for the U.S.

Population: This study is a secondary analysis of the National Cancer Institute's Surveillance, Epidemiology, and End Result (SEER) Program. Adults with primary cutaneous melanoma from 1982 to 2011 were included; the final sample size was 185,219. The outcome was survival; both cause-specific and all-cause mortality were examined. The main exposure was race/ethnicity. Kaplan-Meier survival analysis was used to estimate overall survival. Cox proportional hazards regression was used to estimate unadjusted and adjusted hazard ratios (HRs). A P-value less than 0.05 was considered statistically significant.More than 50% of patients in all races/ethnicities were diagnosed at the in situ or localized stage. Non-Hispanic White patients were more frequently diagnosed at the in situ stage. Overall, more men were diagnosed than women. The majority of cases among all races were men. Non-Hispanic Black females represented the smallest percentage of melanoma cases among all races. The smallest number of diagnoses across all races/ethnicities was made from 1982 to 1991. Median follow-up was 81 months and no collinearity was observed in the adjusted models. When examining cause-specific mortality and controlling for site and stage at diagnosis, gender, age and decade of diagnosis, the HR for non-Hispanic Black patients was lower than that for non-Hispanic White patients (HR 0.7; 95% confidence interval (CI): 0.6-0.8). However, when examining all-cause mortality, this difference disappeared (HR 1.1; 95% CI: 1.0-1.2). Stage at diagnosis impacted HR; patients diagnosed with distant metastases had significantly worse survival.When taking cause-specific mortality into consideration and after controlling for stage and site at diagnosis, gender, and age and decade of diagnosis, non-Hispanic Black patients had a lower HR compared to non-Hispanic White patients. However, this difference disappeared when examining all-cause mortality. Further research is needed to explore this finding and to determine what factors may be associated with late-stage melanoma diagnosis.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adult
  • African Continental Ancestry Group / statistics & numerical data*
  • Aged
  • Cross-Cultural Comparison*
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Melanoma / ethnology*
  • Melanoma / mortality*
  • Melanoma / pathology
  • Middle Aged
  • Neoplasm Staging
  • Proportional Hazards Models
  • SEER Program / statistics & numerical data*
  • Skin Neoplasms / ethnology*
  • Skin Neoplasms / mortality*
  • Skin Neoplasms / pathology
  • United States