Investigators may have uncovered sex-based disparities in the detection and survival of melanoma in Black patients, according to a recent study published by Steadman et al in the Journal of Surgical Oncology.
Background
Melanoma is an aggressive type of skin cancer that accounts for about 75% of skin cancer–related mortality. Although melanoma is less common in Black patients, the disease is often detected at more advanced stages when prognoses are poorer compared with White patients.
Extremity melanoma refers to skin cancer that can develop on the arms, legs, hands, and feet.
Previous studies on melanoma haven’t focused on how race and sex affect patient outcomes or the influence of race and ethnicity across all groups.
“We want to broaden and deepen our reach to better understand the disease that affects all patients. What we've done … with this study and others is to identify the need. We have a rich, integrated, multidisciplinary clinical research practice in melanoma, and we want to address clinical needs and knowledge gaps relevant to our practice,” noted senior study author Tina Hieken, MD, a researcher at the Mayo Clinic Comprehensive Cancer Center.
Study Methods and Results
In the recent study, the investigators analyzed the outcomes of 492,597 non-Hispanic Black patients and White patients with melanoma.
The investigators found that Black female patients with melanoma experienced better outcomes than Black male patients. For instance, compared with Black female patients, Black male patients were more likely to be older at diagnosis and have melanoma that metastasized to their lymph nodes. This translated to poorer survival rates. Among Black male patients with stage III melanoma, the 5-year survival rate was 42% vs 71% among Black female patients.
“We compared non-Hispanic Black patients to White patients and saw striking differences in how patients presented with the disease,” explained Dr. Hieken. “We saw more extremity melanoma and more later-stage disease,” she added.
Various factors such as social risk factors and biological components may play a role in these sex-based disparities; however, further research may be needed to help determine why these differences exist.
“When we talk about [patients with] later-stage melanoma who are female vs male in that non-Hispanic Black patient cohort who ended up doing worse, some biological things may be going on here that are interesting,” emphasized Dr. Hieken. “Several immune signals suggest that [female patients] may respond better to some immunotherapies than [male patients],” she indicated.
Conclusions
The recent findings may serve as a wake-up call for all health-care professionals struggling to diagnose and cure melanoma, regardless of the patient's sex or skin tone. The investigators suggested that added vigilance in early screening may be necessary for Black male patients. Health-care professionals were advised to thoroughly examine areas of the skin such as the palms, soles, and under the fingernails—where melanoma might be more challenging to identify in patients with darker skin tones.
“We can incorporate screening for skin lesions or lesions under the nails into the visit for patients as part of their regular checkups. What we want to do is elevate care for our patients,” underscored Dr. Hieken.
In future studies, the investigators hope to explore melanoma in a broader range of patients and include more Black participants in clinical trials—which may be critical to bridging this knowledge gap and potentially identifying more effective treatment options for this patient population.
Disclosure: The research in this study was supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and Breast and Melanoma Surgical Oncology in the Department of Surgery. For full disclosures of the study authors, visit onlinelibrary.wiley.com.
