Despite Advances, Melanoma Rates Still Vary by Race and Ethnicity

While white and Hispanic individuals are being diagnosed with melanoma more frequently in recent years, Hispanic and black patients continue to have advanced skin cancer at diagnosis, according to a report in the December issue of Archives of Dermatology, one of the JAMA/Archives journals. Those findings were made by a team of researchers from the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, led by Shasa Hu, M.D., assistant professor of dermatology and cutaneous surgery and Robert Kirsner, M.D., Steifel Laboratories Professor and vice chairman of the Department of Dermatology and Cutaneous Surgery.

Nationwide, the incidence (rate of new cases diagnosed) of melanoma increased 2.4 percent per year in the last decade. Hu and Kirsner note that research and public education efforts have focused on melanoma prevention in white populations because of their higher risk of developing melanoma. They believe that improvements in secondary prevention have resulted in earlier detection of early-stage melanoma, which likely accounts for survival among whites increasing from 68 percent in the early 1970s to 92 percent in recent years. However, they did not see similar advances in other racial and ethnic groups. “Blacks in the U.S.,” says Kirsner, “have more advanced melanoma in association with worse survival rates.”

Hu and colleagues analyzed data extracted from the Florida Cancer Data System, a state-wide, population-based cancer incidence registry, housed at Sylvester. Of 41,072 cases of melanoma diagnosed from 1990 to 2004, 39,670 were diagnosed in white non-Hispanic individuals, 1,148 in white Hispanics and 254 in blacks. This analysis is among the largest in terms of numbers of melanoma for blacks and Hispanics.

In the timeframe studied, incidence rates increased by at least 3 percent per year among white non-Hispanic men and women. In white Hispanic women, there was a similar increase, of more than 3 percent, but white Hispanic men saw less than 1.0 percent increase. Among African-American men and women, there was virtually no increase.

However, both white Hispanics and black individuals had more advanced melanoma when they were diagnosed. Eighteen percent of white Hispanic patients and 26 percent of black patients had disease that had spread either regionally or to distant parts of their bodies, compared with 12 percent of white non-Hispanic patients. The proportion of distant-stage disease diagnosed among white Hispanic and black patients did not change significantly from 1990 to 2004, compared with a steady decrease in such advanced cases among white non-Hispanic patients.

Hu says melanoma among darker-skinned populations has not received as much attention, partly due to their overall lower risk compared with white non-Hispanics. She points out that their findings indicate the lowest survival rates and delayed melanoma diagnosis is often seen in blacks. Hu says the expanding population and increasing melanoma rate of 2.9 percent per year among Hispanics are proof that racial and ethnic disparities are “becoming an increasingly important public health issue.”

The team of researchers says the improvement in melanoma diagnosis among whites suggests that public education and more screening can help reduce the impact of the disease. “The results of our study should motivate the expansion of melanoma awareness, especially for earlier diagnosis to the minority communities,” says Kirsner. “With those measures, we can ultimately alleviate the disparities in melanoma outcome in these populations.”

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