title: The expanding melanoma burden in California hispanics: Importance of socioeconomic distribution, histologic subtype, and anatomic location.
abstract: BACKGROUND
  The incidence patterns and socioeconomic distribution of cutaneous melanoma among Hispanics are poorly understood.
  
  
  METHODS
  The authors obtained population-based incidence data for all Hispanic and non-Hispanic white (NHW) patients who were diagnosed with invasive cutaneous melanoma from 1988 to 2007 in California. By using a neighborhood-level measure of socioeconomic status (SES), the variables investigated included incidence, thickness at diagnosis, histologic subtype, anatomic site, and the relative risk (RR) for thicker (>2 mm) versus thinner (≤ 2 mm) tumors at diagnosis for groups categorized by SES.
  
  
  RESULTS
  Age-adjusted melanoma incidence rates per million were higher in NHWs (P < .0001), and tumor thickness at diagnosis was greater in Hispanics (P < .0001). Sixty-one percent of melanomas in NHWs occurred in the High SES group. Among Hispanics, only 35% occurred in the High SES group; and 22% occurred in the Low SES group. Lower SES was associated with thicker tumors (P < .0001); this association was stronger in Hispanics. The RR of thicker tumors versus thinner tumors (≤ 2 mm) in the Low SES group versus the High SES group was 1.48 (95% confidence interval [CI], 1.37-1.61) for NHW men and 2.18 (95% CI, 1.73-2.74) for Hispanic men. Patients with lower SES had less of the superficial spreading melanoma subtype (especially among Hispanic men) and more of the nodular melanoma subtype. Leg/hip melanomas were associated with higher SES in NHW men but with lower SES in Hispanic men.
  
  
  CONCLUSIONS
  The socioeconomic distribution of melanoma incidence and tumor thickness differed substantially between Hispanic and NHW Californians, particularly among men. Melanoma prevention efforts targeted to lower SES Hispanics and increased physician awareness of melanoma patterns among Hispanics are needed.
authors.affiliation: Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Stanford Cancer Center, Stanford, California 94063, USA. pollitt@stanford.edu
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Pollitt
authors.forename: Christina A
authors.initials: CA
authors.lastname: Clarke
authors.forename: Susan M
authors.initials: SM
authors.lastname: Swetter
authors.forename: David H
authors.initials: DH
authors.lastname: Peng
authors.forename: John
authors.initials: J
authors.lastname: Zadnick
authors.forename: Myles
authors.initials: M
authors.lastname: Cockburn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California; D002648:Child; D002675:Child, Preschool; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000208:ethnology* / Q000473:pathology; D008875:Middle Aged; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000208:ethnology* / Q000473:pathology; D012923:Social Class; D044465:White People