title: Racial differences in survival after surgical treatment for melanoma.
abstract: BACKGROUND
  Surgical-treatment outcomes for melanoma in African Americans are poorly characterized as a result of low incidence of melanoma among African Americans. We examined differences by race in overall and melanoma-specific survival, stratified by receipt of surgical treatment and by specific types of surgical treatment.
  
  
  METHODS
  Data from the 1973-2004 public-use Surveillance, Epidemiology and End Results Program (SEER) were analyzed by Cox proportional hazard models to compare the effects of surgical treatments on overall and melanoma-specific survival in blacks, whites, and other race, controlling for confounding demographic and tumor-related variables.
  
  
  RESULTS
  Of 151,154 patients with first primary melanoma (148,883 whites, 789 blacks and 1,532 other race), 142,653 (94.4%) received surgical treatment. Among patients who received surgical treatment, 10-year melanoma-specific survival was lower in blacks (73%) than in whites (88%) and other race (85%); black patients were at significantly higher risk of overall and melanoma-specific mortality when compared with white (hazard ratio [HR] = 1.64, 95% confidence interval [CI] 1.44-1.86, P < 0.0001 and HR = 1.50, 95% CI 1.25-1.79, P < 0.0001, respectively) and with other race (HR = 1.55, 95% CI 1.31-1.85, P < 0.0001 and HR = 1.49, 95% CI 1.16-1.91, P = 0.0017, respectively). Blacks who underwent biopsy, wide excision and surgery not otherwise specified were at higher risk of overall mortality compared with whites with the same treatment.
  
  
  CONCLUSIONS
  Overall and melanoma-specific survival was lower in blacks undergoing surgical treatment for melanoma compared to both whites and other race. Reasons for these disparities remain poorly understood.
authors.affiliation: Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA. kcollins@dom.wustl.edu
authors.forename: Karen Kadela
authors.initials: KK
authors.lastname: Collins
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
authors.forename: Dadrie
authors.initials: D
authors.lastname: Baptiste
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Moley
authors.forename: Donna B
authors.initials: DB
authors.lastname: Jeffe
mesh_terms: D044383:Black People / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000208:ethnology* / Q000401:mortality* / Q000601:surgery; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D012878:Skin Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000601:surgery; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American