title: Association Between Race/Ethnicity and Survival of Melanoma Patients in the United States Over 3 Decades: A Secondary Analysis of SEER Data.
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.
  
  
  METHODS
  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.
authors.affiliation: From the Department of Medical and Population Health Sciences Research (MW-P, JMA), Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine (JMA), Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL (MW-P), and College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia (MKA, AMN, ESA-A, TMA, SAD, SAA).
authors.forename: Melissa
authors.initials: M
authors.lastname: Ward-Peterson
authors.forename: Juan M
authors.initials: JM
authors.lastname: Acuña
authors.forename: Mohammed K
authors.initials: MK
authors.lastname: Alkhalifah
authors.forename: Abdulrahman M
authors.initials: AM
authors.lastname: Nasiri
authors.forename: Elharith S
authors.initials: ES
authors.lastname: Al-Akeel
authors.forename: Talal M
authors.initials: TM
authors.lastname: Alkhaldi
authors.forename: Sakhr A
authors.initials: SA
authors.lastname: Dawari
authors.forename: Sami A
authors.initials: SA
authors.lastname: Aldaham
mesh_terms: D000328:Adult; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data*; D003431:Cross-Cultural Comparison; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018426:SEER Program / Q000706:statistics & numerical data*; D012878:Skin Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D014481:United States; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American