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Taylor MA, Sharma D, Thomas SI, Ituarte BE, Sharma B, Tassone P, Wei EX. Examining racial and ethnic disparities in cutaneous melanoma of the head and neck. J Am Acad Dermatol 2024:S0190-9622(24)02829-9. [PMID: 39288870 DOI: 10.1016/j.jaad.2024.08.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/21/2024] [Accepted: 08/14/2024] [Indexed: 09/19/2024]
Affiliation(s)
- Mitchell A Taylor
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska; School of Medicine, Creighton University, Omaha, Nebraska
| | - Divya Sharma
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sierra I Thomas
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska; School of Medicine, University of Utah, Salt Lake City, Utah
| | - Bianca E Ituarte
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Bhavya Sharma
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri, Columbia, Missouri
| | - Patrick Tassone
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri, Columbia, Missouri
| | - Erin X Wei
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska.
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Watson C, Crichlow Q, Valaiyapathi B, Szaflarski JP, Fobian AD. The effects of racial and socioeconomic disparities on time to diagnosis and treatment of pediatric functional seizures in the United States. Seizure 2024; 119:58-62. [PMID: 38796952 PMCID: PMC11229518 DOI: 10.1016/j.seizure.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE The present study sought to assess the effects of racial and socioeconomic status in the United States on time to treatment and diagnosis of pediatric functional seizures (FS). METHODS Eighty adolescents and their parent/guardian completed a demographics questionnaire and reported date of FS onset, diagnosis, and treatment. Paired samples t-tests compared time between FS onset and diagnosis, onset and treatment, and diagnosis and treatment based on race (White vs racial minority), annual household income (≤$79,999 vs ≥$80,000), maternal and paternal education (≤Associate's Degree vs Bachelor's Degree), and combined parental education (≤Post-graduate training vs Graduate degree). RESULTS Adolescents with lower annual household income began treatment >6 months later than adolescents with greater annual household income (p = 0.049). Adolescents with lower maternal and paternal education (≤Associate's Degree vs Bachelor's Degree) began treatment >4 and ∼8.5 months later than adolescents with greater maternal and paternal education (p = 0.04; p = 0.03), respectively. Adolescents with lower maternal education also received a diagnosis >5 months later (p = 0.03). Adolescents without a mother or father with a graduate degree received a diagnosis and began treatment∼3 and >11 months later (p = 0.03; p = 0.01) than adolescents whose mother or father received a graduate degree, respectively. No racial differences were found. CONCLUSIONS Adolescents with lower annual household income and/or parental education experienced increased duration between FS onset and treatment and diagnosis. Research is needed to clarify the mechanisms underlying this relationship, and action is needed to reduce these disparities given FS duration is associated with poorer prognosis and greater effects on the brain.
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Affiliation(s)
- Caroline Watson
- Department of Psychology, University of Alabama at Birmingham, United States
| | - Queenisha Crichlow
- Department of Psychology, University of Alabama at Birmingham, United States
| | - Badhma Valaiyapathi
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 2nd Ave S, SC 1004, Birmingham, AL 35294, United States
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, United States
| | - Aaron D Fobian
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 2nd Ave S, SC 1004, Birmingham, AL 35294, United States.
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Steadman JA, Glasgow AE, Neequaye NN, Habermann EB, Hieken TJ. Distinct presentation of melanoma in Black patients may inform strategies to improve outcomes. J Surg Oncol 2024; 129:1041-1050. [PMID: 38436625 DOI: 10.1002/jso.27608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/18/2024] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Melanoma guidelines stem largely from data on non-Hispanic White (NHW) patients. We aimed to identify features of melanoma within non-Hispanic Black (NHB) patients to inform strategies for earlier detection and treatment. METHODS From 2004 to 2019 Surveillance, Epidemiology, and End Results (SEER) data, we identified nonmetastatic melanoma patients with known TN category and race. Kaplan-Meier cancer-specific survival (CSS) estimates and multivariable Cox proportional hazard modeling analyses were performed. RESULTS Of 492 597 patients, 1499 (0.3%) were NHB, who were younger (21% vs. 17% age <50) and more commonly female (54% vs. 41%) than NHW, both p < 0.0005. For NHBs, lower extremity was the most common site (52% vs. 15% for NHWs, p < 0.0001), T category was higher (55% Tis-T1 vs. 82%; 27% T3-T4 vs. 8%, p < 0.0001) and stage at presentation was higher (19% Stage III, vs. 6%, p < 0.0001). Within the NHB cohort, males were older, and more often node-positive than females. Five-year Stage III CSS was 42% for NHB males versus 71% for females, adjusting for age and clinical nodal status (hazard ratio 2.48). CONCLUSIONS NHB melanoma patients presented with distinct tumor characteristics. NHB males with Stage III disease had inferior CSS. Focus on this high-risk patient cohort to promote earlier detection and treatment may improve outcomes.
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Affiliation(s)
- Jessica A Steadman
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy E Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nikki N Neequaye
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Tina J Hieken
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Poondru S, Gaurav A, Yang LJ, Kundu RV. Perceptions of Sun Protection, Skin Tone, Colorism, and Dermatologic Care Among South Asians in the USA. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01938-w. [PMID: 38658504 DOI: 10.1007/s40615-024-01938-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/12/2024] [Accepted: 01/31/2024] [Indexed: 04/26/2024]
Abstract
South Asians (SAs) are among the fastest growing populations in the USA. Colorism - the system of inequality that views lighter skin as more advantageous in society - is prevalent in SA culture. This study evaluates motivations of sun protection use, attitudes of colorism, and skin lightening (SL) practices among SA Americans. Two-hundred-four participants recruited from online forums and ResearchMatch completed a questionnaire. Over half (111/204) reported use of sunscreen, of which 39.6% (44/111) reported daily or frequent use. Nearly half of respondents (98/204) believed that they are not at risk for skin cancer, with 37.7% (77/204) reporting minimal knowledge of skin cancers and only 4.9% (10/204) receiving a total body skin exam. One-third (65/204) reported being more concerned about prevention of tanning than skin cancer. In total, 38.2% (78/204) of respondents reported use of SL products, of which 33.3% (26/78) reported hydroquinone-based products and 26.9% (21/78) were unaware of the ingredients in their SL product. Only 16.7% (13/78) consulted a medical professional before using SL products. While many agreed that SA culture places high importance on light skin with regards to beauty standards (82.3%, 168/204), less noted that lighter skin is more beautiful (37.0%, 74/204). SL users more strongly agreed with colorism attitudes than non-users. Limitations include a small sample size with younger participants. Dermatologists must be mindful of the cultural motivations for skin tone preferences, sun protection habits, and SL behaviors and provide culturally relevant education on sunscreen, skin cancer, and risks of SL for the SA community.
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Affiliation(s)
- Sneha Poondru
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St Ste 1600, Chicago, IL, 60611, USA
| | - Ahana Gaurav
- School of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Lynna J Yang
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St Ste 1600, Chicago, IL, 60611, USA
| | - Roopal V Kundu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St Ste 1600, Chicago, IL, 60611, USA.
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Andrade LF, Lalama MJ, Choragudi S, Maisonet J, Ayala J, Figueroa C, Lopez LC, Tavarez L, Kirsner RS, Strasswimmer J. Knowledge, Attitudes, and Perceptions of Skin Cancer Clinical Trials in the Hispanic Population. Cureus 2024; 16:e57480. [PMID: 38707098 PMCID: PMC11065540 DOI: 10.7759/cureus.57480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVE To determine the factors that might limit Hispanic patients from participating in dermatological clinical trials. METHODS From January 2022 to July 2022, we administered a 31-item, in-person questionnaire to patients recruited in the waiting area of the Caridad Center, one of the largest free clinics in the United States with a predominately Hispanic population, and a nearby private primary care clinic. RESULTS Overall, Hispanic patients agreed significantly more with statements in the domain of attitude and behavioral beliefs compared to non-Hispanic survey respondents. The Hispanic ethnicity was associated with increased odds of agreeing with the following statements: "My community would really benefit from skin cancer clinical trials" (OR=0.52; 95% CI 0.30, 0.92), "My participation in a skin cancer study would be very good" (OR=0.59; 95% CI 0.35, 0.99), and "I like to do good for others" (OR=0.41; 95% CI 0.22, 0.77). CONCLUSION While the United States population is composed of 18.5% Hispanics, they only account for 1% of patients enrolled in clinical trials. This study helps identify potential motivational factors for Hispanic patients to participate in skin cancer clinical trials.
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Affiliation(s)
- Luis F Andrade
- Dermatology, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Maria J Lalama
- Medicine, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Siri Choragudi
- Medicine, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, USA
| | | | - Juan Ayala
- Dermatology, Caridad Center, Boynton Beach, USA
| | - Cesar Figueroa
- Internal Medicine, Cesar Figueroa Clinic, Delray Beach, USA
| | - Liz C Lopez
- Dermatology, Florida Atlantic University, Boca Raton, USA
| | - Lauren Tavarez
- Dermatology, Florida Atlantic University, Boca Raton, USA
| | - Robert S Kirsner
- Dermatology, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - John Strasswimmer
- Dermatology, Florida Atlantic University, Boca Raton, USA
- Surgery, Strasswimmer Dermatology, Delray Beach, USA
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Hernandez AE, Benck KN, Huerta CT, Ogobuiro I, De La Cruz Ku G, Möller MG. Rural Melanoma Patients Have Less Surgery and Higher Melanoma-Specific Mortality. Am Surg 2024; 90:510-517. [PMID: 38061913 DOI: 10.1177/00031348231216485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND Melanoma causes most skin cancer-related deaths, and disparities in mortality persist. Rural communities, compared to urban, face higher levels of poverty and more barriers to care, leading to higher stage at presentation and shorter survival in melanoma. To further evaluate these disparities, we sought to assess the association between rurality and melanoma cause-specific mortality and receipt of recommended surgery in a national cohort. METHODS Patients with primary non-ocular, cutaneous melanoma from the SEER database, 2000-2017, were included. Outcomes included melanoma-specific survival and receipt of recommended surgery. Rurality was based on Rural-Urban Continuum Codes. Variables included age, sex, race, ethnicity, income, and stage. Multivariate regression models assessed the effect of rurality on survival and receipt of recommended surgery. RESULTS 103,606 patients diagnosed with non-ocular cutaneous primary melanoma met criteria during this period. 93.3% (n = 96620) were in urban areas and 6.7% (n = 6986) were in rural areas. On multivariate regression controlling for age, sex, race, ethnicity, and stage patients living in a rural area were less likely to receive recommended surgery (aOR .52, 95% CI: .29-.90, P = .02) and had increased hazard of melanoma-specific mortality (aHR 1.19, 95% CI: 1.02-1.40, P = .03) even after additionally controlling for surgery receipt. CONCLUSION Using a large national cohort, our study found that rural patients were less likely to receive recommended surgery and had shorter melanoma cause-specific survival. Our findings highlight the importance of access to cancer care in rural areas and how this ultimately effects survival for these patients.
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Affiliation(s)
- Alexandra E Hernandez
- Department of Surgery, Division of Surgical Oncology,University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kelley N Benck
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carlos T Huerta
- Department of Surgery, Division of Surgical Oncology,University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ifeanyichukwu Ogobuiro
- Department of Surgery, Division of Surgical Oncology,University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gabriel De La Cruz Ku
- University of Massachusetts School of Medicine, Worcester, MA, USA
- Universidad Cientifica del Sur, Lima, Peru
| | - Mecker G Möller
- University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
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Fernandez JM, Evans TD, Schissel M, Siller A, Wei EX, Wysong A. Racial and ethnic differences in time to definitive surgery for melanoma: A retrospective study from the National Cancer Database. J Am Acad Dermatol 2024; 90:829-831. [PMID: 38042414 DOI: 10.1016/j.jaad.2023.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 11/03/2023] [Accepted: 11/21/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Jennifer M Fernandez
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Tyler D Evans
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Makayla Schissel
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Alfredo Siller
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Erin X Wei
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska.
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Lau WC, Huang L, Zheng X, Ming WK, Leong NC, Tak Wong Y, Yin Z, Yu H, Lyu J, Deng L. Prognostic nomograms for predicting long-term overall survival in spindle cell melanoma: a population-based study. Front Endocrinol (Lausanne) 2024; 15:1260966. [PMID: 38572477 PMCID: PMC10988970 DOI: 10.3389/fendo.2024.1260966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/06/2024] [Indexed: 04/05/2024] Open
Abstract
Background There are few research findings on the survival prognosis of spindle cell melanoma (SCM), which is an unusual kind of melanoma. The purpose of this study was to develop a thorough nomogram for predicting the overall survival (OS) of patients with SCM and to assess its validity by comparing it with the conventional American Joint Committee on Cancer (AJCC) staging system. Methods The Surveillance, Epidemiology, and End Results database was searched, and 2,015 patients with SCM were selected for the analysis. The patients were randomly divided into training (n = 1,410) and validation (n = 605) cohorts by using R software. Multivariate Cox regression was performed to identify predictive factors. A nomogram was established based on these characteristics to predict OS in SCM. The calibration curve, concordance index (C-index), area under the receiver operating characteristic curve, and decision-curve analysis were utilized to assess the accuracy and reliability of the model. The net reclassification improvement and integrated discrimination improvement were also applied in this model to evaluate its differences with the AJCC model. Results The developed nomogram suggests that race, AJCC stage, chemotherapy status, regional node examination status, marital status, and sex have the greatest effects on OS in SCM. The nomogram had a higher C-index than the AJCC staging system (0.751 versus 0.633 in the training cohort and 0.747 versus 0.650 in the validation cohort). Calibration plots illustrated that the model was capable of being calibrated. These criteria demonstrated that the nomogram outperforms the AJCC staging system alone. Conclusion The nomogram developed in this study is sufficiently reliable for forecasting the risk and prognosis of SCM, which may facilitate personalized treatment recommendations in upcoming clinical trials.
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Affiliation(s)
- Wai Chi Lau
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Liying Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xinkai Zheng
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China
| | - Wai-kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Nga Cheng Leong
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China
- Department of Dermatology, Kiang Wu Hospital, Macau, China
| | - Yu Tak Wong
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China
- SHENZHEN BeauCare Clinic, Shenzhen, China
| | - Zhinan Yin
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine Zhuhai People’s Hospital Affiliated with Jinan University, Zhuhai, China
- The Biomedical Translational Research Institute, Health Science Center (School of Medicine), Jinan University, Guangzhou, China
| | - Hai Yu
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China
| | - Liehua Deng
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China
- Department of Dermatology, The Fifth Affiliated Hospital of Jinan University, Heyuan, China
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Pourghadiri A, Mukovozov I, Joseph M, Liu C. A 10-Year Evaluation of Skin Tone Diversity in the Journal of Cutaneous Medicine and Surgery. J Cutan Med Surg 2024; 28:202-203. [PMID: 38303652 DOI: 10.1177/12034754241229632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Affiliation(s)
- Amir Pourghadiri
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Marissa Joseph
- Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Chaocheng Liu
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
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10
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Wilkowski CM, Brown-Korsah JB, Tripathi R, Bordeaux JS. Factors associated with time to surgical treatment for dermatofibrosarcoma protuberans. J Am Acad Dermatol 2024; 90:609-612. [PMID: 37871804 DOI: 10.1016/j.jaad.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/10/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023]
Affiliation(s)
| | - Jessica B Brown-Korsah
- Department of Internal Medicine, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Raghav Tripathi
- Department of Dermatology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Jeremy S Bordeaux
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
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Wix SN, Brown AB, Heberton M, Adamson AS, Gill JG. Clinical Features and Outcomes of Black Patients With Melanoma. JAMA Dermatol 2024; 160:328-333. [PMID: 38265787 PMCID: PMC10809140 DOI: 10.1001/jamadermatol.2023.5789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/22/2023] [Indexed: 01/25/2024]
Abstract
Importance Melanoma in Black individuals has an annual incidence of approximately 1 in 100 000 people. Most studies of melanoma in Black patients have used population databases, which lack important, precise clinical details. Objective To identify patient-level and tumor-level characteristics of melanoma in Black patients. Design, Setting, and Participants This case series included Black patients with melanoma at 2 tertiary care centers (University of Texas Southwestern [UTSW] Medical Center and Parkland Health), affiliated with a single institution, UTSW in Dallas, Texas. Self-reported Black patients with a histopathologic diagnosis of melanoma were identified between January 2006 and October 2022. Main Outcomes and Measures The main variables were demographics, clinical characteristics, personal and family medical history, immunosuppression history, comorbidities, histopathology reports, molecular/genetic studies, imaging reports, melanoma treatments and responses, time to progression, metastatic sites, and survival rates. Results A total of 48 Black patients with melanoma (median [range] age at diagnosis, 62 [23-86] years; 30 [63%] female) were included in the study. Of 40 primary cutaneous melanomas, 30 (75%) were located on acral skin, despite only 10 of 30 (33%) being histologically classified as acral lentiginous melanomas. Compared with those with acral disease, patients with nonacral cutaneous melanomas were more likely to be immunocompromised (4 of 10 [40%] vs 2 of 30 [7%]) or have a personal history of cancer (6 of 10 [60%] vs 5 of 30 [17%]), with all 3 patients with superficial spreading melanoma having a history of both. No patients had more than 1 confirmed primary melanoma. Overall, 13 Black patients (27%) with melanoma developed stage IV disease, of whom 12 died because of disease progression. Those diagnosed with advanced acral melanoma, mucosal/ocular melanoma, or melanoma of unknown primary lacked actionable sequence variations, were nonresponsive to immunotherapy, and had the poorest outcomes. No patients with nonacral cutaneous melanomas developed distant metastases or died of melanoma. Conclusions and Relevance This single-institution case series highlights several features of melanoma in Black patients that have not been captured in existing population-level registries, including precise anatomic sites, immune status, family and personal cancer history, and genetics. Multi-institutional registries would improve understanding of melanoma in Black patients.
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Affiliation(s)
- Sophia N. Wix
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Ariel B. Brown
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Meghan Heberton
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Adewole S. Adamson
- Deputy Editor and Web Editor, JAMA Dermatology
- Division of Dermatology, Dell Medical School, The University of Texas at Austin
| | - Jennifer G. Gill
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
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Dhaliwal GS, Shahin AB, Lim ES, Mi L, Mangold AR, Swanson DL, Costello CM. Factors influencing receipt and time to treatment of immunotherapy relative to chemotherapy in stage III and stage IV melanoma. Cancer Med 2024; 13:e6888. [PMID: 38186321 PMCID: PMC10807657 DOI: 10.1002/cam4.6888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/06/2023] [Accepted: 12/16/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Immunotherapies have changed the landscape of late-stage melanoma; however, data evaluating timely access to immunotherapy are lacking. METHODS A retrospective cohort study utilizing the National Cancer Database was conducted. Stage III and IV melanoma cases diagnosed between 2011 and 2018 that received systemic treatment with either immunotherapy or chemotherapy were included. Chemotherapy included BRAF/MEK inhibitors. Multivariable logistic regression models were utilized to evaluate factors associated with the likelihood of receiving immunotherapy as primary systemic treatment relative to chemotherapy; additionally, Cox proportional hazards models were utilized to incorporate time from diagnosis to primary systemic therapy into the analysis. RESULTS The study population was comprised of 14,446 cases. The cohort included 12,053 (83.4%) immunotherapy and 2393 (16.6%) chemotherapy cases. In multivariable logistic regression analysis, factors significantly associated with immunotherapy receipt included population density, circle distance, year of diagnosis, Breslow thickness, and cancer stage. Immunotherapy timing was evaluated using multivariable Cox regression analysis. Minorities were less likely to receive timely immunotherapy than non-Hispanic Whites (HR 0.83, CI 0.74-0.93, p = 0.001). Patients at circle distances of 10-49 miles (HR 0.94, CI 0.89-0.99, p = 0.02) and ≥50 miles (HR 0.83, CI 0.77-0.90, p < 0.001) were less likely to receive timely immunotherapy. CONCLUSION Patients traveling ≥10 miles and minorities have a decreased likelihood of receiving timely immunotherapy administration for primary systemic treatment. Future research is needed to identify what barriers and approaches can be leveraged to address these inequities.
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Affiliation(s)
| | | | | | - Lanyu Mi
- Department of Qualitative Health ScienceScottsdaleArizonaUSA
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Lai J, Bao A, McCaffrey T, Salman R, Gelderen EV, Rizk E, Thompson KG, Epstein JA, Bibee K, Scott J. Predictor Variables Associated With Dermatology Referral Completion and the Impact on Surgical Treatment: A Retrospective Cohort Study. Dermatol Surg 2024; 50:28-34. [PMID: 37962110 DOI: 10.1097/dss.0000000000003989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Delays or failure to complete a dermatologic referral may affect health care outcomes. Factors associated with these delays remain understudied. OBJECTIVE This study investigated socioeconomic and demographic factors associated with delays or failure to complete dermatology referrals and potential impact on surgical outcomes. METHODS A retrospective chart review was performed for 400 patients internally referred to an academic dermatology center from 19 primary-care clinics from July 2018 to June 2019. Only patients referred after an in-person primary-care visit in which the provider documented a specific concerning lesion were included. Multivariate analyses were performed to explore variables associated with delays or failure to complete dermatology referrals. RESULTS Patients were more likely to complete their referral if they had a personal history (adjusted odds ratio [aOR] = 7.843, 95% CI 1.383-14.304) or family history (aOR = 11.307, 95% CI 2.344-20.27) of skin cancer. Patients were more likely to delay referral completion past 30 days if they were ages 18 to 34 (aOR = 6.665, 95% CI 1.285-12.044) and less likely to delay referral past 30 days if they had a previous history of skin cancer (aOR = 0.531, 95% CI 0.181-0.882). LIMITATIONS Single institution, retrospective study, limited surgical patients. CONCLUSION Understanding factors associated with delays in dermatology referral completion can help identify at-risk patient populations.
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Affiliation(s)
- Jonathan Lai
- Johns Hopkins Department of Medicine, Baltimore, Maryland
| | - Aaron Bao
- Johns Hopkins Department of Medicine, Baltimore, Maryland
| | - Tara McCaffrey
- Johns Hopkins Department of Medicine, Baltimore, Maryland
| | - Rumsha Salman
- Johns Hopkins Department of Medicine, Baltimore, Maryland
| | | | - Emanuelle Rizk
- Johns Hopkins Department of Medicine, Baltimore, Maryland
| | | | | | - Kristin Bibee
- Johns Hopkins Department of Medicine, Baltimore, Maryland
- Johns Hopkins Department of Dermatology, Baltimore, Maryland
| | - Jeffrey Scott
- Clinical Skin Center of Northern Virginia, Fairfax, Virginia
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Joshi P, Ogobuiro I, Hernandez A, De La Cruz Ku G, Noe DG, Feun L, Liu ZJ, Möller MG. Racial and ethnic minorities in lower income brackets are associated with late-stage diagnosis of non-ocular melanoma. Cancer Epidemiol 2023; 87:102489. [PMID: 37979223 DOI: 10.1016/j.canep.2023.102489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/27/2023] [Accepted: 11/03/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Despite advances in oncologic care, racial and socio-economic outcome disparities persist in non-ocular melanoma patients. However, the unmet need is understanding the population at risk for late tumor stage at diagnosis. We sought to analyze the groups with an increased risk of unfavorable tumor stage at diagnosis. METHODS Patients with non-ocular melanoma were reviewed using the 2000-2019 SEER Research Data (SEER*Stat) and grouped into early tumor stage at diagnosis (stage I-IIC) and late (stage III-IVC). Multivariable logistic and Cox regression examined the association of demographic, socioeconomic, and clinical factors with late-stage diagnosis and overall survival, respectively. Kaplan-Meier estimates were calculated with racial and county-level household income stratification to evaluate overall survival differences. RESULTS Of 147,606 patients diagnosed with non-ocular melanoma, 38,695 cases were identified based on inclusion and exclusion criteria and separated into those with early-stage diagnosis (median 63 years) and those with late-stage (median 62 years). Male gender, Black race, Asian or Pacific Islander race, and Hispanic ethnicity were significantly associated with late-stage tumor diagnosis (p < 0.001). Receipt of surgery and a median county-level household income >$75,000 were protective for late-stage tumor diagnosis (p < 0.001). Additionally, male gender, Black, Asian or Pacific Islander, American Indian/Alaskan Native races, metastasis, and late-stage diagnosis were associated with factors significantly associated with decreased overall survival (p-value <0.001). Receipt of surgery and a median household income of $50,000-$74,999 and >$75,000 were factors associated with increased overall survival (p < 0.001). The median overall survival was 89 months, but Black patients (58 months) and <$50,000 income households (75 months) had significantly worse survival (p < 0.001). CONCLUSIONS Hispanic ethnicity, Black and Asian or Pacific Islander race, and low-income households were associated with late-stage non-ocular melanoma at diagnosis. Black, Asian or Pacific Islander and American Indian/Alaskan Native races and lower-income households were associated with worse overall survival. Identifying addressable causal factors that link this at-risk population to poor cancer prognosis is warranted.
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Affiliation(s)
- Priyashma Joshi
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Ifeanyichukwu Ogobuiro
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, FL, USA; University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alexandra Hernandez
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, FL, USA; University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gabriel De La Cruz Ku
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA; Universidad Cientifica del Sur, Lima, Peru
| | | | - Lynn Feun
- Department of Medicine-Division of Hematology Oncology, University of Miami Miller School of Medicine, Miami, FL, USA; University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Zhao-Jun Liu
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mecker G Möller
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA.
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15
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Tran AX, Barriera P, Xiong D, Knackstedt T. Racial-Ethnic, Education, and Socioeconomic Differences in the Treatment of Head and Neck Melanoma in situ: A Surveillance Epidemiology and End Results Population-Based Analysis. Dermatol Surg 2023; 49:1134-1138. [PMID: 37962949 DOI: 10.1097/dss.0000000000004005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Incidence and treatment disparities for cutaneous melanomas have been documented among racial and sociodemographic minorities. However, the association between treatment types, race, and socioeconomic status remains unknown. OBJECTIVE To characterize treatment differences for head and neck melanoma in situ (MIS) and lentigo maligna (LM) based on race and sociodemographic variables. MATERIALS AND METHODS A population-based retrospective cohort study of the Surveillance Epidemiology and End Results database (1998-2016) was performed. Univariate and multivariate logistic regression modeling evaluated the association of race and US census-reported sociodemographic factors with Mohs micrographic surgery (MMS) utilization. RESULTS A total of 76,328 adult patients with head and neck MIS/LM were included. MMS accounted for 11.8% of total cases, with increased utilization observed since 1998-2002. Compared with areas with greater percentages of individuals completing high school (first quartile), patients living in the second (Odds ratio [OR] 0.71; 95% confidence interval [CI] 0.64-0.80; p < .001), third (OR 0.74; 95% CI 0.63-0.86; p < .001), and fourth quartiles (OR 0.44; 95% CI 0.35-0.55; p < .001) were less likely to undergo MMS for their MIS/LM. CONCLUSION Educational efforts and awareness can bridge the knowledge gaps of appropriate treatment in patients with head and neck MIS/LM.
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Affiliation(s)
- Andrew X Tran
- Department of Dermatology, MetroHealth System, Cleveland, Ohio
| | - Paola Barriera
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David Xiong
- Department of Dermatology, University Hospitals, Cleveland, Ohio
| | - Thomas Knackstedt
- Department of Dermatology, Case Western Reserve School of Medicine, Cleveland, Ohio
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Pinehurst Dermatology & Mohs Surgery Center, Pinehurst, North Carolina
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16
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Rose MA, Miura J, Sharon C, Ermer JP, Karakousis G, Wachtel H. Current Patterns of Treatment and Outcomes in Advanced Melanoma at a Single Institution. J Surg Res 2023; 291:25-33. [PMID: 37331189 PMCID: PMC10524477 DOI: 10.1016/j.jss.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Treatment of advanced melanoma has been transformed by novel systemic therapies. The purpose of this study is to describe the current utilization patterns of immunotherapies with respect to survival outcomes in advanced melanoma. METHODS We performed a retrospective cohort study of patients with Stage 3 and 4 melanoma at our institution (2009-2019). Primary outcomes included overall survival (OS) and progression free survival (PFS). Kaplan-Meier survival analysis and Cox proportional hazards regression analysis evaluated associations between covariates and survival outcomes. RESULTS Of 244 patients, 5-y OS was 62.4%. Lymphovascular invasion (hazard ratio [HR] = 2.462, P = 0.030) was associated with shorter PFS whereas female gender (HR = 0.324, P = 0.010) was associated with longer PFS. Residual tumor (HR = 146, P = 0.006) and Stage 4 disease (HR = 3.349, P = 0.011) were associated with shorter OS. Use of immunotherapy increased from 2% to 23% over the study period, and use of neoadjuvant immunotherapy also increased up to 2016. Timing of immunotherapy administration was not significantly associated with survival. Of the 193 patients who received 2 or more treatment types, the most common treatment sequence was surgery followed by immunotherapy (n = 117, 60.6%). CONCLUSIONS Immunotherapy is increasingly used for treatment of advanced melanoma. In this heterogeneous cohort, there was no significant association between timing of immunotherapy and survival outcomes.
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Affiliation(s)
- Michelle A Rose
- Perelman School of Medicine, University of Pennsylvania, Philadelphia Pennsylvania
| | - John Miura
- Perelman School of Medicine, University of Pennsylvania, Philadelphia Pennsylvania; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cimarron Sharon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jae P Ermer
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Giorgos Karakousis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia Pennsylvania; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather Wachtel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia Pennsylvania; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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17
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Carvajal P, Zoroquiain P. PRAME/MELAN-A double immunostaining as a diagnostic tool for conjunctival melanocytic lesions: A South American experience. Pathol Res Pract 2023; 250:154776. [PMID: 37696245 DOI: 10.1016/j.prp.2023.154776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/19/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION PRAME (PReferentially expressed Antigen in Melanoma) is an antigen that is predominantly expressed in human melanomas. In cutaneous melanocytic lesions, PRAME expression is associated with malignancy. The objective of this study was to evaluate the co-expression of PRAME and Melan A to evaluate their diagnostic value in different conjunctival melanocytic lesions (CML). METHODS 37 CML (23 nevi, 9 primary acquired melanosis (PAM), and 5 conjunctival melanomas) were evaluated by immunohistochemistry for PRAME and Melan-A. The percentage of melanocytic cells co-expressing PRAME and Melan-A was qualitatively evaluated as follows: negative, 0%; 1 + , 1-25%; 2 + , 26-50%; 3 + , 51-75% and 4 + , ≥ 76%. RESULTS Of the invasive melanoma cases, 80% showed a 4 + pattern of marking, whereas 20% showed a 3 + pattern. 11% of the PAMs showed a 4 + pattern and 88.9% showed a 1 + pattern. All the nevi showed a 1 + pattern. The sensitivity and specificity of PRAME 4 + for differentiating high-grade CML from the benign and low-grade grouped CML are 93% and 100%, respectively. CONCLUSION PRAME/MELAN-A double immunostain is particularly useful to differentiate benign from malignant conjunctival melanocytic lesions.
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Affiliation(s)
- Pedro Carvajal
- Pathology Department, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - Pablo Zoroquiain
- Pathology Department, School of Medicine, Pontificia Universidad Católica de Chile, Chile.
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18
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Fane LS, Wei AH, Tripathi R, Bordeaux JS. Asian American and Pacific Islander patients with melanoma have increased odds of treatment delays: A cross-sectional study. J Am Acad Dermatol 2023; 89:529-536. [PMID: 37224968 DOI: 10.1016/j.jaad.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/26/2023] [Accepted: 05/06/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Asian American and Pacific Islander (AAPI) melanoma patients have higher mortality than non-Hispanic White (NHW) patients. Treatment delays may contribute, but whether AAPI patients have longer time from diagnosis to definitive surgery (TTDS) is unknown. OBJECTIVES Investigate TTDS differences between AAPI and NHW melanoma patients. METHODS Retrospective review of AAPI and NHW melanoma patients in the National Cancer Database (NCD) (2004-2020). The association of race with TTDS was evaluated by multivariable logistic regression, controlling for sociodemographic characteristics. RESULTS Of 354,943 AAPI and NHW melanoma patients identified, 1155 (0.33%) were AAPI. AAPI patients had longer TTDS for stage I, II, and III melanoma (P < .05 for all). Adjusting for sociodemographic factors, AAPI patients had 1.5 times the odds of a TTDS between 61 and 90 days and twice the odds of a TTDS >90 days. Racial differences in TTDS persisted in Medicare and private insurance types. Uninsured AAPI patients had the longest TTDS (mean, 53.26 days), while those with private insurance had the shortest TTDS (mean, 34.92 days; P < .001 for both). LIMITATION AAPI patients comprised 0.33% of the sample. CONCLUSIONS AAPI melanoma patients have increased odds of treatment delays. Associated socioeconomic differences should inform efforts to reduce disparities in treatment and survival.
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Affiliation(s)
- Lauren S Fane
- School of Medicine, Case Western Reserve University, Cleveland, Ohio.
| | - Angela H Wei
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Raghav Tripathi
- Department of Dermatology, Johns Hopkins, Baltimore, Maryland
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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19
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Brunsgaard EK, Jensen J, Grossman D. Melanoma in skin of color: Part II. Racial disparities, role of UV, and interventions for earlier detection. J Am Acad Dermatol 2023; 89:459-468. [PMID: 35533770 DOI: 10.1016/j.jaad.2022.04.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/08/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
Despite a higher incidence of melanoma among White individuals, melanoma-specific survival is worse among individuals with skin of color. Racial disparities in survival are multifactorial. Decreased skin cancer education focused on people with skin of color, lower rates of screening, increased socioeconomic barriers, higher proportions of more aggressive subtypes, and underrepresentation in research and professional education contribute to delays in diagnosis and treatment. Although high, intermittent UV exposure during childhood has been established as a significant modifiable risk factor for melanoma in individuals with lighter skin phototypes, there are limited data on UV exposure and melanoma risk in people with darker skin phototypes. The second article of this continuing medical education series will examine factors contributing to racial disparities in melanoma-specific survival, discuss the role of UV radiation, and address the need for further research and targeted educational interventions for melanoma in individuals with skin of color.
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Affiliation(s)
- Elise K Brunsgaard
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Jakob Jensen
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah; Department of Communication, University of Utah, Salt Lake City, Utah
| | - Douglas Grossman
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah; Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah; Department of Oncological Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah.
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20
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Olateju OA, Zeng Z, Thornton JD, Mgbere O, Essien EJ. Management of metastatic melanoma in Texas: disparities in the utilization of immunotherapy following the regulatory approval of immune checkpoint inhibitors. BMC Cancer 2023; 23:655. [PMID: 37442992 DOI: 10.1186/s12885-023-11142-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The utilization of modern-immunotherapies, notably immune checkpoint inhibitors (ICIs), has increased markedly in patients with metastatic melanoma over the past decade and are recommended as standard treatment. Given their increasing adoption in routine care for melanoma, understanding patient access to immunotherapy and patterns of its use in Texas is crucial as it remains one of the few states without Medicaid expansion and with high rates of the uninsured population. The objectives of this study were to examine the trend in the utilization of immunotherapy and to determine factors associated with immunotherapy utilization among patients with metastatic melanoma in the era of ICIs in Texas. METHODS A retrospective cohort study was conducted using the Texas Cancer Registry (TCR) database. The cohort comprised of adult (≥ 18 years) patients with metastatic melanoma diagnosed between June 2011 and December 2018. The trend in immunotherapy utilization was assessed by determining the proportion of patients receiving immunotherapy each year. The Average Annual Percent Change (AAPC) in immunotherapy utilization was assessed using joinpoint regression, while multivariable logistic regression was used to determine the association between patient characteristics and immunotherapy receipt. RESULTS A total of 1,795 adult patients with metastatic melanoma were identified from the TCR. Immunotherapy utilization was higher among younger patients, those with no comorbidities, and patients with private insurance. Multivariable analysis showed that the likelihood of receipt of immunotherapy decreased with older age [(adjusted Odds Ratio (aOR), 0.92; 95% CI, 0.89- 0.93, p = 0.001], living in high poverty neighborhood (aOR, 0.52; 95% CI, 0.44 - 0.66, p < 0.0001), having Medicaid (aOR, 0.58; 95% CI, 0.44 - 0.73, p = 0.02), being uninsured (aOR, 0.49; 95% CI, 0.31 - 0.64, p = 0.01), and having comorbidities (CCI score 1: aOR, 0.48; 95% CI, 0.34 - 0.71, p = 0.003; CCI score ≥ 2: aOR, 0.32; 95% CI, 0.16 - 0.56, p < 0.0001). CONCLUSIONS AND RELEVANCE This cohort study identified sociodemographic and socioeconomic disparities in access to immunotherapy in Texas, highlighting the need for policies such as Medicaid expansion that would increase equitable access to this innovative therapy.
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Affiliation(s)
- Olajumoke A Olateju
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA
| | - Zhen Zeng
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA
| | - J Douglas Thornton
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA
| | - Osaro Mgbere
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA
- Institute of Community Health, University of Houston College of Pharmacy, Houston, TX, USA
- Public Health Science and Surveillance Division, Houston Health Department, Houston, TX, USA
| | - Ekere James Essien
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA.
- Institute of Community Health, University of Houston College of Pharmacy, Houston, TX, USA.
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21
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Tripathi R, Larson K, Fowler G, Han D, Vetto JT, Bordeaux JS, Yu WY. ASO Author Reflections: Using Big Data to Bring Precision Medicine to Melanoma Management. Ann Surg Oncol 2023; 30:4329-4330. [PMID: 36820933 DOI: 10.1245/s10434-023-13268-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Johns Hopkins Medicine, Baltimore, MD, USA.
| | | | - Graham Fowler
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Dale Han
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - John T Vetto
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Jeremy S Bordeaux
- Department of Dermatology, Case Comprehensive Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Wesley Y Yu
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
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22
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Gazivoda VP, Koshenkov VP, Kangas-Dick AW, Greenbaum A, Davis C, Smith FO, Hilden PD, Berger AC. Factors Associated With Upstaging of Melanoma Thickness on Final Excision. J Surg Res 2023; 289:253-260. [PMID: 37150080 DOI: 10.1016/j.jss.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 02/19/2023] [Accepted: 04/04/2023] [Indexed: 05/09/2023]
Abstract
INTRODUCTION The incidence and risk factors associated with upstaging from initial biopsy to definitive excision in cutaneous melanoma have not been established. The aim of this study was to determine the incidence of tumor stage upstaging and associated risk factors using the National Cancer Database. METHODS A retrospective study of the National Cancer Database between 2012 and 2016 was performed. The cohort of patients undergoing excision of melanoma with available data comprised 133,592 patients. Differences in characteristics for upstaging were determined using Wilcox rank-sum, chi-square, or Fisher's exact tests. Multivariable analysis was performed using logistic regression to determine factors associated with upstaging. RESULTS Incidence of upstaging was 5.2%. Upstaged patients were older, male, of non-White race, and of lower education level (P < 0.001). Lesions of the head/neck and lower extremity had increased incidence of upstaging compared to the trunk (P < 0.001). Nodular and acral lentiginous melanoma was associated with higher incidence of upstaging compared to superficial spreading melanoma (P < 0.001). Patients with lymphovascular invasion had increased risk of upstaging (P < 0.001). CONCLUSIONS Upstaging of melanoma is infrequent but is significantly more prevalent in non-White patients and those with lower educational status. Provider and patient education should include the higher risk of upstaging in these groups and the possible need for further surgical intervention, such as re-excision of margins and sentinel lymph node biopsy.
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Affiliation(s)
- Victor P Gazivoda
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Vadim P Koshenkov
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Aaron W Kangas-Dick
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Alissa Greenbaum
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Catherine Davis
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Franz O Smith
- Division of Surgical Oncology, RWJ Barnabas Health, Livingston, New Jersey
| | - Patrick D Hilden
- Department of Biostatistics, RWJ Barnabas Health, Livingston, New Jersey
| | - Adam C Berger
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
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23
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Garrison ZR, Hall CM, Fey RM, Clister T, Khan N, Nichols R, Kulkarni RP. Advances in Early Detection of Melanoma and the Future of At-Home Testing. Life (Basel) 2023; 13:life13040974. [PMID: 37109503 PMCID: PMC10145469 DOI: 10.3390/life13040974] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/17/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
The past decade has seen numerous advancements in approaches to melanoma detection, each with the common goal to stem the growing incidence of melanoma and its mortality rate. These advancements, while well documented to increase early melanoma detection, have also garnered considerable criticism of their efficacy for improving survival rates. In this review, we discuss the current state of such early detection approaches that do not require direct dermatologist intervention. Our findings suggest that a number of at-home and non-specialist methods exist with high accuracy for detecting melanoma, albeit with a few notable concerns worth further investigation. Additionally, research continues to find new approaches using artificial intelligence which have promise for the future.
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Affiliation(s)
- Zachary R Garrison
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Connor M Hall
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Rosalyn M Fey
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Terri Clister
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Nabeela Khan
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Rebecca Nichols
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Rajan P Kulkarni
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
- Cancer Early Detection Advanced Research Center (CEDAR), Portland, OR 97239, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR 97239, USA
- Operative Care Division, U.S. Department of Veterans Affairs Portland Health Care System, Portland, OR 97239, USA
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Abstract
Health disparities are differences in health or disease incidence, prevalence, severity, or disease burden that are experienced by disadvantaged populations. Their root causes are attributed in large part to socially determined factors, including educational level of attainment, socioeconomic status, and physical and social environments. There is an expanding body of evidence documenting differences in dermatologic health status among underserved populations. In this review, the authors highlight inequities in outcomes across 5 dermatologic conditions, including psoriasis, acne, cutaneous melanoma, hidradenitis suppurativa, and atopic dermatitis.
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Affiliation(s)
- Stafford G Brown
- Eastern Virginia Medical School; William & Mary Raymond A. Mason School of Business
| | - Caryn B C Cobb
- Hampton University Skin of Color Research Institute; The Warren Alpert Medical School of Brown University
| | - Valerie M Harvey
- Hampton Roads Center for Dermatology, 860 Omni Boulevard, Suite 114, Newport News, VA 23606, USA.
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25
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Ogunleye TA. Unconscious Bias. Dermatol Clin 2023; 41:285-290. [PMID: 36933917 DOI: 10.1016/j.det.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Unconscious biases (also known as implicit biases) are involuntary stereotypes or attitudes held about certain groups of people that may influence our behaviors, understandings, and actions, often with unintended detrimental consequences. Implicit bias appears in multiple facets of medical education, training, and promotion with negative effects on diversity and equity efforts. Notable health disparities exist among minority groups in the United States, which may partly be attributable to unconscious biases. Although there is little evidence supporting the effectiveness of current bias/diversity training programming, standardization and blinding may be helpful, evidence-based methods to reduce implicit bias.
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Affiliation(s)
- Temitayo A Ogunleye
- Perelman School of Medicine at the University of Pennsylvania, 3737 Market Street, 11th Floor, Philadelphia, PA 19104, USA.
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Avila FR, Spaulding AC, Rinker BD, Huayllani MT, Boczar D, Torres-Guzman RA, Maita KC, Ho OA, Forte AJ. Demographic Characteristics Influence Treatment Costs of Invasive Melanoma in Florida. Ann Plast Surg 2023; 90:248-254. [PMID: 36796047 DOI: 10.1097/sap.0000000000003422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Demographic characteristics are known to influence the treatment and outcomes of patients with invasive melanoma. Whether these characteristics influence treatment costs is unknown. We aimed to analyze whether patient demographics and tumor characteristics influence treatment costs for patients with invasive cutaneous melanoma in Florida. METHODS This was a cross-sectional study in which the Florida Inpatient and Outpatient Dataset of the Agency for Health Care Administration was analyzed for patients with a diagnosis of invasive melanoma between January 1, 2013 and December 31, 2018. Categorical variables were assessed using Pearson χ2 tests, and continuous variables were evaluated using Kruskal-Wallis tests. Logistic regression analysis was conducted to identify the association between patient demographics and total costs. All analyses were done using SAS 9.4 statistical software (SAS Institute, Inc). RESULTS Multivariate analysis showed that sex (P < 0.001), hospital setting (P < 0.001), race/ethnicity (P < 0.01), patient region (P < 0.01), Elixhauser Comorbidity Index score (P < 0.001), presence of metastasis (P < 0.01), total number of procedures (P < 0.001), and length of stay (P < 0.001) were correlated with the cost of treatment of invasive cutaneous melanoma. After stratification, the association between cost and race/ethnicity disappeared for inpatients but remained for Black patients in the outpatient setting (P < 0.001). The association between cost and patient residence regions also differed when the cohort was stratified. CONCLUSIONS Strategies addressing disparities in treatment cost of invasive melanoma should differ, depending on the hospital setting where the patient is being treated.
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Affiliation(s)
| | - Aaron C Spaulding
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | | | - Maria T Huayllani
- Department of Plastic and Reconstructive Surgery, Ohio State University, Columbus, OH
| | - Daniel Boczar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
| | | | | | - Olivia A Ho
- From the Division of Plastic Surgery, Mayo Clinic
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27
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Seck S, Hamad J, Schalka S, Lim HW. Photoprotection in skin of color. Photochem Photobiol Sci 2023; 22:441-456. [PMID: 36227521 DOI: 10.1007/s43630-022-00314-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/25/2022] [Indexed: 10/17/2022]
Abstract
As populations in many parts of the world are projected to become more racially diverse over the coming decades, we must better understand the unique characteristics of the skin of populations with skin of color (SOC). This review aims to highlight important physiologic and clinical considerations of photoprotection in SOC. Ultraviolet radiation and visible light affect dark and light skin differently. SOC populations have historically not been informed on photoprotection to the same degree as their light skinned counterparts. This has exacerbated dermatologic conditions in which SOC populations are disproportionately affected, such as hyperpigmentary disorders. Patients should be encouraged to utilize multiple methods of photoprotection, ranging from avoidance of sunlight during peak intensity hours, seeking shade, wearing sun-protective clothing and wide-brimmed hat, and applying sunscreen. Ideal sunscreens for SOC populations include those with UVA-PF/SPF ratios ≥ 2/3 and tinted sunscreens to protect against VL. Although there have been increased efforts recently, more research into photoprotection for SOC and targeted public education are required to disseminate photoprotection resources that are patient-centered and evidence-based.
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Affiliation(s)
- Sokhna Seck
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Judy Hamad
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health, Henry Ford Medical Center - New Center One, 3031 West Grand Blvd, Suite 800, Detroit, MI, 48202, USA
| | | | - Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health, Henry Ford Medical Center - New Center One, 3031 West Grand Blvd, Suite 800, Detroit, MI, 48202, USA.
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Muacevic A, Adler JR, Adolphe L, Milani K. Racial Differences in Perceived Risk and Sunscreen Usage. Cureus 2023; 15:e33752. [PMID: 36793846 PMCID: PMC9925027 DOI: 10.7759/cureus.33752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2022] [Indexed: 01/15/2023] Open
Abstract
Background Although White individuals have higher incidence of melanoma, clinical outcomes are worse among patients with skin of color. This disparity arises from delayed diagnoses and treatment that are largely due to clinical and sociodemographic factors. Investigating this discrepancy is crucial to decrease melanoma-related mortality rates in minority communities. A survey was used to investigate the presence of racial disparities in perceived sun exposure risks and behaviors. Methods A survey consisting of 16 questions was deployed via social media to assess skin health knowledge. Over 350 responses were recorded, and the extracted data were analyzed using statistical software. Results Of the respondents, White patients were significantly more likely to have higher perceived risk of developing skin cancer, highest levels of sunscreen usage, and higher reported frequency of skin checks performed by primary care providers (PCPs). There was no difference between racial groups in the amount of education provided by PCPs related to sun exposure risks. Conclusion The survey findings suggest inadequate dermatologic health literacy as a result of other factors such as public health and sunscreen product marketing rather than as a consequence of inadequate dermatologic education provided in healthcare settings. Factors such as racial stereotypes in communities, implicit biases in marketing companies, and public health campaigns should be considered. Further studies should be conducted to determine these biases and improve education in communities of color.
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29
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Zheng DX, Cwalina TB, Mulligan KM, Levoska MA, Scott JF, Mostaghimi A. Prevalence and predictors of transportation barriers to health care among US adults with a history of skin cancer. J Am Acad Dermatol 2023; 88:201-203. [PMID: 35461984 DOI: 10.1016/j.jaad.2022.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Affiliation(s)
- David X Zheng
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
| | - Thomas B Cwalina
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Kathleen M Mulligan
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Melissa A Levoska
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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30
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Fernandez JM, Poling KL, Desai AD, Koblinski JE, Borgstrom M, Abraham I, Behbahani S. Primary cutaneous melanoma in Black patients: An analysis of 2464 cases from the National Cancer Database 2004-2018. Pigment Cell Melanoma Res 2023; 36:42-52. [PMID: 36112089 DOI: 10.1111/pcmr.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/12/2022] [Indexed: 12/31/2022]
Abstract
Melanoma in Black patients carries a poor prognosis. Due to its rarity, melanoma in this population has not been well characterized. This study evaluates survival predictors in Black patients with melanoma. This was a retrospective cohort study of Black patients with cutaneous melanoma from the National Cancer Database 2004-2018. Of the 2464 cases, melanoma was more common among females than males (57.1% vs. 42.9%, p < .001). Median Breslow depth was 1.8 mm (interquartile range 0.4-4.4). Lower extremities were the most common location (52.8%), followed by upper extremities (13.1%) along with otherwise specified/overlapping/other (13.1%), then by trunk (11.8%), and lastly head and neck (9.2%). Stage at diagnosis was I (30.7%), II (27.5%), III (24.1%), and IV (17.7%). Ulceration was observed in 41.4% of lesions. Acral lentiginous melanoma (ALM) was the most common specific histologic subtype (20.3%), followed by superficial spreading melanoma (9.4%). After adjusting for confounders, higher stages and primary site on the head and neck were the strongest independent predictors of worse overall survival. Melanoma in Black patients is most likely to appear on the lower extremities. A large portion (41.8%) presented with stage III or IV disease. ALM was the most common specific histologic subtype.
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Affiliation(s)
- Jennifer M Fernandez
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kristi L Poling
- College of Medicine - Tucson, University of Arizona, Tucson, Arizona, USA
| | - Amar D Desai
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jenna E Koblinski
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mark Borgstrom
- University Information Technology Services, University of Arizona, Tucson, Arizona, USA
| | - Ivo Abraham
- Center for Health Outcomes and Pharmacoeconomic Research, University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Sara Behbahani
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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31
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McKenzie S, Brown-Korsah JB, Syder NC, Omar D, Taylor SC, Elbuluk N. Variations in genetics, biology, and phenotype of cutaneous disorders in skin of color. Part II: Differences in clinical presentation and disparities in cutaneous disorders in skin of color. J Am Acad Dermatol 2022; 87:1261-1270. [PMID: 35817332 DOI: 10.1016/j.jaad.2022.03.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/20/2022]
Abstract
Skin of color (SOC) patients are projected to comprise the majority of the population by 2044, yet knowledge gaps in the clinical presentation and treatment of both common and uncommon dermatologic conditions in skin of color persist. Improved awareness of disparities that disproportionately impact SOC patients is necessary to address health inequity in the field of dermatology. The first part of this CME discussed structural, genetic, and immunophenotypic differences in SOC in common inflammatory disorders as well as cutaneous malignancies. The second part of this CME highlights clinical differences in the phenotypic presentation of the inflammatory disorders of atopic dermatitis, psoriasis, and hidradenitis suppurativa as well as the cutaneous malignancies of melanoma, basal cell carcinoma, and cutaneous T-cell lymphoma. Health disparities associated with each of these conditions are also discussed.
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Affiliation(s)
- Shanice McKenzie
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jessica B Brown-Korsah
- Case Western Reserve University, School of Medicine, Cleveland, Ohio; Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicole C Syder
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Deega Omar
- George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California.
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32
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McElroy-Brooklyn J, Faires Griffith C. A Decline in Black and Dermatology Physician Assistants. J Physician Assist Educ 2022; 33:275-276. [PMID: 36355607 DOI: 10.1097/jpa.0000000000000469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Jameka McElroy-Brooklyn
- Jameka McElroy-Brooklyn, PA-C, is a physician assistant at Pinnacle Dermatology in Woodbridge, Virginia
- Cynthia Griffith, MPAS, PA-C, is a physician assistant in the Department of Dermatology at the University of Texas Southwestern Medical Center in Dallas, Texas
| | - Cynthia Faires Griffith
- Jameka McElroy-Brooklyn, PA-C, is a physician assistant at Pinnacle Dermatology in Woodbridge, Virginia
- Cynthia Griffith, MPAS, PA-C, is a physician assistant in the Department of Dermatology at the University of Texas Southwestern Medical Center in Dallas, Texas
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Fabregas JC, Carter BT, Lutzky J, Robinson WR, Brant JM. Impact of Medicaid Expansion Status and Race on Metastatic Disease at Diagnosis in Patients with Melanoma. J Racial Ethn Health Disparities 2022; 9:2291-2299. [PMID: 34648145 DOI: 10.1007/s40615-021-01166-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Black patients are diagnosed with melanoma at a later stage, as compared with their white counterparts. It is unknown if Medicaid expansion might ameliorate this disparity. METHODS Using data from the 2016 National Cancer Database, we conducted a retrospective cohort study. The primary objective was to evaluate whether being diagnosed with melanoma at a Medicaid Expansion State (MES) and black race are associated with a late diagnosis of melanoma. Main exposure: Being diagnosed in a MES. Secondary exposure: Race. Main outcome: Odds of Stage IV vs Stages 0-III at diagnosis. Univariate, multivariate logistic regression, and propensity score analyses were conducted to evaluate the potential associations. Sub-group analysis was conducted according to age < 65 or ≥ 65 years. RESULTS A total of 216,604 patients were included, 40-90 years of age, [Formula: see text] 64 years [SD 12.47]. In univariate analysis, patients diagnosed in MES were 15% less likely (95% CI, 0.81-0.88) to be diagnosed with Stage IV melanoma. Black race (vs white) had 3.04 increased odds (95% CI, 2.56-3.60) of late diagnosis. In multivariate analysis, adjusting for socio-economic confounders, patients < 65 years of age were 13% less likely (95% CI, 0.82-0.92) to be diagnosed with Stage IV melanoma. By propensity score analysis, the strength of the associations remained. Black race (vs white) was associated with higher odds (95% CI, 1.91-3.08) of being diagnosed with Stage IV disease. For black patients < 65 years, being diagnosed in a state without Medicaid expansion had 2.55 higher odds (95% CI, 1.93-3.38) of being diagnosed with Stage IV melanoma, which decreased to 2.11 odds (95% CI, 1.34-3.33) in MES. The interaction between race and MES was statistically significant (P = 0.008). CONCLUSIONS This study suggests that patients are less likely to be diagnosed with Stage IV melanoma in MES. This beneficial effect is more pronounced among Black minorities.
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Affiliation(s)
- Jesus C Fabregas
- University of Florida Health Cancer Center, University of Florida, 1600 SW Archer Road, D2-3, Gainesville, FL, 32610, USA
| | - Benjamin T Carter
- Billings Clinic, 2800 Tenth Avenue North, Billings, MT, 59107, USA.,Collaborative Science & Innovation, 2800 Tenth Avenue North, Billings, MT, 59101, USA
| | - Jose Lutzky
- University of Miami - Sylvester Comprehensive Cancer Center, 1475 NW Ave, Floor 2, Miami, FL, 33136, USA
| | - William Russell Robinson
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, J2500 N State St, Jackson, MS, 39216, USA
| | - Jeannine M Brant
- Billings Clinic, 2800 Tenth Avenue North, Billings, MT, 59107, USA.
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Hao X, Lai W, Xia X, Xu J, Wu Y, Lv C, Meng Q, Lv K, Huang S, Luo Z, Dong J, Yuan Q. Skin cancer outcomes and risk factors in renal transplant recipients: Analysis of organ procurement and transplantation network data from 2000 to 2021. Front Oncol 2022; 12:1017498. [PMID: 36505816 PMCID: PMC9731355 DOI: 10.3389/fonc.2022.1017498] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Posttransplant skin cancer is the most common malignancy after patients have undergone renal transplantation. Through comprehensive observation with a large sample size nationwide, understanding the risk factors and outcome of posttransplant skin cancer will help to develop appropriate patient surveillance and disease prevention strategies. Materials and methods This retrospective population-based cohort study was based on Organ Procurement and Transplantation Network data released in March 2021. Characteristics and outcomes, including patient survival and graft survival of recipients, were compared. Risk factors for posttransplant skin cancer, cancer onset momentum, and mortality were determined. Results A total of 199,564 renal transplant recipients were included. After renal transplantation, 7,334 (3.68%), 6,093 (3.05%), and 936 (0.47%) were diagnosed with squamous cell carcinoma, basal cell carcinoma, and melanoma, respectively. Skin cancer was the major cause of death (squamous cell carcinoma: 23.8%, basal cell carcinoma: 18%, and melanoma: 41.6%). Five-year survival rates ranked from best to worst were as follows: basal cell carcinoma (96.7 [95% confidence interval: 96.3-97.2]%), squamous cell carcinoma (94.1 [93.5-94.6]%), melanoma (89.7 [87.7-91.6]%), and cancer-free (87.4 [87.2-87.5]%) (p < 0.001 for all except melanoma vs. cancer-free, p = 0.534). Regarding graft survival, death-censored graft survival, posttransplant skin cancer, and melanoma were significantly better than the cancer-free group (p < 0.001). Independent risk factors for developing posttransplant skin cancer included older age, male sex, Caucasian race, pretransplant malignancy, polycystic kidney disease-induced end-stage renal disease (ESRD), retransplantation, private health insurance, T-cell depletion induction, and tacrolimus/mycophenolic acid use. Caucasian race and pretransplant malignancy were independent risk factors for posttransplant skin cancer onset momentum. Male sex, Caucasian race, pretransplant malignancy, hypertension- or diabetes-induced ESRD, retransplantation, diabetes history, deceased donor, cyclosporin, and mTOR inhibitor use were independent risk factors for posttransplant skin cancer mortality. Conclusion Although posttransplant skin cancer is a major cause of recipient death, information regarding its impact on patient and graft survival is limited. Given the differences regarding risk factors for posttransplant skin cancer incidence, onset momentum, and mortality, personalized approaches to screening may be appropriate to address the complex issues encountered by kidney transplant recipients.
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Affiliation(s)
- Xiaowei Hao
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China,Department of Urology, No.971 Hospital of PLA Navy, Tsingtao, Shandong, China
| | - Wenhui Lai
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China,Department of Postgraduate, Hebei North University, Zhangjiakou, Hebei, China
| | - Xinze Xia
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China,Department of Urology, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Junnan Xu
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yangyang Wu
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chao Lv
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qingyang Meng
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Kaikai Lv
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shuai Huang
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China,Department of Postgraduate, Hebei North University, Zhangjiakou, Hebei, China
| | - Zhenjun Luo
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China,Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Jun Dong
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China,*Correspondence: Jun Dong, ; Qing Yuan,
| | - Qing Yuan
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China,*Correspondence: Jun Dong, ; Qing Yuan,
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Kiuru M, Li Q, Zhu G, Terrell JR, Beroukhim K, Maverakis E, Keegan THM. Melanoma in women of childbearing age and in pregnancy in California, 1994-2015: a population-based cohort study. J Eur Acad Dermatol Venereol 2022; 36:2025-2035. [PMID: 35870141 PMCID: PMC9560982 DOI: 10.1111/jdv.18458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Melanoma is one of the most common malignancies during pregnancy. There is debate regarding the impact of pregnancy on the prognosis of melanoma. Recent large population-based studies from the United States are lacking. OBJECTIVES To determine the characteristics and survival of women with pregnancy-associated melanoma. METHODS This population-based, retrospective cohort study used California Cancer Registry data linked with state-wide hospitalization and ambulatory surgery data to identify 15-44-year-old female patients diagnosed with melanoma in 1994-2015, including pregnant patients. Multivariable logistic regression compared demographic and clinical characteristics between pregnant and non-pregnant women with melanoma. Multivariable cox proportional hazards regression models assessed melanoma-specific and overall survival. RESULTS We identified 13 108 patients, of which 1406 were pregnant. Pregnancy-associated melanoma was more frequent in Hispanic compared to non-Hispanic White women. Melanoma occurring post-partum was associated with greater tumour thickness (2.01-4.00 vs. 0.01-1.00 mm, odds ratio 1.75, 95% confidence interval: 1.03-2.98). There were otherwise no significant differences between pregnant and non-pregnant women. Worse survival was associated with Asian, Black and Native American race/ethnicity (vs. non-Hispanic White), lower neighbourhood socio-economic status, public insurance, tumour site, greater tumour thickness and lymph node involvement, but not pregnancy. CONCLUSIONS Melanoma occurring post-partum was associated with greater tumour thickness, but pregnancy status did not affect survival after melanoma. Race/ethnicity, socio-economic status and health insurance impacted survival, emphasizing the importance of reducing health disparities.
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Affiliation(s)
- M Kiuru
- Department of Dermatology, University of California Davis, Sacramento, California, USA
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California, USA
| | - Q Li
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis, Sacramento, California, USA
| | - G Zhu
- Department of Dermatology, University of California Davis, Sacramento, California, USA
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - J R Terrell
- Department of Dermatology, University of California Davis, Sacramento, California, USA
| | - K Beroukhim
- Department of Dermatology, University of California Davis, Sacramento, California, USA
| | - E Maverakis
- Department of Dermatology, University of California Davis, Sacramento, California, USA
| | - T H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis, Sacramento, California, USA
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Hauc SC, Rodriguez J, Long AS, Matejac K, Aboukhater LM, Ihnat JM, Junn A, Dinis J, Phillips S, Alperovich M. Racial and Geographic Disparities in Reconstructive Procedures Following Melanoma Resection. J Plast Reconstr Aesthet Surg 2022; 75:4212-4220. [PMID: 36182571 DOI: 10.1016/j.bjps.2022.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 07/26/2022] [Accepted: 08/16/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Melanoma occurs most commonly in non-Hispanic White patients; however, Black and Hispanic patients experience greater morbidity and mortality. This study assesses how race and socioeconomic factors influence rates of reconstructive procedures and hospital-based outcomes in melanoma patients. METHODS Data were extracted from the National Inpatient Sample database from the years 2010-2015. Patients with melanoma who underwent a reconstructive procedure were identified. Univariate and multivariate logistic regression analysis was used to identify the relationship between dependent variables and various patient/hospital components for patients undergoing reconstructive procedures. RESULTS Black and Hispanic patients had a greater length of stay (LOS) than non-Hispanic White patients (OR: 2.252, p = 0.0307, and OR: 2.592, p = 0.0014), and Hispanic patients were less likely to receive more complex reconstructive procedures (OR: 0.449, p = 0.0487). Patients living in rural areas were less likely to receive complex reconstructive procedures than those in both urban teaching and non-teaching hospitals (OR: 3.313, p = 0.0135, and OR: 3.505, p = 0.0074). Pedicled or rotational flaps were less likely to be performed at medium- or large-sized hospitals (OR: 0.610, p = 0.0296, and OR: 0.496, p = 0.0002). CONCLUSION Race and socioeconomic factors are important predictors of access to complex reconstructive procedures and hospital-based outcomes following extirpation in melanoma patients.
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Time-to-treatment initiation for cutaneous melanoma reflects disparities in healthcare access in Brazil: a retrospective study. Public Health 2022; 210:1-7. [PMID: 35863157 DOI: 10.1016/j.puhe.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/24/2022] [Accepted: 06/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aimed at identifying the sociodemographic and first treatment characteristics affecting time-to-treatment initiation (TTI) of patients with cutaneous melanoma assisted by the Brazilian Unified Health System (SUS). STUDY DESIGN Retrospective observational study using cutaneous melanoma cases recorded in the Brazilian Hospital-Based Cancer Registries (HBCR). METHODS A total of 12,783 cutaneous melanoma cases were included in the analysis. Based on the legislation, TTI in Brazil is 60 days; therefore, the cohort was dichotomized into TTI within 60 days and over. The association among variables was evaluated through the Chi-squared test. Kaplan-Meier method and log-rank hypothesis test were used to determine the probability of initiating treatment within 60 days. Cox proportional hazards regression model was used for multivariate analysis. RESULTS Median TTI was 28 days (95% CI, 25-29). First treatment in SUS provided more than 60 days after diagnosis (34.8%) was associated with females; low level of formal education; living or getting treatment in northern Brazil; being diagnosed in SUS and treated at different healthcare facilities, in addition to starting treatment with radiotherapy or systemic therapy. There were no significant differences in access to health care before and after the enactment of the 60-day law. CONCLUSION Increased TTI for cutaneous melanoma is associated with sociodemographic and first treatment characteristics in Brazil; approximately one-third of cases did not have access to first treatment within the period established by law. Receiving the diagnosis and treatment at different healthcare facilities (transitions in care) is the main independent factor associated with TTI longer than 60 days.
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Shao K, Feng H. Racial and Ethnic Healthcare Disparities in Skin Cancer in the United States: A Review of Existing Inequities, Contributing Factors, and Potential Solutions. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:16-22. [PMID: 35942012 PMCID: PMC9345197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective Racial and ethnic health disparities affect the diagnosis and management of melanoma and nonmelanoma skin cancers, leading to deleterious outcomes. Non-Hispanic White patients make up the majority of skin cancers cases, yet racial and ethnic minorities have poorer prognoses and outcomes. The skin cancer literature is fragmented with regards to potential contributors to these healthcare disparities. In this article, we provide a comprehensive review of the skin cancer literature to briefly quantify racial and ethnic inequities, highlight contributing factors, and propose practical changes that can be made. Methods A PubMed search was completed to identify articles related to racial and ethnic health care disparities in the context of melanoma, basal cell carcinoma, squamous cell carcinoma, Merkel cell carcinoma, and dermatofibrosarcoma protuberans. Results Relative to non-Hispanic White patients, patients of racial and ethnic minorities have differing clinical presentations of skin cancers and genetic risk factors. Insurance, access to specialty care, cultural beliefs, and available educational resources further contribute to racial and ethnic disparities. Limitations We are limited to the level of detail provided in the existing literature, and at some times are unable to distinguish race of Hispanic populations. We also acknowledge that there are different nationalities grouped under these broad labels as well as multi-racial populations that may not be accounted for. Conclusion Awareness of and familiarization with innate factors and potentially more modifiable contributors can help inform efforts to close the observed gap in racial and ethnic inequities.
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Affiliation(s)
- Kimberly Shao
- Both authors are with the Department of Dermatology at University of Connecticut, Farmington, Connecticut
| | - Hao Feng
- Both authors are with the Department of Dermatology at University of Connecticut, Farmington, Connecticut
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Gwan A, Tanner-Sanders LN, Nair N, Chapple AG, Jernigan A. Equity in visual representation of vulvar conditions in major gynecology textbooks. J Natl Med Assoc 2022; 114:314-323. [PMID: 35331566 DOI: 10.1016/j.jnma.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/03/2022] [Accepted: 02/14/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate images of vulvar conditions (VCs) in major gynecologic textbooks and describe the skin tone representation. METHODS Images of VCs in gynecological textbooks for medical students, obstetrics and gynecology (OBG) residents, and fellows were compiled. Texts were categorized into education levels (medical student, resident, or fellow) and selected based on the recommendations of OBG attendings and fellows at LSUHSCNew Orleans. Skin tones were scored according to the Fitzpatrick Scale (FS) and categorized as benign, infectious, inflammatory, and dysplasia/cancerous. Publishing and primary author demographics were collected. Proportional odds regression (POR) predicted FS based on image pathologies and book titles. RESULTS Of 512 images selected from 21 textbooks, 77.0% [N = 395] were lighter skin tones (FS I-III). VCs were represented by the darkest skin tone (FS of VI) in 19.6% of images in texts targeting residents, compared to 8.5% and 4.5% in fellow and student textbooks, respectively (p <0.001). Compared to a cornerstone surgical atlas, the pediatric and adolescent gynecology text consisted of lighter skin tones. A prominent general gynecology text used darker skin tones. Images of infectious conditions were more likely to be darker skin tones than other VCs (p = 0.010). CONCLUSIONS Most textbook images of VCs represent lighter skin tones, and women with darker skin are more underrepresented in texts geared at fellows and students. Inadequate exposure to the appearance of VCs on darker skin promotes and propagates racial inequities in healthcare. Medical textbooks should present visually diverse images of vulvar pathologies to train physicians to be well versed in caring for patients of all skin tones.
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Affiliation(s)
- Anwei Gwan
- Louisiana State University School of Medicine, New Orleans, LA
| | - La' Nasha Tanner-Sanders
- The Department of Obstetrics and Gynecology, Louisiana State University Health New Orleans, 1542 Tulane Avenue, New Orleans, LA 70112
| | - Navya Nair
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Louisiana State University Health New Orleans, 1542 Tulane Avenue, New Orleans, LA 70112
| | - Andrew G Chapple
- Biostatistics Program, School of Public Health, LSUHSC School of Public Health, 2020 Gravier St., New Orleans, LA 70112
| | - Amelia Jernigan
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Louisiana State University Health New Orleans, 1542 Tulane Avenue, New Orleans, LA 70112.
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Zakhem GA, Pulavarty AN, Lester JC, Stevenson ML. Skin Cancer in People of Color: A Systematic Review. Am J Clin Dermatol 2022; 23:137-151. [PMID: 34902111 DOI: 10.1007/s40257-021-00662-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND People of African, Asian, Hispanic or Latino, Pacific Islander, and Native Indian descent are considered people of color by the Skin of Color Society (SOCS). OBJECTIVES In this study, we assess incidence, risk factors, clinical characteristics, histopathology, treatment, and survival for skin malignancies in people of color as defined by the SOCS, by systematically reviewing the literature. METHODS An electronic literature search of the PubMed, EMBASE, and MEDLINE databases was performed. Articles published from 1 January 1990 through 12 December 2020 were included in the search. RESULTS We identified 2666 publications potentially meeting the study criteria. Titles and abstracts of these studies were reviewed and 2353 were excluded. The full text of 313 articles were evaluated and 251 were included in this review. CONCLUSION Differences in incidence, patterns, treatment, and survival exist among people of color for cutaneous malignancies. Further research and initiatives are needed to account for and mitigate these differences.
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Affiliation(s)
- George A Zakhem
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Akshay N Pulavarty
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Jenna C Lester
- University of California San Francisco, San Francisco, CA, USA
| | - Mary L Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA.
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Shao K, Hooper J, Feng H. Racial/Ethnic Health Disparities in Dermatology in the United States Part 2: Disease-specific Epidemiology, Characteristics, Management, and Outcomes. J Am Acad Dermatol 2022; 87:733-744. [PMID: 35143915 DOI: 10.1016/j.jaad.2021.12.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/02/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
Racial and ethnic disparities in dermatology negatively affect outcomes such as mortality and quality of life. Dermatologists and dermatologic surgeons should be familiar with disease-specific inequities that may influence their practice. The second article in this two-part continuing medical education series highlights gaps in frequency, clinical presentation, management, and outcomes by race and ethnicity. We review cutaneous malignancies including basal cell carcinoma, squamous cell carcinoma, melanoma, Merkel cell carcinoma, dermatofibrosarcoma protuberans, and cutaneous T cell lymphoma, and inflammatory disorders including atopic dermatitis, psoriasis, hidradenitis suppurativa, acne vulgaris, and rosacea.
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Affiliation(s)
- Kimberly Shao
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - Jette Hooper
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT.
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Lam M, Zhu JW, Hu A, Beecker J. Racial Differences in the Prognosis and Survival of Cutaneous Melanoma From 1990 to 2020 in North America: A Systematic Review and Meta-Analysis. J Cutan Med Surg 2021; 26:181-188. [PMID: 34676795 PMCID: PMC8950707 DOI: 10.1177/12034754211052866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Factors influencing the difference in the diagnosis and treatment of melanoma in racial minority groups are well-described in the literature and include atypical presentations and socioeconomic factors that impede access to care. Objective To characterize the differences in melanoma survival outcomes between non-Hispanic white patients and ethnic minority patients in North America. Methods We conducted searches of Embase via Ovid and MEDLINE via Ovid of studies published from 1989 to August 5, 2020. We included observational studies in North America which reported crude or effect estimate data on patient survival with cutaneous melanoma stratified by race. Results Forty-four studies met our inclusion criteria and were included in this systematic review. Pooled analysis revealed that black patients were at a significantly increased risk for overall mortality (HR 1.42, 95% CI, 1.25-1.60), as well as for melanoma-specific mortality (HR 1.27, 95% CI, 1.03-1.56). Pooled analyses using a representative study for each database yielded similar trends. Other ethnic minorities were also more likely report lower melanoma-specific survival compared to non-Hispanic white patients. Conclusion Our results support findings that melanoma patients of ethnic minorities, particularly black patients, experience worse health outcomes with regards to mortality. Overall survival and melanoma-specific survival are significantly decreased in black patients compared to non-Hispanic white patients. With the advent of more effective, contemporary treatments such as immunotherapy, our review identifies a gap in the literature investigating present-day or prospective data on melanoma outcomes, in order to characterize how current racial differences compare to findings from previous decades.
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Affiliation(s)
- Megan Lam
- 12362 Faculty of Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada
| | - Jie Wei Zhu
- 12362 Faculty of Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada
| | - Angie Hu
- 2129 Faculty of Science, University of Calgary, AB, Canada
| | - Jennifer Beecker
- Division of Dermatology, University of Ottawa, ON, Canada.,153195 The Ottawa Hospital, ON, Canada.,Ottawa Research Institute, ON, Canada.,Probity Medical Research Inc., Waterloo, ON, Canada
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Asare EA, Swami U, Stewart JH. Landmark Series on Disparities in Surgical Oncology: Melanoma. Ann Surg Oncol 2021; 28:6986-6993. [PMID: 34191178 DOI: 10.1245/s10434-021-10273-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although the lifetime risk of melanoma is disproportionately higher in whites, blacks have a poorer overall survival with an absolute survival difference of 25%. Significant progress has been made in melanoma treatment in the past decade; however, these successes may not be available or accessible to all segments of the population. METHODS In this review, we highlight important studies in melanoma as well as informative retrospective studies from databases and nonmelanoma cancers where appropriate. RESULTS There are no level I evidence-based studies on disparities in melanoma, and most likely there will never be, but the studies presented herein and clinical experience demonstrate that disparities in clinical outcomes from melanoma exists. CONCLUSIONS By becoming aware of the disparities, we can help mitigate them by engagement, education, and corrective and empowering actions through awareness campaigns, appropriate clinical trial design, encouraging participation in clinical trials, increasing the diversity of providers, and advocacy.
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Affiliation(s)
- Elliot A Asare
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA.,Intermountain Healthcare Center, Murray, UT, USA
| | - Umang Swami
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
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Narang J, Hue JJ, Bingmer K, Hardacre JM, Winter JM, Ocuin LM, Ammori JB, Mangla A, Bordeaux J, Rothermel LD. Sentinel lymph node biopsy guideline concordance in melanoma: Analysis of the National Cancer Database. J Surg Oncol 2021; 124:669-678. [PMID: 34109633 DOI: 10.1002/jso.26565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVES This study investigated the impact of treating facility type on guideline-concordant sentinel lymph node biopsy (SLNB) management in T1a* (defined as a Breslow depth <0.76 mm without ulceration or mitoses) and T2/T3 melanoma. METHODS This was a retrospective cohort study utilizing the National Cancer Database from 2012 to 2016. RESULTS Our cohort included 109,432 patients. For T1a* melanomas, 85% of patients received guideline-concordant SLNB management at community and academic facilities versus 75% of patients at integrated network facilities (p < .001). Over 83% of patients with T2/T3 melanoma treated at an academic facility received guideline-concordant SLNB management versus 77% treated at a community facility (p < .001). Adjusting for demographic and clinical factors, integrated (adjusted odds ratio, aOR = 0.54), and comprehensive community (aOR = 0.74) facilities were less likely to provide guideline-concordant SLNB management in patients with T1a* melanoma compared to academic facilities. Community facilities (aOR = 0.72) were less likely to provide guideline-concordant SLNB management in patients with T2/T3 melanoma compared to academic facilities. CONCLUSION Academic facilities provide the highest rate of guideline-concordant sentinel lymph node management. Comparatively, community programs may underutilize SLNB in T2/T3 disease, while integrated and comprehensive community facilities may over-utilize SLNB in T1a* disease.
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Affiliation(s)
- Jatin Narang
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Jonathan J Hue
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | | | - Jordan M Winter
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lee M Ocuin
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - John B Ammori
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ankit Mangla
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jeremy Bordeaux
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luke D Rothermel
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Ashrafzadeh S, Asgari MM, Geller AC. The Need for Critical Examination of Disparities in Immunotherapy and Targeted Therapy Use Among Patients With Cancer. JAMA Oncol 2021; 7:1115-1116. [PMID: 34042941 DOI: 10.1001/jamaoncol.2021.1322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sepideh Ashrafzadeh
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Maryam M Asgari
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts.,Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Cwalina TB, Jella TK, Zheng DX, Tripathi R, Levoska MA, Bordeaux JS, Scott JF. Utilization of health information technology among skin cancer patients: A cross-sectional study of the National Health Interview Survey from 2011 to 2018. J Am Acad Dermatol 2021; 86:899-902. [PMID: 33744360 DOI: 10.1016/j.jaad.2021.03.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Thomas B Cwalina
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Tarun K Jella
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David X Zheng
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Raghav Tripathi
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Melissa A Levoska
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Li W, Xiao Y, Xu X, Zhang Y. A Novel Nomogram and Risk Classification System Predicting the Cancer-Specific Mortality of Patients with Initially Diagnosed Metastatic Cutaneous Melanoma. Ann Surg Oncol 2020; 28:3490-3500. [PMID: 33191484 DOI: 10.1245/s10434-020-09341-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/22/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cutaneous melanoma and distant organ metastasis has varying outcomes. Considering all prognostic indicators in a prediction model might assist in selecting cases who could benefit from a personalized therapy strategy. OBJECTIVE This study aimed to develop and validate a prognostic model for patients with metastatic melanoma. METHODS A total of 1535 cases diagnosed with metastatic cutaneous melanoma (stage IV) were identified from the Surveillance, Epidemiology, and End Results database. Patients were randomly divided into the training (n = 1023) and validation (n = 512) cohorts. A prognostic nomogram was established based predominantly on results from the competing-risk regression model for predicting cancer-specific death (CSD). The area under the time-dependent receiver operating characteristic curve (AUC), calibration curves, and decision curve analyses (DCAs) were used to evaluate the nomogram. RESULTS No significant differences were observed in the clinical characteristics between the training and validation cohorts. In the training cohort, patient-, tumor-, and treatment-related predictors of CSD for metastatic melanoma included age, sex, race, marital status, insurance, American Joint Committee on Cancer T and N stage, number of metastatic organs, surgical treatment, and chemotherapy. All these factors were used for nomogram construction. The time-dependent AUC values of the training and validation cohorts suggested a favorable performance and discrimination of the nomogram. The 6-, 12-, and 18-month AUC values were 0.706, 0.700, and 0.706 in the training cohort, and 0.702, 0.670, and 0.656 in the validation cohort, respectively. The calibration curves for the probability of death at 6, 12, and 18 months showed acceptable agreement between the values predicted by the nomogram and the observed outcomes in both cohorts. DCA curves showed good positive net benefits in the prognostic model among most of the threshold probabilities at different time points (death at 6, 12, and 18 months). Based on the total nomogram scores of each case, all patients were divided into the low-risk (n = 511), intermediate-risk (n = 512), and high-risk (n = 512) groups, and the risk classification could identify cases with a high risk of death in both cohorts. CONCLUSIONS A predictive nomogram and a corresponding risk classification system for CSD in patients with metastatic melanoma were developed in this study, which may assist in patient counseling and in guiding clinical decision making for cases with metastatic melanoma.
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Affiliation(s)
- Wei Li
- Department of Plastic and Burns Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Xiao
- Department of Plastic and Burns Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuewen Xu
- Department of Plastic and Burns Surgery, West China Hospital, Sichuan University, Chengdu, China.
| | - Yange Zhang
- Department of Plastic and Burns Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Adamson AS, Jackson BE, Baggett CD, Thomas NE, Pignone MP. Association of surgical interval and survival among hospital and non-hospital based patients with melanoma in North Carolina. Arch Dermatol Res 2020; 313:653-661. [PMID: 33098016 PMCID: PMC7584309 DOI: 10.1007/s00403-020-02146-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/30/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022]
Abstract
Surgical excision is important for melanoma treatment. Delays in surgical excision after diagnosis of melanoma have been linked to decreased survival in hospital-based cohorts. This study was aimed at quantifying the association between the timeliness of surgical excision and overall survival in patients diagnosed with melanoma in hospital- and non-hospital-based settings, using a retrospective cohort study of patients with stage 0–III melanoma and using data linked between the North Carolina Central Cancer Registry to Medicare, Medicaid, and private health insurance plan claims across the state. We identified 6,496 patients diagnosed between 2004 and 2012 with follow-up through 2017. We categorized the time from diagnostic biopsy to surgical excision as < 6 weeks after diagnosis, 6 weeks to 90 days after diagnosis, and > 90 days after melanoma diagnosis. Multivariable Cox regression was used to estimate differences in survival probabilities. Five-year overall survival was lower for those with time to surgery over 90 days (78.6%) compared with those with less than 6 weeks (86%). This difference appeared greater for patients with Stage 1 melanoma. This study was retrospective, included one state, and could not assess melanoma specific mortality. Surgical timeliness may have an effect on overall survival in patients with melanoma. Timely surgery should be encouraged.
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Affiliation(s)
- Adewole S Adamson
- Department of Internal Medicine (Division of Dermatology), Dell Medical School at The University of Texas At Austin, 1601 Trinity St., Stop Z0900, Austin, TX, 78712, USA. .,LIVESTRONG Cancer Institutes, The University of Texas at Austin, Austin, TX, USA. .,Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Bradford E Jackson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher D Baggett
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nancy E Thomas
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael P Pignone
- Department of Internal Medicine (Division of Dermatology), Dell Medical School at The University of Texas At Austin, 1601 Trinity St., Stop Z0900, Austin, TX, 78712, USA.,LIVESTRONG Cancer Institutes, The University of Texas at Austin, Austin, TX, USA
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Thompson LL, Pan CX, Chang MS, Krasnow NA, Blum AE, Chen ST. Impact of ethnicity on the diagnosis and management of cutaneous toxicities from immune checkpoint inhibitors. J Am Acad Dermatol 2020; 84:851-854. [PMID: 33080345 DOI: 10.1016/j.jaad.2020.09.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Leah L Thompson
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Catherina X Pan
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael S Chang
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nira A Krasnow
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy E Blum
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven T Chen
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
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