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William Stout R, Gallo N, Torres-Small S, Okose O, Zhao C, Hayes T, Gleysteen J, Wood CB. The Role of Socioeconomic Status in Patients With Cutaneous Melanoma of the Head and Neck. Laryngoscope 2024. [PMID: 39185781 DOI: 10.1002/lary.31730] [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: 03/05/2024] [Revised: 07/12/2024] [Accepted: 08/01/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE To determine the effects of socioeconomic status (SES) on cutaneous melanoma of the head and neck. DATA SOURCE Surveillance Epidemiology and End Results (SEER) Program. REVIEW METHODS We conducted a retrospective analysis of patients diagnosed with cutaneous melanoma of the head and neck from 2006 to 2018, utilizing population-based data including socioeconomic status (SES) assessed by the US-based Yost quintile index. SES quintiles ranged from Group 1 (lowest) to Group 5 (highest). We examined disease severity at diagnosis (stage, Breslow thickness, and spread) and survival outcomes (overall survival, cause-specific survival) to assess the impact of SES. RESULTS A total of 53,967 melanomas of the head and neck were identified (14,146 females; 39,821 males; 51,890 white; 125 black; 317 other). Group 1 patients had a significantly higher percentage of end-stage disease (stage IV) at diagnosis (n = 101; 3.2% vs. n = 280; 1.9%, respectively) (p < .001), increased Breslow thickness (.80 mm vs .60 mm, respectively) (p < .001), and higher percentage of distant disease (n = 152; 3.6% vs. n = 431; 2.1%, respectively) (p < .001). Group 1 patients experienced a higher death rate from melanoma than group 5 patients (n = 585; 14% vs n = 1,753; 8.6%). Survival increased with SES. CONCLUSIONS When evaluating cutaneous melanoma of the head and neck, low SES is related to more severe disease at diagnosis and worse survival outcomes. Addressing the underlying causes of this relationship could lead to more equitable management and survival outcomes. LEVEL OF EVIDENCE III Laryngoscope, 2024.
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Affiliation(s)
- R William Stout
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, U.S.A
| | - Nina Gallo
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
- Department of Otolaryngology-New Orleans, Louisiana State University Health Science Center, New Orleans, Louisiana, United States
| | - Sofia Torres-Small
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, U.S.A
| | - Okenwa Okose
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Chenhao Zhao
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Tristan Hayes
- Department of Otolaryngology-New Orleans, Louisiana State University Health Science Center, New Orleans, Louisiana, United States
| | - John Gleysteen
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - C Burton Wood
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
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Zheng S, Feng J, Chen Z, Wei C, Pan Y, Liu J. The Impact of Socioeconomic Status on the Incidence and Stage of Melanoma in China: A Single-Center Observational Study. Ann Plast Surg 2024; 93:S59-S63. [PMID: 38718342 DOI: 10.1097/sap.0000000000003925] [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: 08/06/2024]
Abstract
BACKGROUND The role of high socioeconomic status (SES) as an established risk factor for melanoma has been well documented in Western countries and regions. However, research on the association between melanoma and SES in China remains limited. This study aimed to investigate the association between SES and melanoma incidence and stage in China. METHODS Five measures of SES were accessed, including education level, ethnic background, per capita household income, occupation, and medical insurance coverage. A scoring system based on the Kuppuswamy Socio-Economic Scale was used to create a quantitative assessment of SES. To improve clarity and precision, we refined the language in the original text. Clinical stage at diagnosis was classified according to the Chinese Society Oncology Melanoma Guidelines. RESULTS A total of 122 patients with pathologic melanoma were enrolled in this study from January 2013 to December 2017. Of these patients, 58 (48%) were male and 64 (52%) were female, with a mean age of 59.23 ± 9.91 years. Patients in the age groups of 45-59 and 60-73 had a higher incidence of melanoma compared to other age groups. Acral lentiginous melanoma was the most commonly observed subtype, accounting for 48% of cases. Patients with a low level of education (middle school and below) and a low level of monthly household income (<3000 CNY) had a higher risk of developing melanoma, as did those who were unemployed. Interestingly, a higher proportion of melanoma diagnoses were made in patients with medical insurance than those without. However, no significant differences in melanoma staging were found based on education level ( P = 0.153), monthly household income ( P = 0.507), occupation ( P = 0.687), or insurance status ( P = 0.537). According to the Kuppuswamy Socio-Economic Scale, there were 0 in upper class, 50 in upper middle class, 44 in lower middle class, 28 in upper lower class, 0 in lower class. The mean K-score was 13.85. No statistically significant interaction was observed between K-score and tumor stage. CONCLUSIONS Patients with lower SES have a higher risk of developing melanoma. However, no significant differences were found in melanoma staging based on SES.
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Affiliation(s)
- Shaoluan Zheng
- From the Plastic and Reconstructive Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen
| | - Jia Feng
- Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai
| | - Zhiwei Chen
- Artificial Intelligence Center for Plastic Surgery and Cutaneous Soft Tissue Cancers, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chuanyuan Wei
- Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai
| | - Yuyan Pan
- Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai
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Radgoudarzi N, Dallalzadeh L, Saseendrakumar BR, Guo J, Halfpenny W, Kikkawa DO, Baxter S. Medical, Environmental, and Social Determinants Associated With Periocular Cutaneous Malignancies in the United States Using the All of Us National Database. Cureus 2024; 16:e65831. [PMID: 39219888 PMCID: PMC11363474 DOI: 10.7759/cureus.65831] [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: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE To identify common factors associated with periocular cutaneous malignancies using the National Institutes of Health (NIH) All of Us database. METHODOLOGY In this case-control study, we extracted electronic health records and sociodemographic data for 385 cases of periocular cutaneous malignancies from the All of Us nationwide database. Controls (N = 1540) were matched to the demographic characteristics of the 2020 United States Census. Bivariate analyses and multivariable logistic regression determined variables significantly associated with increased odds of periocular cutaneous malignancies. We analyzed medical, environmental, and social determinants to evaluate which factors were associated with increased odds of periocular cutaneous malignancies. RESULTS Among the cases, the mean (standard deviation) age was 66.8 (11.2) years at the time of diagnosis. The majority were male (207, 54%) and white (361, 94%). Periocular cutaneous malignancy was significantly more likely among individuals with high sun exposure (odds ratio [OR] 14.79, 95% confidence interval [CI] 3.35-85.73, P = 0.001), those identifying as white race (OR 3.88, 95% CI 1.06-25.33, P = 0.079), and those with higher socioeconomic status, including higher annual income (OR 1.35, 95% CI 1.25-1.46, P < 0.001). CONCLUSIONS This study demonstrates similar risk factors for periocular cutaneous malignancies, echoing prior research that showed increased associations with lighter-pigmented skin and higher socioeconomic status. It also sheds light on the positive impact of physician surveillance and health utilization factors in the early detection and treatment of these malignancies, aspects less explored in prior analyses.
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Affiliation(s)
- Niloofar Radgoudarzi
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, USA
| | - Liane Dallalzadeh
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Bharanidharan R Saseendrakumar
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, USA
| | - Joy Guo
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, USA
| | - William Halfpenny
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, USA
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, USA
| | - Sally Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, USA
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Negbenebor NA. Championing Diversity in Mohs and Cutaneous Oncology: Reducing Disparities in Skin Cancer Care for Patients of Color. Am Soc Clin Oncol Educ Book 2024; 44:e433376. [PMID: 39013125 DOI: 10.1200/edbk_433376] [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: 07/18/2024]
Abstract
Skin cancer is the most common type of cancer affecting people in America. Skin cancer grows in patients from many diverse racial and ethnic backgrounds. Research shows that there are significant disparities that exist in the diagnosis and treatment of skin cancer for patients of color. Patients of color have lower incidence but higher rates of mortality for certain types of skin cancers. This article expounds on the role of diversity in Mohs surgery and cutaneous oncology to improve medical outcomes and address these health care disparities. By training an oncology workforce that has increased representation and improved cultural competence, the health care system can collaborate to achieve health equity in the treatment of skin cancer. Through both collaboration and advocacy, the oncology field can create an inclusive health care system that prioritizes the needs of all patients.
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Affiliation(s)
- Nicole A Negbenebor
- Department of Dermatology, Mohs Micrographic Surgery and Cutaneous Oncology, University of Iowa, Iowa City, IA
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Shaw VR, Hudock A, Zhang B, Amos C, Cheng C. Sex-Based Differences in Melanoma Survival Improvement from 2004 to 2018. Cancers (Basel) 2024; 16:1308. [PMID: 38610986 PMCID: PMC11011041 DOI: 10.3390/cancers16071308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/20/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Melanoma is the deadliest form of skin cancer and its incidence and mortality vary by sex, age, race, and socioeconomic status. Relatively few studies, however, have characterized disparities in survival improvement across these demographic groups in melanoma. METHODS Survival data from the Surveillance, Epidemiology, and End Results (SEER) database were obtained from 2004 to 2018. The compiled data were analyzed for cancer-specific survival (CSS) to produce multivariable Cox regressions that estimate sex-based survival disparities across patient demographic groups. Additionally, time-to-progression and survival analyses were conducted for a cohort of patients with carcinoma-in situ (CIS) that developed into melanoma. RESULTS In both female and male patients, melanoma diagnosis in more recent years (2014-2018 versus 2004-2008) was associated with an improved CSS, with females demonstrating an HR of 0.55 (95% CI: 0.49-0.60) and males demonstrating an HR of 0.49 (0.46-0.53). The trend remained consistent upon analyzing the effects of both sex and race on survival improvement for White and Hispanic males and females, but the results were not significant for Black and Asian patients. Joint sex and age analysis demonstrated significant reductions in HR across all age groups for female and male patients with a diagnosis in more recent years. Analysis of lesions progressing from CIS to melanoma (high-risk CIS) demonstrated an increased OR for males over females (OR: 1.70; 95% CI: 1.55-1.85), while survival analysis demonstrated no difference between sexes in the HR. Finally, for male patients, high-risk CIS demonstrated worse CSS compared to female patients with high-risk CIS (OR: 1.43; 95% CI: 1.15-1.79). CONCLUSION Overall, melanoma survival has improved in recent years, though some patient subgroups have experienced a lower improvement in survival from 2004 to 2018.
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Affiliation(s)
- Vikram R. Shaw
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX 77030, USA; (V.R.S.); (C.A.)
| | - Angela Hudock
- School of Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Baoyi Zhang
- Department of Chemical and Biomolecular Engineering, Rice University, Houston, TX 77005, USA;
| | - Christopher Amos
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX 77030, USA; (V.R.S.); (C.A.)
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Chao Cheng
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX 77030, USA; (V.R.S.); (C.A.)
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
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Negretti GS, Bayasi F, Goldstein S, Omega M, Taylor O, Ni R, Chiang L, Kim R, Lien E, Barke M, Dockery PW, Shields CL. Association of Fitzpatrick Skin Type with metastatic risk from uveal melanoma in 854 consecutive patients at a single center. Eye (Lond) 2024; 38:565-571. [PMID: 37770529 PMCID: PMC10858041 DOI: 10.1038/s41433-023-02735-1] [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: 03/02/2023] [Revised: 08/08/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE To assess the association of skin color using Fitzpatrick Skin Type (FST) with metastatic risk of uveal melanoma. SUBJECTS 854 consecutive patients with uveal melanoma and documented FST. METHODS Retrospective detailed review of patient charts was performed for FST (type I- white, II-fair, III-average, IV-light brown, V-brown, VI-black), clinical details of the patient and the uveal melanoma, tumor cytogenetic classification according to The Cancer Genome Atlas (TCGA), and outcome of melanoma-related metastasis and death. RESULTS The FST classification was type I (n = 97 patients), type II (n = 665), type III (n = 79), type IV (n = 11), type V (n = 2), type VI (n = 0). A comparison of patient FST (type I vs. II vs. III-V) revealed significant differences in mean age at presentation (64.1 vs. 58.5 vs. 49.8 years, p < 0.001), race white (100% vs. 98% vs. 75%, p < 0.001), presence of ocular melanocytosis (3% vs. 3% vs. 10%, p = 0.01), visual acuity <20/200 at presentation (6% vs. 7% vs. 13%, p = 0.03), genetic results showing TCGA group B tumors (11% vs. 14% vs. 26%, p = 0.01) or TCGA group D tumors (22% vs. 11% vs. 9%, p = 0.01), 10-year incidence of melanoma-related metastasis (25% vs. 15% vs. 14%, p = 0.02) and 10-year incidence of melanoma-related death (9% vs. 3% vs. 4%, p = 0.04). FST was a significant predictor of melanoma-related metastasis (p = 0.02, Hazard ratio 2.3). CONCLUSIONS Fitzpatrick skin type may be a predictor of melanoma-related metastasis, with metastasis and TCGA Group D tumors being more common in patients with FST I.
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Affiliation(s)
- Guy S Negretti
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Ferris Bayasi
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Samuel Goldstein
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Michelle Omega
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Olivia Taylor
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Roselind Ni
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Lawrence Chiang
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Rachel Kim
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Eric Lien
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Matthew Barke
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Philip W Dockery
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Carol L Shields
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA.
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Massouh N, Jaffa AA, Jaffa MA. Role of Insulin Use and Social Determinants of Health on Non-melanoma Skin Cancer: Results From the Behavioral Risk Factor Surveillance System. Cancer Control 2024; 31:10732748241249896. [PMID: 38680117 DOI: 10.1177/10732748241249896] [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: 05/01/2024] Open
Abstract
BACKGROUND Non-melanoma skin cancer (NMSC) is a frequent type of malignancy with a steadily increasing incidence rate worldwide. Although NMSC was shown to be associated with diabetes, no studies have addressed the extent to which insulin use influences the risk of NMSC in light of social determinants of health (SDOH). We conducted a quantitative study that examined the interplay between insulin use, SDOH, additional covariates, and NMSC among individuals with diabetes. METHODS We based our analysis on the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a national survey conducted yearly in the US. We performed weighted chi-squared test, logistic regression, and survival analyses on 8685 eligible participants with diabetes enrolled in the BRFSS. RESULTS Kaplan Meier survival curves showed higher probability of NMSC event-free survival for participants with diabetes using insulin compared to participants with diabetes not using insulin (log-rank test P < .001). Significant associations were detected between insulin use and reduced odds of NMSC (OR .56; 95% CI: .38-.82), and decreased hazard (HR .36; 95% CI: .21-.62), along with indices of SDOH. CONCLUSIONS Our findings suggest that socioeconomic differences related to the healthcare system and behavioral patterns are linked to discrepancies in the use of insulin and the development of NMSC.
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Affiliation(s)
- Nour Massouh
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ayad A Jaffa
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Division of Endocrinology, Diabetes & Metabolic Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Miran A Jaffa
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Zheng S, Yu H, Zheng X, Wu UT, Ming WK, Huang H, Song J, Zhang X, Lyu J, Deng L. Analysis and prediction of 5-year survival in patients with cutaneous melanoma: a model-based period analysis. Front Endocrinol (Lausanne) 2023; 14:1238086. [PMID: 38125787 PMCID: PMC10731280 DOI: 10.3389/fendo.2023.1238086] [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: 06/10/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023] Open
Abstract
Background The survival and prognosis of patients are significantly threatened by cutaneous melanoma (CM), which is a highly aggressive disease. It is therefore crucial to determine the most recent survival rate of CM. This study used population-based cancer registry data to examine the 5-year relative survival rate of CM in the US. Methods Period analysis was used to assess the relative survival rate and trends of patients with CM in the Surveillance, Epidemiology, and End Results (SEER) database during 2004-2018. And based on the data stratified by age, gender, race and subtype in the SEER database, a generalized linear model was 12established to predict the 5-year relative survival rate of CM patients from 2019 to 2023. Results The 5-year relative survival increased to various degrees for both total CM and CM subtypes during the observation period. The improvement was greatest for amelanotic melanoma, increasing from 69.0% to 81.5%. The 5-year overall relative survival rates of CM were 92.9%, 93.5%, and 95.6% for 2004-2008, 2009-2013, and 2014-2018, respectively. Females had a marginally higher survival rate than males for almost all subtypes, older people had lower survival rates than younger people, white patients had higher survival rates than nonwhite ones, and urban locations had higher rates of survival from CM than rural locations did. The survival rate of CM was significantly lower for distant metastasis. Conclusion The survival rate of patients with CM gradually improved overall during 2004-2018. With the predicted survival rate of 96.7% for 2019-2023, this trend will still be present. Assessing the changes experienced by patients with CM over the previous 15 years can help in predicting the future course of CM. It also provides a scientific foundation that associated departments can use to develop efficient tumor prevention and control strategies.
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Affiliation(s)
- Suzheng Zheng
- Department of Dermatology, The First Affiliated Hospital of Jinan University and Jinan University Institute of Dermatology, Guangzhou, China
| | - Hai Yu
- Department of Dermatology, The First Affiliated Hospital of Jinan University and Jinan University Institute of Dermatology, Guangzhou, China
| | - Xinkai Zheng
- Department of Dermatology, The First Affiliated Hospital of Jinan University and Jinan University Institute of Dermatology, Guangzhou, China
| | - U Tim Wu
- Meng Yi Centre Limited, Macao, Macao SAR, 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
| | - Hui Huang
- Department of Dermatology, The First Affiliated Hospital of Jinan University and Jinan University Institute of Dermatology, Guangzhou, China
| | - Jiaxin Song
- Department of Dermatology, The First Affiliated Hospital of Jinan University and Jinan University Institute of Dermatology, Guangzhou, China
| | - Xiaoxi Zhang
- Department of Dermatology, The First Affiliated Hospital of Jinan University and 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 and Jinan University Institute of Dermatology, Guangzhou, China
- Department of Dermatology, The Fifth Affiliated Hospital of Jinan University, Heyuan, China
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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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10
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Lwin TM, Kaelberer Z, Ruan M, Molina G, Boland G. Surgical Utilization and Outcomes for Patients with Stage IV Melanoma in the Modern Immunotherapy Era. Ann Surg Oncol 2023; 30:5005-5012. [PMID: 37121988 DOI: 10.1245/s10434-023-13543-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/16/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND The benefit of surgery for patients with stage IV melanoma in the modern era of effective immunotherapy is unclear. This study aimed to evaluate trends and outcomes after surgical resection of stage IV melanoma in the modern immunotherapy era. METHODS Patients with stage IV melanoma who received surgery, immunotherapy, or both from 2012 to 2017 were identified from the National Cancer Database (NCDB). Demographics, facility-level characteristics, and use of immunotherapy were compared between patients who received surgery and those who did not. Multivariate Poisson regression modeling, Kaplan-Meier survival analysis, and Cox regression analysis were performed. RESULTS The study identified 9800 patients with stage IV melanoma, and 2160 of these patients (22 %) underwent surgery. The patients who received surgery were more likely to be younger (P < 0.001), to have private insurance (P < 0.001), to have a higher median income (P = 0.008), and to receive treatment at academic/research programs (P < 0.001), whereas they were less likely to receive immunotherapy (33.7 % vs 36.6 %; P = 0.013). The patients who received immunotherapy had a lower likelihood of undergoing surgery (relative risk [RR], 0.82; 95 % confidence interval [CI[, 0.75-0.88; P < 0.001). The patients who received both surgery and immunotherapy had a better overall survival rate (hazard ratio [HR], 0.41; 95 % CI, 0.36-0.46; P < 0.01) than the patients who received neither immunotherapy nor surgery. CONCLUSIONS The use of immunotherapy was associated with a lower use of surgery for patients with stage IV melanoma. The patients with stage IV disease who received both surgery and immunotherapy had the highest overall survival rates.
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Affiliation(s)
- Thinzar M Lwin
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Zoey Kaelberer
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Mengyuan Ruan
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - George Molina
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Genevieve Boland
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
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Wojcik KY, Hawkins M, Anderson-Mellies A, Hall E, Wysong A, Milam J, Hamilton AS, Cockburn MG. Melanoma survival by age group: Population-based disparities for adolescent and young adult patients by stage, tumor thickness, and insurance type. J Am Acad Dermatol 2023; 88:831-840. [PMID: 36610687 PMCID: PMC10246749 DOI: 10.1016/j.jaad.2022.10.063] [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: 02/12/2021] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Melanoma survival literature predominantly represents patients >65 years of age. Study of younger patients may reveal potential age-group-specific differences in survival outcome. OBJECTIVE Identify factors associated with differences in melanoma survival in 2 age groups, adolescents and young adults (AYAs; ages 15-39) and older adults (ages 40-64). METHODS This population-based registry study included all cases (n = 81,597) of cutaneous melanoma diagnosed at ages 15 to 64 from 2004 to 2015 in California. Age-group-specific multivariable Cox hazard regressions were used. RESULTS In the adjusted, age-group-specific models, AYA patients with stage IV melanoma had worse survival (hazard ratio: 20.39, 95% CI: 13.30-31.20) than was observed among older adults (hazard ratio: 10.79, 95% CI: 9.33-12.48). Thicker tumors and public insurance were also associated with worse survival for AYAs than observed in models for older adults. AYAs experienced better survival when detected at earlier stages. LIMITATIONS Registry data do not routinely collect behavioral information or family history of melanoma. CONCLUSIONS Survival was much worse for AYAs with stage IV melanoma than observed among older adults. To improve AYA survival, early melanoma detection is critical. Greater awareness, suspicion, and screening for AYA melanoma may disrupt delays in diagnosis and reduce the excess burden of mortality from stage IV melanoma in young patients.
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Affiliation(s)
- Katherine Y Wojcik
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
| | - Makenzie Hawkins
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Evan Hall
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Joel Milam
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California, Irvine, California
| | - Ann S Hamilton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern CA, Los Angeles, California
| | - Myles G Cockburn
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern CA, Los Angeles, California; Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
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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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13
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King ALO, Lee V, Yu B, Mirza FN, Zogg CK, Yang DX, Tran T, Leventhal J, An Y. Factors associated with the use of adjuvant radiation therapy in stage III melanoma. Front Oncol 2023; 13:1005930. [PMID: 36816935 PMCID: PMC9929351 DOI: 10.3389/fonc.2023.1005930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Objective The role of radiation therapy (RT) in melanoma has historically been limited to palliative care, with surgery as the primary treatment modality. However, adjuvant RT can be a powerful tool in certain cases and its application in melanoma has been increasingly explored in recent years. The aim of this study is to explore national patterns of care and associations surrounding the use of adjuvant RT for stage III melanoma. Methods The National Cancer Data Base (NCDB) was used to identify patients who were diagnosed with stage III melanoma between 2004 and 2014. Exclusion criteria included those with distant metastatic disease, in-situ histology, no confirmed positive nodes, palliative intent therapy, and dosing regimens inconsistent with National Comprehensive Cancer Network (NCCN) guidelines for adjuvant RT in melanoma. Patients treated with and without adjuvant RT were compared and factors associated with use of adjuvant RT were identified using multivariable logistic regression analyses. Results A total of 7,758 cases of stage III melanoma were analyzed, of which 11.7% received adjuvant RT. The mean age of the overall cohort was 58.5 years, and the majority of patients were male (64.7%), white (96.6%), on private insurance (51.3%), and presented to a non-high-volume facility (90.3%). Multivariable regression analyses revealed that patients who present to the hospital in 2009-2014 as compared to 2004-2008 (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.36-1.92), had 4 or more positive nodes (OR 4.30, 95% CI 3.67-5.04), and had microscopic residual tumor (OR 2.11, 95% CI 1.46-3.04) were more likely to receive adjuvant RT. Factors that were negatively associated with receiving adjuvant RT included female gender (OR 0.72, 95% CI 0.61-0.85) and median income of at least $63,000 (OR 0.66, 95% CI 0.52-0.83). Conclusions This study demonstrates the rising use of RT for stage III melanoma in recent years and identifies demographic, social, clinical, and hospital-specific factors associated with patients receiving adjuvant RT. Further investigation is needed to explore disease benefits to improve guidance on the utilization of RT in melanoma.
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Affiliation(s)
- Amber L. O. King
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Victor Lee
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, United States
| | - Beverly Yu
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Fatima N. Mirza
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Cheryl K. Zogg
- Department of Surgery, Yale School of Medicine, New Haven, CT, United States
| | - Daniel X. Yang
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, United States
| | - Thuy Tran
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, CT, United States
| | - Jonathan Leventhal
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Yi An
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, United States
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14
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Asadi LK, Khalili A, Wang SQ. The sociological basis of the skin cancer epidemic. Int J Dermatol 2023; 62:169-176. [PMID: 35020194 DOI: 10.1111/ijd.15987] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/09/2021] [Accepted: 11/06/2021] [Indexed: 01/20/2023]
Abstract
Given the precipitous rise in its incidence in recent decades, skin cancer has been recognized as a growing epidemic. We explore the sociological underpinnings of this epidemic, including: (1) aging of the demographic; (2) human ecologic factors (residing in areas with high ambient ultraviolet levels and a depleted ozone layer); (3) large-scale European migration to more equatorial latitudes; (4) social structures that for centuries minimized miscegenation and maximized segregation; (5) gender-based differences in sunbathing, tanning, sunscreen use, and clothing choice; (6) occupational ultraviolet exposure; (7) the complex interplay of socioeconomic status, race, and urbanization on skin cancer incidence and mortality; (8) the effects of war on skin cancer incidence; (9) cultural shifts in clothing, travel, outdoor sports, recreation, and attitudes towards being tan; and (10) the indirect effects of religion. We show that without these sociological factors, the most common type of cancer would not be nearly as common.
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Affiliation(s)
- Leila K Asadi
- Division of Dermatology, Memorial Sloan-Kettering Cancer Center, Basking Ridge, New Jersey, USA
| | - Ahmad Khalili
- Professor Emeritus of Sociology, Department of Interdisciplinary Programs, Slippery Rock University, Slippery Rock, Pennsylvania, USA
| | - Steven Q Wang
- Division of Dermatology, Memorial Sloan-Kettering Cancer Center, Basking Ridge, New Jersey, USA
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15
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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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16
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Kolla AM, Seixas A, Adotama P, Foster V, Kwon S, Li V, Lee AY, Stein JA, Polsky D. A health equity framework to address racial and ethnic disparities in melanoma. J Am Acad Dermatol 2022; 87:1220-1222. [PMID: 35970385 PMCID: PMC9623655 DOI: 10.1016/j.jaad.2022.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/01/2022] [Accepted: 05/28/2022] [Indexed: 10/31/2022]
Affiliation(s)
- Avani M Kolla
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Azizi Seixas
- Department of Psychiatry and Behavioral Sciences, The University of Miami Miller School of Medicine, Miami, Florida; Department of Population Health, NYU Grossman School of Medicine, New York, New York; Department of Psychiatry, NYU Grossman School of Medicine, New York, New York
| | - Prince Adotama
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Victoria Foster
- Department of Population Health, NYU Grossman School of Medicine, New York, New York; The Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Simona Kwon
- Department of Population Health, NYU Grossman School of Medicine, New York, New York; The Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Vivienne Li
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Ann Y Lee
- The Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York; Department of Surgery, NYU Grossman School of Medicine, New York, New York
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - David Polsky
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York; The Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York.
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17
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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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18
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Brown AE, Najmi M, Duke T, Grabell DA, Koshelev MV, Nelson KC. Skin Cancer Education Interventions for Primary Care Providers: A Scoping Review. J Gen Intern Med 2022; 37:2267-2279. [PMID: 35710666 PMCID: PMC9202989 DOI: 10.1007/s11606-022-07501-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 03/23/2022] [Indexed: 11/19/2022]
Abstract
Primary care physicians (PCPs) are often the first line of defense against skin cancers. Despite this, many PCPs do not receive a comprehensive training in skin conditions. Educational interventions aimed at skin cancer screening instruction for PCPs offer an opportunity to detect skin cancer at earlier stages and subsequent improved morbidity and mortality. A scoping review was conducted to collect data about previously reported skin cancer screening interventions for PCPs. A structured literature search found 51 studies describing 37 unique educational interventions. Curriculum elements utilized by the interventions were divided into categories that would facilitate comparison including curriculum components, delivery format, delivery timing, and outcome measures. The interventions varied widely in design, including literature-based interventions, live teaching sessions, and online courses with durations ranging from 5 min to 24 months. While several interventions demonstrated improvements in skin cancer knowledge and competency by written exams, only a few revealed positive clinical practice changes by biopsy review or referral analysis. Examining successful interventions could aid in developing a skin cancer detection curriculum for PCPs that can produce positive clinical practice and population-based changes in the management of skin cancer.
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Affiliation(s)
- Ashley E Brown
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Maleka Najmi
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
| | - Taylor Duke
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Daniel A Grabell
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Misha V Koshelev
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kelly C Nelson
- Department of Dermatology, MD Anderson Cancer Center, Houston, TX, USA
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19
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Sugumar K, Hue JJ, Hardacre JM, Ammori JB, Rothermel LD, Dorth J, Saltzman J, Mohamed A, Selfridge JE, Bajor D, Winter JM, Ocuin LM. Combined multiagent chemotherapy and radiotherapy is associated with prolonged overall survival in patients with non-operatively managed stage II-III pancreatic adenocarcinoma. HPB (Oxford) 2022; 24:433-442. [PMID: 34465529 DOI: 10.1016/j.hpb.2021.08.938] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/25/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most patients with pancreatic adenocarcinoma (PDAC) do not undergo surgical resection. The role of radiotherapy (RT) in non-operatively managed localized pancreatic adenocarcinoma is unclear. METHODS The National Cancer Database (2010-2016) was queried for patients with clinical stage II-III PDAC treated with multiagent systemic chemotherapy (CT) +/- RT but not surgery. Factors associated with the receipt of RT and overall survival were compared after adjusting for patient demographics and clinical characteristics. RESULTS A total of 14,921 patients were included, of whom 9279 received CT and 5382 received CT + RT. Patients treated with CT + RT were more likely to be younger (65vs66yrs), treated at non-academic facilities (48.8%vs46.7%), have private insurance (40.3%vs36.5%), and have clinical T4 tumors (53.6%vs48.7%). Most patients who were treated with RT received external beam radiotherapy (89.3%), and the median dose was 5,000 cGy. Median time to start of RT was 129 days. CT + RT was associated with longer overall survival (15.9vs11.8mos,p < 0.001), and remained associated with survival on multivariable analysis (HR 0.74, 95%CI 0.70-0.78). On a 4-month conditional survival analysis, combined CT + RT remained associated with improved survival compared to CT alone (16.0vs13.1mos,p < 0.001). CONCLUSIONS In patients with non-operatively managed localized pancreatic adenocarcinoma, combined radiotherapy and multiagent systemic chemotherapy is associated with improved overall survival compared to chemotherapy alone.
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Affiliation(s)
- Kavin Sugumar
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jonathan J Hue
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jeffrey M Hardacre
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - John B Ammori
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Luke D Rothermel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jennifer Dorth
- Department of Radiology, Division of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Joel Saltzman
- Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amr Mohamed
- Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jennifer E Selfridge
- Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - David Bajor
- Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jordan M Winter
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Lee M Ocuin
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Roth M, Beauchemin M, Kahn JM, Bleyer A. Patterns of National Cancer Institute-Sponsored Clinical Trial Enrollment in Black Adolescents and Young Adults. Cancer Med 2021; 10:7620-7628. [PMID: 34592782 PMCID: PMC8559464 DOI: 10.1002/cam4.4292] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/08/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Both adolescent and young adult (AYA) and Black or African American (hereafter referred to as Black) cancer patients are historically under-enrolled in cancer treatment trials (CTT). The purpose of this study was to quantify enrollment of Black AYAs in National Cancer Institute (NCI)-sponsored CTTs overall and by age, sex, and cancer diagnosis during 2000-2015. METHODS Utilizing data from NCI's Cancer Therapy Evaluation Program and the Surveillance, Epidemiology and End Results (SEER) Program, we assessed CTT enrollment in Black patients with cancer and measured changes in enrollment over time between the study periods 2000-2007 and 2008-2015. Enrollment patterns were compared across age groups (≤14 years [y], 15-19y, 20-29y, 30-39y and 40+ years), sex, and cancer diagnosis. RESULTS From 2000 through 2015, <3% of Black AYAs (20-39y) enrolled on CTTs. While AYAs had significantly higher cancer incidence than children, 20.5% fewer Black AYAs enrolled on CTTs. Enrollment was lowest among Black males 20-29y, with a mean of 18 enrolling in CTTs annually. The proportion of AYA enrollees who were Black did not change significantly over time periods (2000-2007 vs 2008-2015). CONCLUSIONS Few Black AYAs enroll in CTTs each year. Given known benefits of clinical trial participation and the well-documented racial and age-related differences in cancer outcomes, addressing barriers to enrollment in these patients may, in turn, reduce disparities. Targeted interventions aimed at increasing the CTT enrollment of Black cancer patients, particularly young Black men, are urgently needed. PRECIS This study documents that compared with Black children, Black adolescent, and young adult (AYA) patients were less likely to enroll in NCI-sponsored CTTs from 2000 to 2015. Black AYA male enrollment decreased with increasing age, highlighting disparities among this specific population in CTT enrollment.
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Affiliation(s)
- Michael Roth
- Division of Pediatrics, Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Melissa Beauchemin
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Justine M Kahn
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Archie Bleyer
- Knight Cancer Institute and Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA
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21
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Mao L, Qi Z, Zhang L, Guo J, Si L. Immunotherapy in Acral and Mucosal Melanoma: Current Status and Future Directions. Front Immunol 2021; 12:680407. [PMID: 34149718 PMCID: PMC8212860 DOI: 10.3389/fimmu.2021.680407] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
Acral and mucosal melanomas are extremely rare in Caucasians; however, they are the predominant melanoma subtypes in Asians and other non-Caucasian populations. Acral and mucosal melanomas share many clinicopathological features, including aggressive phenotypes, similar genetic landscapes, and grim prognoses. In spite of advances in melanoma management, patients with acral and mucosal melanomas show limited benefit from current therapies. The rarity of these subtypes of melanoma is a significant factor contributing to the poor understanding of these pathological subtypes and the lack of effective interventions. Furthermore, the mechanisms contributing to disparities between different types of melanoma remain largely unclear. Herein, we comprehensively review current knowledge on the clinicopathological characteristics and mutational landscapes of acral and mucosal melanomas, as well as providing an overview of current therapies for patients with these aggressive melanoma subtypes, focusing on available immunotherapeutic interventions. We also discuss pathological differences between different melanoma subtypes and summarize current knowledge on melanoma disparities between Asians and Caucasians. Finally, we discuss emerging immunotherapeutic strategies for the treatment of acral and mucosal melanomas, focusing on combination therapies with immune checkpoint inhibitors. Unraveling the unique features of acral and mucosal melanomas is key for their early diagnosis and for the development of effective therapies.
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Affiliation(s)
- Lili Mao
- Department of Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhonghui Qi
- Department of Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Li Zhang
- Global Medical Affairs, MSD China, Shanghai, China
| | - Jun Guo
- Department of Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Lu Si
- Department of Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
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22
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Brady J, Kashlan R, Ruterbusch J, Farshchian M, Moossavi M. Racial Disparities in Patients with Melanoma: A Multivariate Survival Analysis. Clin Cosmet Investig Dermatol 2021; 14:547-550. [PMID: 34079319 PMCID: PMC8163579 DOI: 10.2147/ccid.s311694] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022]
Abstract
Purpose As the most common cause of skin cancer death, incidence and mortality of melanoma vary widely between ethnic and racial groups. Methods Surveillance, Epidemiology, and End Results (SEER) data were used to examine the incidence and survival in patients with melanoma concerning race and ethnicity in Wayne County, Michigan between 2000 and 2016. Results Analysis of data revealed significantly higher melanoma-specific death in non-Hispanic black patients compared to their non-Hispanic white counterparts (p <0.001). However, no increased risk of death due to melanoma was observed following adjustment of data for the stage, age, and sex (H.R. = 1.00, 95% CI 0.64-1.56). Conclusion Non-Hispanic black patients have the highest percentage of late-stage melanoma. Increased incidence of melanoma mortality in non-Hispanic black patients is likely a consequence of late-stage diagnosis.
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Affiliation(s)
- Joshua Brady
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Reem Kashlan
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Julie Ruterbusch
- Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Mehdi Farshchian
- Department of Dermatology, Wayne State University, Detroit, MI, USA
| | - Meena Moossavi
- Department of Dermatology, Wayne State University, Detroit, MI, USA
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23
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Tolaymat LM, Reimer DK, Feig J, Gillis MS, Speicher LL, Haga CB, Gabriel EM, Heckman MG, Yin M, Fosko SW, Keaveny AP, Dawson NL. Skin cancer in non-white liver transplant recipients: Mayo Clinic experience. Int J Dermatol 2021; 60:986-990. [PMID: 33742703 DOI: 10.1111/ijd.15519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/21/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited data are available on the development of skin cancer and the associated risk factors for non-White liver transplant (LT) recipients. The aim of this study is to determine the incidence of newly diagnosed skin cancer postoperatively and to identify the risk factors for the development of skin cancer in non-White LT recipients. METHODS We conducted an initial retrospective chart review of non-White LT patients who received a transplant at our center between January 1, 2011, and December 31, 2013. RESULTS Of the 96 patients in the study cohort, 32% were Black, 17% were Asian, 15% were White Hispanic, and 10% were Black Hispanic. One patient had a history of nonmelanoma skin cancer before transplant. No skin cancers were diagnosed during follow-up (median, 1.3 years; range, 17 days to 8.6 years). CONCLUSION Our center's experience is consistent with the literature and suggests that the incidence of newly diagnosed skin cancer in non-White liver transplant recipients is low. Longer follow-up may provide additional insights into the specific risk factors for the posttransplant development of skin cancer.
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Affiliation(s)
| | | | - Joshua Feig
- University of North Florida, Jacksonville, FL, USA
| | | | - Leigh L Speicher
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Claire B Haga
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Mingyuan Yin
- Research Administration, Mayo Clinic, Jacksonville, FL, USA
| | - Scott W Fosko
- Department of Dermatology, University of Florida, Gainesville, FL, USA
| | - Andrew P Keaveny
- Division of Transplant Medicine, Mayo Clinic, Jacksonville, FL, USA.,Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Nancy L Dawson
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
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24
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Evaluation of dermatologist performance in the 2017 merit-based incentive payment system based on patient social factors. J Am Acad Dermatol 2021; 86:672-675. [PMID: 33662464 DOI: 10.1016/j.jaad.2021.02.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/11/2021] [Accepted: 02/22/2021] [Indexed: 11/23/2022]
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25
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Guo Y, Shen M, Zhang X, Xiao Y, Zhao S, Yin M, Bu W, Wang Y, Chen X, Su J. Unemployment and Health-Related Quality of Life in Melanoma Patients During the COVID-19 Pandemic. Front Public Health 2021; 9:630620. [PMID: 33692982 PMCID: PMC7937627 DOI: 10.3389/fpubh.2021.630620] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/03/2021] [Indexed: 12/25/2022] Open
Abstract
The outbreak of coronavirus disease-2019 (COVID-19) ineluctably caused social distancing and unemployment, which may bring additional health risks for patients with cancer. To investigate the association of the pandemic-related impacts with the health-related quality of life (HRQoL) among patients with melanoma during the COVID-19 pandemic, we conducted a cross-sectional study among Chinese patients with melanoma. A self-administered online questionnaire was distributed to melanoma patients through social media. Demographic and clinical data, and pandemic-related impacts (unemployment and income loss) were collected. HRQoL was determined by the Functional Assessment of Cancer Therapy-General (FACT-G) and its disease-specific module (the melanoma subscale, MS). A total of 135 patients with melanoma completed the study. The mean age of the patients was 55.8 ± 14.2 years, 48.1% (65/135) were male, and 17.04% (34/135) were unemployed since the epidemic. Unemployment of the patients and their family members and income loss were significantly associated with a lower FACT-G score, while the MS score was associated with the unemployment of the patients' family members. Our findings suggested that unemployment is associated with impaired HRQoL in melanoma patients during the COVID-19 epidemic.
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Affiliation(s)
- Yeye Guo
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xu Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Mingzhu Yin
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Wenbo Bu
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Yan Wang
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
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26
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Anaba EL. Comparative study of cutaneous melanoma and its associated issues between people of African decent and Caucasians. Dermatol Ther 2021; 34:e14790. [PMID: 33480165 DOI: 10.1111/dth.14790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/16/2020] [Accepted: 01/17/2021] [Indexed: 01/08/2023]
Abstract
Cutaneous melanoma is uncommon in people of African descent unlike their Caucasian counterparts. This rarity of cutaneous melanoma in people of African descent makes studies in this group difficult. In the few studies that are available, several differences exist in the incidence, disease severity, course of the disease, treatment modalities and survival rates between these two groups. Observed difference in cutaneous melanoma between people of African descent and Caucasians include; a higher incidence and better prognosis in Caucasians, a low awareness of melanoma, no definite risk factors, presentation with advanced disease, poor melanoma specific survival in people of African descent. Other differences are a better UV-induced DNA damage recovery, acral as opposed to truncal melanoma, female preponderance and lack of preventive measures in people of African descent.
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Affiliation(s)
- Ehiaghe L Anaba
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
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Rodríguez-Rabassa MS, Simmons VN, Vega A, Moreno D, Irizarry-Ramos J, Quinn GP. Perceptions of and Barriers to Lung Cancer Screening Among Physicians in Puerto Rico: A Qualitative Study. J Health Care Poor Underserved 2021; 31:973-991. [PMID: 33410819 DOI: 10.1353/hpu.2020.0072] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Low-dose computed tomography (LDCT), an accepted U.S. screening tool for early lung cancer detection, is not widely-used in Puerto Rico. We investigated knowledge and attitudes about LDCT in focus groups of primary care physicians (PCP) and individuals at high risk for lung cancer (HRI) in Puerto Rico. Transcribed/translated audio-recorded discussions were analyzed with the constant comparison method. Both groups had limited knowledge about LDCT and concerns regarding insurance coverage. Most HRIs had never had a provider recommend LDCT and believed that having symptoms was necessary to obtain LDCT screening. Perceived barriers included fears about results and the procedure; a perceived benefit was having early detection and possibly being cured. Few PCPs had ever recommended LDCT to a patient, with those who had basing their decision on symptoms/smoking history but having challenges with insurance. More education on LDCT is needed among HRIs, and U.S. Preventive Services Task Force guidelines should be widely distributed to encourage physician recommendations.
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28
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Sanchez DP, Maymone MBC, McLean EO, Kennedy KF, Sahni D, Secemsky EA, Vashi NA. Racial and ethnic disparities in melanoma awareness: A cross-sectional survey. J Am Acad Dermatol 2020; 83:1098-1103. [PMID: 32380221 DOI: 10.1016/j.jaad.2020.04.137] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hispanics are among the fastest growing population in the United States and are predicted to account for one third of the nation by 2060. Although melanoma is more common among white patients, Hispanic individuals are at greater risk of late-stage diagnosis, increased tumor thickness, and poorer survival. OBJECTIVE To better understand public awareness of melanoma and evaluate change over the last 21 years, particularly among high-risk minority populations. METHODS A cross-sectional survey collecting information on knowledge and awareness of melanoma was conducted on 285 participants from May through November 2017. RESULTS Approximately 39% of participants were unaware of melanoma. Sixty-five percent successfully identified early signs of disease. Approximately 86% of Fitzpatrick skin types (FST) I and II identified melanoma as a cancer, compared to 46.3% of FST III and IV and 57.6% of FST V and VI. Hispanic particiapnts were less likely to know what melanoma was compared to white participants (odds ratio [OR], 0.27; 95% confidence interval [CI], 0.65-0.11; P = .0037). US natives (OR, 2.38; 95% CI, 5.56-1.04; P = .0403) and patients with any college education (OR, 2.86; 95% CI, 5.26-1.54; P = .0007) were more likely to know the meaning of melanoma. CONCLUSION White participants and those with any college education were more likely to know the meaning of melanoma. Individuals of racial and ethnic minorities would benefit from educational programs geared toward early detection.
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Affiliation(s)
| | - Mayra B C Maymone
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Emily O McLean
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Debjani Sahni
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Neelam A Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.
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29
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The ongoing racial disparities in melanoma: An analysis of the Surveillance, Epidemiology, and End Results database (1975-2016). J Am Acad Dermatol 2020; 84:1585-1593. [PMID: 32861710 DOI: 10.1016/j.jaad.2020.08.097] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/06/2020] [Accepted: 08/20/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although most patients with cutaneous melanoma are non-Hispanic whites (NHWs), minorities consistently suffer worse melanoma-specific survival (MSS). Much of the literature comes from analyses of registries from the 1990s and 2000s. OBJECTIVE We sought to evaluate whether and to what degree racial disparity in MSS persists since 2010. METHODS We analyzed 381,035 patients from the Surveillance, Epidemiology, and End Results registry. Race categories included Hispanic, NHW, non-Hispanic black (NHB), non-Hispanic Asian or Pacific Islander (NHAPI), and non-Hispanic American Indian/Alaska Native (NHAIAN). We evaluated the association between MSS and race in 3 time periods: before the year 2000, 2000 to 2009, and 2010 or later. NHW was the reference group for all analyses. RESULTS Racial disparity worsened from before the year 2000 to 2010 or later for Hispanic (P < .001), NHB (P = .024), and NHAPI (P < .001) patients. Across all minority groups, patients with localized disease suffered increasing disparity (P = .010 for Hispanic, P < .001 for NHB, P = .023 for NHAPI, and P = .042 for NHAIAN patients). Among those with regional and distant disease, Hispanic patients were the only minority to experience worsening disparity (P = .001 and P = .019, respectively). LIMITATIONS Lack of immunotherapy and targeted treatment information. CONCLUSIONS Racial disparity in MSS is worsening. Improving postdiagnosis management for minorities with localized disease is imperative to mitigate disparity and improve survival.
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30
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Cortez JL, Vasquez J, Wei ML. The impact of demographics, socioeconomics, and health care access on melanoma outcomes. J Am Acad Dermatol 2020; 84:1677-1683. [PMID: 32783908 DOI: 10.1016/j.jaad.2020.07.125] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022]
Abstract
Disparities in melanoma care exist in the United States. Disparities in provider type, patient demographics, place of residence, insurance status, socioeconomic status, race/ethnicity, and age impact melanoma outcomes. Melanomas detected by dermatologists are thinner, at an earlier stage, and have better survival outcomes compared with detection by primary care providers or patients. Lower socioeconomic status, race/ethnicity, and place of residence are associated with decreased access to or use of dermatologists, or both, and more advanced melanomas at diagnosis. Additionally, uninsured and publicly insured individuals are more likely to present with late-stage melanomas, resulting in worse outcomes. This review provides a comprehensive overview of how structural and patient-level characteristics influence melanoma outcomes in order to inform clinical care and health care policy as it relates to addressing gaps in melanoma care.
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Affiliation(s)
- Jose L Cortez
- Department of Dermatology, University of California, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Juan Vasquez
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Maria L Wei
- Department of Dermatology, University of California, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California; University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
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31
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Hartman R, Xue Y, Singer S, Markossian T, Joyce C, Mostaghimi A. Modelling the value of risk‐stratified skin cancer screening of asymptomatic patients by dermatologists. Br J Dermatol 2020; 183:509-515. [DOI: 10.1111/bjd.18816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 12/11/2022]
Affiliation(s)
- R.I. Hartman
- Department of Dermatology Brigham and Women's Hospital and Harvard Medical School Boston MA USA
| | - Y. Xue
- Harvard Combined Dermatology Residency Training Program Boston MA USA
| | - S. Singer
- Department of Dermatology Brigham and Women's Hospital and Harvard Medical School Boston MA USA
| | - T.W. Markossian
- Department of Public Health Sciences Loyola University Stritch School of Medicine Chicago IL USA
| | - C. Joyce
- Department of Public Health Sciences Loyola University Stritch School of Medicine Chicago IL USA
| | - A. Mostaghimi
- Department of Dermatology Brigham and Women's Hospital and Harvard Medical School Boston MA USA
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32
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Abstract
BACKGROUND Skin cancer has traditionally been studied in Caucasian skin. Although it does occur with increased relative frequency in Caucasians, patients with skin of color suffer from elevated morbidity and mortality when diagnosed with skin cancer. OBJECTIVE To detail the unique demographic, clinical, and genetic features of melanoma in patients with skin of color, including Hispanic, African American, and Asian patients. MATERIALS AND METHODS A PubMed search was conducted spanning dates 1947 to June 2017. A total of 246 articles were screened, from which 69 were included in this review. RESULTS Relative to Caucasians, melanoma has unique demographic, clinical, and genetic features in African Americans, Hispanics, and Asians that include gender and subtype predominance. CONCLUSION Familiarization with these unique presentations of skin cancer in skin of color is imperative to accurate identification and treatment of cutaneous malignancies in these populations and ultimately to improved disease-related outcomes.
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33
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Baranowski MLH, Yeung H, Chen SC, Gillespie TW, Goodman M. Factors associated with time to surgery in melanoma: An analysis of the National Cancer Database. J Am Acad Dermatol 2019; 81:908-916. [PMID: 31163238 DOI: 10.1016/j.jaad.2019.05.079] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 05/22/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Timely treatment for melanoma may affect survival, and characterizing the predictors of delay may inform intervention strategies. OBJECTIVE To determine characteristics associated with the interval between diagnosis and surgery in melanoma. METHODS The National Cancer Database was used to examine factors associated with the interval between diagnosis and surgery among 213 146 patients with stage I, II, or III cutaneous melanoma. RESULTS Among privately insured patients, time to surgery was longer for patients aged 50 to 70 years (hazard ratio [HR], 0.96) and older than 70 years (HR, 0.83) compared with those younger than 50 years. In contrast, patients without private insurance experienced a shorter surgical wait time if older (HR for age 50-70 years, 1.07; HR for age >70 years, 1.05). Other factors associated with longer surgical interval included nonwhite race, less education, higher comorbidity burden, advanced stage, and head or neck melanoma location. LIMITATIONS Use of zip code-level data for income and education level. CONCLUSION Patients with melanoma experience disparities in timely receipt of surgery.
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Affiliation(s)
- Marissa L H Baranowski
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Regional TeleHealth Service, Veterans Integrated Services Network 7, Decatur, Georgia
| | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Regional TeleHealth Service, Veterans Integrated Services Network 7, Decatur, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Theresa W Gillespie
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia; Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.
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34
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Dick M, Aurit S, Silberstein P. The Odds of Stage IV Melanoma Diagnoses Based on Socioeconomic Factors. J Cutan Med Surg 2019; 23:421-427. [PMID: 31081374 DOI: 10.1177/1203475419847955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND When diagnosed at stage 0-I, melanoma has a 5-year survival rate of 92% to 100% in comparison with stage IV, which has a 5-year survival rate of 15% to 20%. OBJECTIVE The objective of this article is to identify what socioeconomic and demographic factors were associated with increased odds in receiving a delayed melanoma diagnosis. METHODS This study analyzed the odds of 108,628 patients from the National Cancer Database who were diagnosed between 2004 and 2012 with American Joint Committee on Cancer stage 0-I and stage IV based on race, sex, insurance type, income, facility type, and education. RESULTS We identified significantly (P < .05) increased odds of stage IV primary melanoma diagnosis in those who had nonprivate insurance, including Medicare (odds ratio [OR] = 1.31, 95% confidence interval [CI]: 1.19-1.45), other government insurance (OR = 2.19, 95% CI: 1.61-2.98), Medicaid (OR = 6.97, 95% CI: 5.98-8.13), or no insurance (OR = 5.10, 95% CI: 4.41-5.91). Increased odds of late-stage melanoma were also associated with male sex (OR = 1.46, 95% CI: 1.36-1.57), race and ethnicity other than non-Hispanic white such as Hispanic whites (OR = 1.49, 95% CI: 1.15-1.92) or African Americans (OR=4.81, 95% CI: 3.75-6.18), and who had decreased education (OR = 1.19, 95% CI: 1.09-1.30). There was not a significant increase in odds of late-stage melanoma in patients from areas with the lowest levels of income compared with areas of highest income. CONCLUSIONS Certain socioeconomic and demographic factors are associated with odds of a later-stage melanoma diagnosis.
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Affiliation(s)
- Mary Dick
- 1 Creighton School of Medicine, Omaha, NE, USA
| | - Sarah Aurit
- 2 Clinical Research and Evaluative Sciences at CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Peter Silberstein
- 3 Hematology Oncology at CHI Health Creighton University Medical Center Omaha, NE, USA
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35
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Zhang J, Ye ZW, Townsend DM, Hughes-Halbert C, Tew KD. Racial disparities, cancer and response to oxidative stress. Adv Cancer Res 2019; 144:343-383. [PMID: 31349903 PMCID: PMC7104807 DOI: 10.1016/bs.acr.2019.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
At the intersection of genetics, biochemistry and behavioral sciences, there is a largely untapped opportunity to consider how ethnic and racial disparities contribute to individual sensitivity to reactive oxygen species and how these might influence susceptibility to various cancers and/or response to classical cancer treatment regimens that pervasively result in the formation of such chemical species. This chapter begins to explore these connections and builds a platform from which to consider how the disciplines can be strengthened further.
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Affiliation(s)
- Jie Zhang
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, United States.
| | - Zhi-Wei Ye
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, United States
| | - Danyelle M Townsend
- Department of Pharmaceutical and Biomedical Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Chanita Hughes-Halbert
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, United States; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Kenneth D Tew
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, United States
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36
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Melanoma prognosis in the United States: Identifying barriers for improved care. J Am Acad Dermatol 2019; 80:1256-1262. [PMID: 30659870 DOI: 10.1016/j.jaad.2019.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/11/2018] [Accepted: 01/02/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite improvements in melanoma mortality, disparities in melanoma survival persist. We evaluated possible sociodemographic and health care-based predictors of differences in melanoma survival in the United States by using the melanoma mortality-to-incidence ratio (MIR). METHODS State-based MIRs were calculated by using US cancer statistics data from 1999 to 2014. Pearson correlations and linear regressions were used to determine associations between MIR and dermatologist density, primary care provider density, number of physicians by state, number of National Cancer Institute-designated cancer centers, health care spending per capita, average household income, racial/ethnic makeup of the population, percentage of uninsured individuals, and percentage with a bachelor's degree. RESULTS The mean overall MIR was 0.15 ± 0.04; only Alaska was an outlier (0.24). No state MIRs increased significantly over time; MIR decreased for most states. Multivariable analysis revealed that states with more active physicians (P = .02) and a higher percentage non-Hispanic whites (P = .004) had higher MIRs (poorer survival). Significant Pearson correlations were seen between MIR and melanoma incidence (r = -0.72, P < .001), melanoma mortality (r = 0.38, P < .001), dermatologist density (r = 0.32, P < .001), and National Cancer Institute-designated cancer center count (r = -0.12, P = .001). CONCLUSIONS Melanoma survival is improved in higher-incidence areas and areas with higher dermatologist density. These findings highlight areas of poorer melanoma survival and the need for local studies evaluating disparities in melanoma survival.
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37
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Wright CY. Next-generation melanoma prevention efforts for overlooked populations and populations with health disparities: a South African perspective. Melanoma Manag 2018; 5:MMT09. [PMID: 30459940 PMCID: PMC6240884 DOI: 10.2217/mmt-2018-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/31/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Caradee Y Wright
- Environment & Health Research Unit, South African Medical Research Council, Pretoria, South Africa.,Department of Geography, Geoinformatics & Meteorology, University of Pretoria, Pretoria, South Africa.,Environment & Health Research Unit, South African Medical Research Council, Pretoria, South Africa.,Department of Geography, Geoinformatics & Meteorology, University of Pretoria, Pretoria, South Africa
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38
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Abstract
As cutaneous cancers are the most common malignancies affecting US citizens, they represent a significant public health problem and health care cost burden. There are a variety of treatment options available to manage cutaneous malignancies, but limited data are available regarding outcomes, including quality of life, recurrence, and mortality. Here, we examine outcomes of skin cancer surgery as they relate to sociodemographic data and treatment factors.
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39
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Survival trends among patients with metastatic melanoma in the pretargeted and the post-targeted era: a US population-based study. Melanoma Res 2018; 28:56-60. [PMID: 29023264 DOI: 10.1097/cmr.0000000000000394] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In 2011, ipilimumab was approved by the US Food and Drug Administration (FDA) for metastatic melanoma. Since its approval, numerous targeted therapies have been approved by the FDA. Population-based studies assessing the survival benefit from these agents are lacking. We therefore carried out this study to compare the 1-year, 2-year, and median overall survival (OS) among metastatic melanoma patients in pretargeted and post-targeted eras. This is a retrospective study that utilized the Surveillance, Epidemiology, and End Results (SEER-18) database, version 8.3.4 (22 March 2017). The patient groups were defined as the pretargeted era (2004-2010) and the post-targeted era (2011-2014) as ipilimumab was approved by the FDA in 2011. The database comprised of 5471 patients (3314 in the pretargeted era and 2157 in the post-targeted era). OS in the post-targeted era was found to be significantly better compared with the pretargeted era by Kaplan-Meier curve (1-year OS: 38.9 vs. 36.8%, 2-year OS: 28.3 vs. 23.5%, and median survival: 8 vs. 7 months, P=0.001 by the log-rank test). The survival was significantly better in the post-targeted era compared with the pretargeted era on multivariate analysis using a Cox proportional hazard model after adjusting for age, sex, race, and metasectomy status (adjusted hazard ratio of 0.889, 95% CI: of 0.832-0.951, P=0.001). There is significant survival benefit in metastatic melanoma patients since the introduction of immune checkpoint-blocking agents.
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Mota Garcia T, Hiyoshi A, Udumyan R, Sjöqvist H, Fall K, Montgomery S. Acne in late adolescence is not associated with a raised risk of subsequent malignant melanoma among men. Cancer Epidemiol 2017; 51:44-48. [PMID: 29032321 DOI: 10.1016/j.canep.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/06/2017] [Accepted: 10/01/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND To evaluate the association of acne in late adolescence with the risk for subsequent malignant melanoma (MM) in men. METHODS Swedish register-based cohort study of 242,096 males born between 1952 and 1956, who took part in compulsory assessments for Swedish military conscription in late adolescence between 1969 and 1975, with subsequent diagnoses of MM (n=1,058) up to December 31, 2009. Covariates included measures of childhood circumstances and information from adolescence on presence of acne, physical fitness, cognitive function, body mass index (BMI), and a summary of diagnoses. Cox regression was used for the analysis. RESULTS In total 1,058 men were diagnosed with MM. Acne was not associated with subsequent MM, with an adjusted hazard ratio (and 95% confidence interval) of 0.95 (0.61 to 1.49). Men with parents who were agricultural workers, and men who lived in northern Sweden, had lower physical fitness, or lower cognitive function had a lower risk of MM. Overweight and obesity was associated with a raised risk, with an adjusted hazard ratio of 1.39 (1.14, 1.71). CONCLUSIONS Acne in late adolescence is unlikely to represent a raised risk for subsequent MM in men. Overweight or obesity was identified as a raised risk for MM, possibly due to the associated increased skin surface area.
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Affiliation(s)
- Teresa Mota Garcia
- Faculty of Health Sciences of the University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilhã, Portugal
| | - Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden.
| | - Ruzan Udumyan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden
| | - Hugo Sjöqvist
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden; Department of Statistics, Örebro University, 701 82, Örebro, Sweden
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE 171 77, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden; Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, SE 171 76 Stockholm, Sweden; Department of Epidemiology and Public Health, University College, WC1E 6BT London, UK
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Chu BS, Koffi W, Hoehn RS, Ertel A, Shah SA, Ahmad SA, Sussman JJ, Neuman HB, Abbott DE. Improvement and persistent disparities in completion lymph node dissection: Lessons from the National Cancer Database. J Surg Oncol 2017; 116:1176-1184. [PMID: 28743173 DOI: 10.1002/jso.24766] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/21/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Completion lymph node dissection (CLND) is recommended for melanoma patients with positive sentinel lymph node biopsies (SLNB); however, 50% do not undergo CLND. We sought to determine CLND trends over time, and factors contributing to variability. METHODS The NCDB was queried for patients undergoing wide local excision (WLE), with or without SLNB and CLND. Cohorts were created based on demographic/socioeconomic variables and era of treatment (Era 1: 2003-07, Era 2: 2008-12). Univariate and multivariate analyses identified factors associated with performance of or trends in CLND. RESULTS 122 849 underwent WLE with SLNB. Of 24 267 (19.8%) with +SLNB, 13 594 (56.0%) continued to CLND. In multivariate analyses, Medicaid (OR 0.78; P = 0.04) or Medicare (OR 0.79; P < 0.01) in Era 1 and patients without insurance in Era 2 (OR 0.78; P = 0.01) underwent less CLND. In both eras, Blacks (OR 0.45; P < 0.01, OR 0.59; P < 0.01), head/neck lesions (OR 0.72; P < 0.01, OR 0.66; P < 0.01) and lower extremity lesions (OR 0.75; P < 0.01, OR 0.72; P < 0.01) underwent less CLND. However, Blacks experienced greatest increase in CLND usage (+9.2%). CONCLUSIONS CLND usage continues to be low and racial/socioeconomic disparities persist. Until the results of MSLT-2 become available, continued focus on understanding poor adherence to, and improving rates of CLND is necessary.
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Affiliation(s)
- Brian S Chu
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Wima Koffi
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Richard S Hoehn
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Audrey Ertel
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Shimul A Shah
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Syed A Ahmad
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | | | - Heather B Neuman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Daniel E Abbott
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Potential therapeutic targets of epithelial-mesenchymal transition in melanoma. Cancer Lett 2017; 391:125-140. [PMID: 28131904 DOI: 10.1016/j.canlet.2017.01.029] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/02/2017] [Accepted: 01/18/2017] [Indexed: 12/16/2022]
Abstract
Melanoma is a cutaneous neoplastic growth of melanocytes with great potential to invade and metastasize, especially when not treated early and effectively. Epithelial-mesenchymal transition (EMT) is the process by which melanocytes lose their epithelial characteristics and acquire mesenchymal phenotypes. Mesenchymal protein expression increases the motility, invasiveness, and metastatic potential of melanoma. Many pathways play a role in promotion of mesenchymal protein expression including RAS/RAF/MEK/ERK, PI3K/AKT/mTOR, Wnt/β-catenin, and several others. Downstream effectors of these pathways induce expression of EMT transcription factors including Snail, Slug, Twist, and Zeb that promote repression of epithelial and induction of mesenchymal character. Emerging research has demonstrated that a variety of small molecule inhibitors as well as phytochemicals can influence the progression of EMT and may even reverse the process, inducing re-expression of epithelial markers. Phytochemicals are of particular interest as supplementary treatment options because of their relatively low toxicities and anti-EMT properties. Modulation of EMT signaling pathways using synthetic small molecules and phytochemicals is a potential therapeutic strategy for reducing the aggressive progression of metastatic melanoma. In this review, we discuss the emerging pathways and transcription factor targets that regulate EMT and evaluate potential synthetic small molecules and naturally occurring compounds that may reduce metastatic melanoma progression.
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Wang Y, Zhao Y, Ma S. Racial differences in six major subtypes of melanoma: descriptive epidemiology. BMC Cancer 2016; 16:691. [PMID: 27576582 PMCID: PMC5004333 DOI: 10.1186/s12885-016-2747-6] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 08/24/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Melanoma accounts for the majority of skin cancer deaths. It has over thirty different subtypes. Different races have been observed to differ in multiple aspects of melanoma. METHODS SEER (Surveillance, Epidemiology, and End Results) data on six major subtypes, namely melanoma in situ (MIS), superficial spreading melanoma (SSM), nodular melanoma (NM), lentigo maligna melanoma (LMM), acral lentiginous melanoma malignant (ALM), and malignant melanoma NOS (NOS), were analyzed. The racial groups studied included NHW (non-Hispanic white), HW (Hispanic white), Black, and Asian/PI (Pacific Islanders). Univariate and multivariate analysis was conducted to quantify racial differences in patients' characteristics, incidence, treatment, and survival. RESULTS Significant racial differences are observed in patients' characteristics. For all subtypes except for ALM, NHWs have the highest incidence rates, followed by HWs, while Blacks have the lowest. For ALM, HWs have the highest rate, followed by NHWs. In stratified analysis, interaction between gender and race is observed. For the first five subtypes and localized and regional NOS, the dominating majority of patients had surgery, while for distant NOS, the distribution of treatment is more scattered. Significant racial differences are observed for distant ALM and NOS. For MIS, SSM, NM, LMM, and ALM, there is no significant racial difference in survival. For NOS, significant racial differences in survival are observed for the localized and regional stages, with NHWs having the best and Blacks having the worst five-year survival rates. CONCLUSIONS Racial differences exist for the six major melanoma subtypes in the U.S. More data collection and analysis are needed to fully describe and interpret the differences across racial groups and across subtypes.
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Affiliation(s)
- Yu Wang
- School of Statistics and The center for Applied Statistics, Renmin University of China, 59 Zhongguancun Ave., Beijing, 100872 China
| | - Yinjun Zhao
- School of Public Health, Yale University, 60 College ST, LEPH 206, New Haven, CT 06520 USA
| | - Shuangge Ma
- School of Statistics and The center for Applied Statistics, Renmin University of China, 59 Zhongguancun Ave., Beijing, 100872 China
- School of Public Health, Yale University, 60 College ST, LEPH 206, New Haven, CT 06520 USA
- VA Cooperative Studies Program Coordinating Center, West Haven, CT USA
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Melanoma Disparities among US Hispanics: Use of the Social Ecological Model to Contextualize Reasons for Inequitable Outcomes and Frame a Research Agenda. J Skin Cancer 2016; 2016:4635740. [PMID: 27651954 PMCID: PMC5019891 DOI: 10.1155/2016/4635740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/03/2016] [Indexed: 11/29/2022] Open
Abstract
Cutaneous melanoma is a significant public health concern, accounting for thousands of deaths annually in the US. Early detection and diagnosis are critical given the poor prognosis and limited treatment options of advanced-stage disease. While non-Hispanic whites have higher incidence rates of melanoma, Hispanics are typically diagnosed at later disease stages and suffer higher morbidity and mortality. Currently, there is a paucity of literature investigating the root causes underlying these trends among Hispanics. Given that Hispanics are the most rapidly expanding demographic segment in the US, it is essential for cancer control efforts to elucidate the major determinants of their poor melanoma outcomes. Herein, we use the social ecological model as a framework to explore the multitude of influences on melanoma disparities among Hispanics and provide recommendations for planning future studies and interventions.
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Hamilton EC, Nguyen HT, Chang YC, Eberth JM, Cormier J, Elting LS, Austin MT. Health Disparities Influence Childhood Melanoma Stage at Diagnosis and Outcome. J Pediatr 2016; 175:182-7. [PMID: 27233520 DOI: 10.1016/j.jpeds.2016.04.068] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/01/2016] [Accepted: 04/20/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To identify health disparities in pediatric patients with melanoma that affect disease presentation and outcome. STUDY DESIGN This was a retrospective cohort study of all persons aged ≤18 years diagnosed with melanoma and enrolled in the Texas Cancer Registry between 1995 and 2009. Socioeconomic status (SES) and driving distance to the nearest pediatric cancer treatment center were calculated for each patient. Logistic regression was used to determine factors associated with advanced-stage disease. Life table methods and Cox regression were used to estimate survival probability and hazard ratios. RESULTS A total of 185 adolescents (age >10 years) and 50 young children (age ≤10 years) were identified. Hispanics (n = 27; 12%) were 3 times more likely than non-Hispanic whites (n = 177; 75%) to present with advanced disease (OR, 3.8; 95% CI, 1.7-8.8). Young children were twice as likely as adolescents to present with advanced disease (OR, 2.2; 95% CI, 1.1-4.3). Distance to treatment center and SES did not affect stage of disease at presentation. Hispanics and those in the lowest SES quartile had a significantly higher mortality risk (hazard ratios, 3.0 [95% CI, 1.2-7.8] and 4.3 [95% CI, 1.4-13.9], respectively). In the adjusted survival model, only advanced disease was predictive of mortality (P < .001). CONCLUSION Hispanics and young children with melanoma are more likely to present with advanced disease, and advanced disease is the single most important predictor of survival. Heightened awareness among physicians is needed to facilitate early detection of melanoma within these groups.
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Affiliation(s)
- Emma C Hamilton
- Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Hoang T Nguyen
- Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Yu-Chia Chang
- Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC; Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC
| | - Janice Cormier
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Linda S Elting
- Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Mary T Austin
- Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Pediatric Patient Care, Children's Cancer Hospital, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
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Watson M, Holman DM, Maguire-Eisen M. Ultraviolet Radiation Exposure and Its Impact on Skin Cancer Risk. Semin Oncol Nurs 2016; 32:241-54. [PMID: 27539279 DOI: 10.1016/j.soncn.2016.05.005] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To review research and evidence-based resources on skin cancer prevention and early detection and their importance for oncology nurses. DATA SOURCES Journal articles, federal reports, cancer surveillance data, behavioral surveillance data. CONCLUSION Most cases of skin cancer are preventable. Survivors of many types of cancer are at increased risk of skin cancers. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses can play an important role in protecting their patients from future skin cancer morbidity and mortality.
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Abstract
Cutaneous malignancies make up the majority of periocular tumors diagnosed and treated by ophthalmologists. In this review, we examine literature regarding ethnic and socioeconomic disparities in incidence and clinical outcomes of the three most common cutaneous periocular tumors: basal cell carcinoma, squamous cell carcinoma, and melanoma. In all three tumor types, the literature shows an increased incidence among two groups: those with lightly pigmented skin and those of higher socioeconomic status. While incidence is high in these groups, clinical outcomes for these patients tend to be good. Those with lower socioeconomic status and ethnic minorities, on the other hand, have a low incidence but are more likely to have poor clinical outcomes. These disparities are likely the result of both biologic and behavioral differences between patients and could provide opportunities for intervention to change risk perception and improve outcomes.
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Affiliation(s)
- Talmage Broadbent
- a Vanderbilt Eye Institute , Vanderbilt University, Nashville , TN , USA
| | - Brian Bingham
- a Vanderbilt Eye Institute , Vanderbilt University, Nashville , TN , USA
| | - Louise A Mawn
- a Vanderbilt Eye Institute , Vanderbilt University, Nashville , TN , USA
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Comprehensive surgical care: less recognized factors in successfull operative treatment. Eur Surg 2015. [DOI: 10.1007/s10353-015-0366-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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