Daily Briefing

What's behind higher melanoma mortality rates among Black men?


According to a new study published in the Journal of the American Academy of Dermatology, black men are at higher risk of death from melanoma compared to other racial/ethnic groups, which researchers say may be partly due to delayed diagnoses.

Study details and key findings

For the study, researchers analyzed data from the National Cancer Database from 2004 to 2018 in white, Black, Asian, American Indian/Alaska Native, and Hispanic men. In total, 205,125 cases of melanoma among male patients were included in the study.

The researchers found that the location of patients' melanomas differed significantly by race. Among white men, most melanomas were located on either the trunk (35.5%) or the head and neck (25.7%). In comparison, only 12.6% of melanomas in Black men were on the trunk and 9.8% on the head.

Half (50.7%) of cases in Black men occurred on their lower extremities. Many melanoma cases in Black men were also found in areas that are not usually exposed to the sun, including the soles of the feet, toes, toenails, fingers, fingernail beds, and palms.

In addition, Black men were more likely to have a melanoma subtype called acral lentiginous melanoma, which is a deadlier form of the disease. Almost 20% of Black men had this type of melanoma, compared to less than 1% of white men.

After a melanoma diagnosis, over 75% of white men live five years or more, but only 51.7% of Black men do the same. Compared to white men, Black men had a 26% higher mortality rate from melanoma.

According to the researchers, delayed melanoma diagnoses among Black men may contribute to their higher mortality rate from the disease. If melanoma is detected early, its five-year survival rate is 99%, but once it has spread to distant parts of the body, the five-year survival rate drops to roughly 32%.

Although only 21.1% of white men were diagnosed at late stages of the disease, almost half (48.6%) of Black men received late diagnoses. Late-stage diagnoses also occurred in 39.6% of Hispanic men, 37.6% of Asian men, and 29.1% of Native American men.

However, the researchers noted that other factors may also contribute to why Black men are at a higher risk of melanoma.

Even after controlling for different factors, including income, insurance, access to healthcare, and education level, they "don't fully explain why Black men would have a 26 percent higher death rate than Whites," said Ashley Wysong, chair of the department of dermatology at the University of Nebraska Medical Center and one of the study's authors. "It does suggest that there are biological factors at work."

Commentary

According to Jeremy Brauer, a physician and clinical associate professor of dermatology at NYU Langone Health, the study underscores a need for more public education on melanoma among both doctors and patients, especially in Black patients where it rarely occurs.

Because doctors are often trained to identify skin cancers on white skin, they may not know how the disease presents differently in different races. "This disproportionate and unfortunate rate of death means we have to try to be much more preventative," Brauer said.

Separately, David Leffell, a professor of dermatology and surgery at Yale University's medical school, said new research is needed to bring attention to melanoma in Black men.

"There hasn't been a focus on this, and when there isn't that focus, there isn't the research funding," Leffell said. "So I think that the article is going to shine some attention on the need to fund research in that area. And who knows? By paying more attention to the less common categories within melanoma, we may come to understand melanoma better in general."

As the number of invasive melanoma cases continues to rise, experts recommend getting annual skin checks at the doctor and doing monthly personal checks of your body for any potential concerning changes. "Watch for anything new, growing, changing, bleeding, not healing, not part of your normal skin" and consult a dermatologist if find anything concerning, Wysong said.

In addition, Wysong noted that since "sun exposure is the biggest modifiable risk factor" melanoma, it's important to protect yourself when you're outside in the sun by seeking shade; wearing protective clothing, hats, and sunglasses; and wearing sunscreen that is at least SPF 30. (Atkins, Washington Post, 7/11; Bellamy, NBC News, 7/11; Pugachevsky, Insider, 7/11; Ducharme, TIME, 7/11; Brunk, Medscape, 7/11)


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