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Past
Incidence of melanoma is disproportionately higher in White populations, and therefore, most people are unaware that survival for Black patients with melanoma is 25% less than for White patients.1 Awareness of the risks of melanoma among Blacks is low. Blacks are also more likely to present with advanced-stage melanoma compared with Whites.2 Many clinicians who diagnose and treat cutaneous neoplasms are unlikely to have received training in the unique characteristics of pigmented skin, thus potentially contributing to the late-stage diagnosis of melanoma in Black patients. Additionally, unequal access to optimal cancer care and clinical trials continues to burden Black patients with melanoma.
Present
Our study3 lays bare the absence of information on Black patients in seminal studies on melanoma4,5 We show that from 1899 to the present, Black patients have continued to present with late-stage disease, and their survival outcomes have remained worse compared with White patients. We also highlight some of the barriers to optimal cancer care, such as delay to initiation of immunotherapy. There has been less research into and fewer clinical trial options for acral lentiginous melanoma (ALM), which is more common in Black people, than for other cutaneous melanoma histologic subtypes.
Future
One of the melanoma educational posters in my clinic mentions Bob Marley as having died of melanoma. Patients are often surprised to hear that, and it is often a unique conversation starter about creating awareness that melanoma affects Black people. Future trials and other studies in melanoma should report on racial demographics as data will help guide the efforts to mitigate disparities. Research to identify targeted therapies and enhance response to immune checkpoint therapies for patients with ALM should be encouraged and promoted. Increasing the racial diversity of clinical practitioners and researchers who deal with melanoma will go a long way to improving the disparities between Black and White patients.
References
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Imahiyerobo-Ip J, Ip I, Jamal S, Nadiminti U, Sanchez M. Skin cancer awareness in communities of color. J Am Acad Dermatol. 2011;64(1):198–200.
Asare EA, Swami, U, Stewart, J. H. Landmark series on disparities in surgical oncology: melanoma. Ann Surg Oncol. 2021. https://doi.org/10.1245/s10434-021-10273-x.
Morton DL, Thompson JF, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599–609.
Faries MB, Thompson JF, Cochran AJ, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 2017;376(23):2211–22.
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Asare, E.A., Stewart, J.H. ASO Author Reflections: Melanoma Killed Bob Marley and Others Too. Ann Surg Oncol 28, 6994 (2021). https://doi.org/10.1245/s10434-021-10283-9
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DOI: https://doi.org/10.1245/s10434-021-10283-9