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Racial differences in time to treatment for melanoma

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Research conducted at Case Western Reserve University and University Hospitals Cleveland Medical Center (UH) found that Black patients with melanoma are likely to experience a longer wait time from diagnosis to surgery when compared to non-Hispanic white (NHW) patients.

Results of the study published online ahead of print in the Journal of the American Academy of Dermatology (Apr. 8, 2020) concluded the time from diagnosis to definitive surgery (TTDS) for melanoma was 23.4 days on average for Black patients compared to 11.7 days for NHW patients.

Further, Black patients were twice as likely to have a TTDS of 41 to 60 days, three times as likely to have a TTDS of 61 to 90 days, and five times as likely to have a TTDS of 91 days or more.

The study was based on the National Cancer Database statistics from 2004 to 2015. Multivariable logistic regression was used by the study’s authors to evaluate the association of race with TTDS controlling for sociodemographic and disease characteristics.

Led by Dr. Jeremy Bordeau, director of the multidisciplinary melanoma program at UH and a professor of dermatology at the medical school, researchers also found disparities despite controlling for various demographic characteristics such as insurance type and income level.

“We already knew that Black patients with melanoma have a worse prognosis and that longer time to treatment is associated with worse survival, but we did not fully understand the relationship between race and time to treatment after controlling for various other factors,” said Raghav Tripathi, the study’s first author, in a press release. Tripathi is a medical student at Case Western Reserve’s School of Medicine and a researcher at UH.

“A more thorough understanding of the factors associated with worse outcomes for Black patients is critical in reducing racial disparities in melanoma outcomes,” Tripathi added.

Of the 233,983 melanoma patients observed in the study, 1,221 were Black. According to Tripathi, because the incidence of melanoma in Black populations is relatively low, using large healthcare databases and sample sizes help researchers include a sufficient number of patients to study racial disparities in skin cancers.

Investigators found that patients with Medicaid had the longest TTDS—an average of 60.4 days—and those with private insurance had the shortest TTDS—44.6 days. Additionally, racial differences in TTDS were present in both insurance groups suggesting that types of insurance did not completely explain the disparities.

Tripathi notes that the precise nature of the association between TTDS and race is unknown. However, Tripathi said Black patients are known to develop more aggressive melanomas and require more complex surgeries that can take longer to arrange, especially if the procedure requires coordination among multiple clinicians.

Awareness about skin cancer among Black Americans can be limited because it is relatively rare in that population, said Tripathi.

“Ultimately, we hope this study will draw attention to the importance of further understanding the various components of TTDS and worse outcomes for Black melanoma patients,” Tripathi said. “Additionally, this study suggests that targeted approaches to improve TTDS for Black melanoma patients are integral in reducing racial disparities in melanoma outcomes.”

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