Disparities in acral lentiginous melanoma: Factors beyond delayed diagnosis.

Abstract

Poor melanoma outcomes in people of color are commonly attributed to a higher acral lentiginous melanoma (ALM) burden and delayed diagnosis. To understand the epidemiology of ALM in different racial groups to establish whether outcome disparities are truly driven by delayed diagnosis. Cutaneous melanoma cases were extracted from the Surveillance, Epidemiology, and End Results Program database. Disease severity at diagnosis and risk of melanoma-specific death, independent of clinicopathological and socioeconomic covariates, were compared among racial groups in the 4 major melanoma histological subtypes. No significant difference in disease severity at diagnosis was observed between Black and White patients with ALM. Remarkably, ALM was the only major melanoma subtype in which Black patients faced a significantly higher risk of mortality (hazard ratio = 2.04, 95% confidence interval: 1.31-3.11) when compared to White patients. Limited data on ALM in non-Black and non-White patients, and a lack of non-US data and large genetic studies decreased our ability to assess disparities more comprehensively. Findings from this study counter previous assumptions that racial disparities in ALM are primarily attributed to delay in diagnosis and socioeconomic challenges, and suggest that more studies are needed to understand the disparity in ALM outcomes among Black patients.