Racial Disparities in Cutaneous Melanoma Mortality: A Systematic Review and Meta-Analysis

Cutaneous melanoma accounts for 5% of new cancer diagnoses in the United States. Despite advancements in treatment of melanoma, marked racial, ethnic, and socioeconomic disparities persist.

To determine if there are racial and ethnic disparities in melanoma survival and to highlight opportunities for interventions to improve melanoma patient outcomes.

The databases PubMed/Medline, EMBASE, and Web of Science were searched from inception to February 9, 2021.

Original publications reporting mortality statistics by race/ethnicity for patients with cutaneous melanoma, vulvar melanoma, or melanoma metastases were selected. Only experimental studies, observational studies, and research letters, with a study population in the United States were included.

This investigation was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Authors performed title and abstract screening, followed by full text review in duplicate.

We hypothesized that racial and ethnic minority groups would have worse melanoma mortality outcomes when compared to White patients.

Five representative studies with dates ranging from 1992-2015 were selected. The overall hazard ratio (HR) for Black patients vs. White patients was 1.31 (95% confidence interval (CI): 1.09-1.57), indicating that Black patients had a 31% increase in the risk of death as compared to White patients. Asian/Pacific Islander patients also had a 31% increase in the risk of death as compared to White patients (HR 1.31, 95% CI: 1.17-1.46). Hispanic patients had a 9% increase in the risk of death as compared to Non-Hispanic White (HR 1.09, 95% CI: 1.03-1.16). There was no significant difference in risk between American Indian/Alaskan Native and White patients (HR 0.94, 95% CI: 0.57-1.55).

Worse melanoma survival outcomes in racial and ethnic minority groups are evidenced by multiple studies. More current investigations of melanoma outcomes in racial and ethnic minorities are necessary to identify and implement measures to narrow the gap in health outcomes.

Question: Are there racial and ethnic disparities in melanoma mortality outcomes?

The pooled meta-analysis revealed that there are significantly worse melanoma survival outcomes in racial and ethnic minority groups when compared to White patients. The overall HR for Black, Asian/Pacific Islander, and Hispanic patients compared to White patients were 1.31, 1.31, and 1.09, respectively. Meaning: Worse melanoma survival outcomes in racial and ethnic minority groups are evidenced by these meta-analyses.