Even though Caucasians are much more likely to develop skin cancer than other ethnic groups, people of color who do get the disease are less likely to survive, a U.S. study suggests.
Among nearly 97,000 patients with melanoma - the rarest and deadliest type of skin malignancy - white patients had the highest likelihood of survival, followed by Hispanics, and then Asian American, Native American and Pacific Islanders. African-American patients had the worse survival odds of all.
"In general, white patients have higher overall survival than black patients because the public and many physicians are not aware that black patients can get melanoma," said senior study author Dr. Jeremy Bordeaux of Case Western Reserve University in Cleveland.
Part of the problem may be that non-white patients get diagnosed when the cancer is more advanced. But that doesn't entirely explain the racial disparities in outcomes, Bordeaux said by email.
"What is more troubling to me is that even when black patients are diagnosed at the same stage as white patients, they still have worse outcomes," Bordeaux added. "Black patients may not be treated as quickly as white patients or they may not be receiving the same treatment, or another possibility is that melanoma in black people may just be more aggressive in general."
The vast majority of skin cancers don’t result in death. But melanoma – a rare form that accounts for less than 2 percent of cases – has a much higher death rate.
This year, an estimated 76,400 people will develop melanoma in the U.S. and 10,100 will die from the disease, according to a recent report in JAMA.
For the current study, researchers analyzed national cancer registry data collected from 1992 to 2009 on patients with melanoma.
They looked at how advanced cancer was at the time of diagnosis and outcomes based on the severity of the disease at that point in time.
At the earliest stages, melanoma may be found only in the outer layer of skin or epidermis, when it's unlikely to spread to other parts of the body. As it progresses, melanoma gets thicker, penetrates more layers of skin and becomes increasingly more likely to spread or become fatal.
African-American patients had the worst overall survival rate, and they were also the group most likely to be diagnosed with melanoma in its later stages, when the disease is more difficult to treat, researchers report in the Journal of the American Academy of Dermatology.
One limitation of the study is that researchers lacked data on some factors that can influence melanoma outcomes, including family history of the disease, follow-up time, income, insurance status, and other medical problems, the authors note.
Even so, the findings should serve as a reminder that patients of every skin color need to use sunscreen and take precautions like staying in the shade during the brightest part of the day, said Dr. Mona Gohara, a dermatology researcher at Yale School of Medicine who wasn't involved in the study.
"There is a false sense of immunity amongst populations of color and the doctors caring for us," Gohara said by email. "Cancer is cancer; no population is fortunate enough to be exempt from this disease."
Doctors and patients may also need to get better at looking for abnormalities on skin of color, whether in self-exams at home or annual cancer screenings at a doctor's office, said Dr. Seemal Desai, a researcher at the University of Texas Southwestern Medical Center and president-elect of the Skin of Color Society.
"Darker skin tones can certainly be more challenging, and I do think you have to see lots of patients with different skin tones to pick up on clues," Desai, who wasn't involved in the study, said by email. "There are dermatologists out there who specialize in skin of color."