Malignancy of Melanosoms Producing Streak Melanomy in African American Baby
Medicine (Baltimore). 2017 April; 96(15): e6258.
Malignant Melanoma in African–Americans
A Population-Based Clinical Outcomes Study Involving 1106 African–American Patients from the Surveillance, Epidemiology, and End Result (SEER) Database (1988–2011)
Krishnaraj Mahendraraj
aDepartment of Surgery, Saint Barnabas Medical Middle, Livingston, NJ
Komal Sidhu
aDepartment of Surgery, Saint Barnabas Medical Middle, Livingston, NJ
Christine Due south.M. Lau
aDepartment of Surgery, Saint Barnabas Medical Centre, Livingston, NJ
bSaint George's Academy School of Medicine, Grenada, West Indies
Georgia J. McRoy
bSaint George'southward University School of Medicine, Grenada, West Indies
Ronald S. Chamberlain
aDepartment of Surgery, Saint Barnabas Medical Center, Livingston, NJ
bSaint George's University School of Medicine, Grenada, West Indies
cSection of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ
dDepartment of Surgery, Banner MD Anderson Cancer Center, Gilbert, AZ.
Franz O. Smith
aDepartment of Surgery, Saint Barnabas Medical Center, Livingston, NJ
Monitoring Editor: Neil Merrett.
Received 2016 November fifteen; Revised 2017 Feb iii; Accustomed 2017 Feb six.
Abstract
Malignant melanoma accounts for 75% of all skin cancer deaths and is potentially curable if identified early. Although melanoma is rare in African–Americans (AA), information technology is associated with a worse prognosis than in Caucasians. This study examines the demographic, pathologic, and clinical factors impacting AA melanoma outcomes.
Data for 1106 AA and 212,721 Caucasian cutaneous melanoma patients were abstracted from the Surveillance, Epidemiology, and End Result (SEER) database (1988–2011). Data were grouped on the basis of histological subtypes: "Superficial Spreading" (SS), "Nodular" (NM), "Lentigo Maligna" (LM), "Acral Lentiginous" (AL), and "Not otherwise specified" (NOS).
Cutaneous malignant melanoma occurs most commonly in the 6th and seventh decade of life. Caucasian patients presented most commonly with trunk melanomas (34.5%), while lower extremity melanomas were more mutual in AAs (56.1%), P < 0.001. AAs presented with deeper tumors, more avant-garde stage of disease, and higher rates of ulceration and lymph node positivity than Caucasians. Cancer-specific bloodshed was significantly higher, while 5-year cancer-specific survival was significantly lower among AAs for NM and AL subtypes. Multivariate analysis identified male gender, regional and distant stage, NM and AL subtypes as independently associated with increased mortality among both indigenous groups.
AAs nowadays most oft with AL melanoma on the lower extremities, and with deeper and more avant-garde phase lesions. AAs have higher cancer-specific bloodshed for NM and LM than Caucasians. Melanoma teaching for AA patients and health care providers is needed to increase disease awareness, facilitate early detection, and promote access to effective treatment.
Keywords: cutaneous melanoma, cancerous melanoma, melanoma, SEER, pare cancer
1. Introduction
According to the National Cancer Establish, cutaneous melanoma represents near five% of all new diagnosed cancer cases, with a reported bloodshed of approximately ii%, making it the deadliest form of peel cancer.[one] The incidence of cutaneous melanoma has been steadily increasing over the last 10 years, and it is estimated that almost 1 million people are currently living with a melanoma diagnosis in the United States.[i] Invasive cutaneous melanoma is the fifth most common cancer diagnosis among men and the seventh nigh common among women.[1] Melanoma is far more than common among Caucasians than African–Americans (AA), with incidence rates of 33.0 per 100,000 men and 20.2 per 100,000 women among Caucasians compared with 1.2 per 100,000 men and ane.0 per 100,000 women among AAs.[1] Exposure to ultraviolet (UV) light is believed to be the most pregnant risk factor for developing cutaneous melanoma, based primarily on the observations that the incidence of melanoma is highest in populations with more directly sunlight and those living closer to the equator.[2–6] Additional gamble factors for melanoma in developed nations include the use of tanning beds and sunburns occurred during tanning amid adolescents.[2] The lower incidence rate of melanoma amidst dark skinned individuals is likely owing to the protective effects of melanin.[7]
Although AAs take a significantly lower risk of melanoma than Caucasians, ethnic disparities with regard to histologic subtypes, anatomic distribution, stage at diagnosis, and survival have been well documented.[half dozen,8–13] In 1976, Reed [fourteen] were the showtime to report the predominance of AL melanoma among AAs. A retrospective written report of 1413 histologically confirmed cases of AL over a 19-year period (1986–2005) reported lower survival rates for AL melanoma amid ethnic minorities including AAs, Hispanics, Asians, and Pacific Islanders than Caucasians.[10] Previous studies have also demonstrated that indigenous minorities presented with more avant-garde disease, had thicker melanomas, besides as lower melanoma-specific survival than Caucasians in a retrospective study involving 288,741 cases of invasive melanoma over vii-yr period (1999–2006).[15] Of note, the AA sample size in each of these studies was quite low, and to date, there are no large-calibration studies specifically analyzing melanoma among AAs, and as such, the explanation for the disparities in clinical outcomes among AA patients is poorly understood.[10,15]
This written report sought to examine a big cohort of AA and Caucasian melanoma patients from the Surveillance, Epidemiology, and End Result (SEER) database, in an effort to place demographic, clinical, and handling strategies that bear upon clinical outcomes and survival.
2. Methods
Information for the current written report were extracted from the SEER database provided by the National Cancer Institute between 1988 and 2011. SEER Stat software version eight.0.four (National Institutes of Wellness (NIH) - National Cancer Found, U.s.) was utilized to extract information from 18 SEER registries (Alaska Native Tumor Registry, Arizona Indians, Cherokee Nation, Connecticut, Detroit, Georgia Center for Cancer Statistics, Greater Bay Area Cancer Registry, Greater California, Hawaii, Iowa, Kentucky, Los Angeles, Louisiana, New Jersey, New United mexican states, Seattle-Puget Sound, and Utah). Ii hundred lx-two one thousand 3 hundred ninety-four cases of cutaneous melanoma were identified from the SEER database. Patients of Caucasian or AA race (213,827 patients) with cutaneous melanoma were identified and exported to IBM SPSSv20.2 (Armonk, NY). V subgroups of melanoma were created for analysis using the SEER International Classification of Disease for Oncology (ICD-O-3) codes based on histological subtypes: "Superficial Spreading (SS)" (8743), "Nodular Melanoma (NM)" (8721), "Lentigo Maligna (LM)" (8742), "Acral Lentiginous (AL)" (8744), and "Malignant Melanoma, (NOS)" (8720). Demographic and clinical data extracted included historic period, gender, ethnicity, geographic region, tumor histology, site, depth, phase, grade, lymph node status, presence of ulceration, and type of handling (surgery, radiations, both, or unknown/no therapy) received. Merely Caucasians and AAs were examined. Endpoints examined included cancer-specific bloodshed, overall survival, and cancer-specific ii- and 5- year survival. Categorical variables were compared using the Chi-foursquare test, and continuous variables were compared using Student t test, and assay of variance (ANOVA). Multivariate assay using the "backward wald" method was performed to calculate odds ratio (OR) and decide independent factors affecting survival. Missing and unknown information were excluded from the multivariate analysis. Kaplan–Meier analysis was used to compare long-term actuarial survival between groups. Statistical significance was accepted at the level of P < 0.05. Approval to behave this study was obtained from Saint Barnabas Medical Center, and given the retrospective nature of the study involving data from the SEER database with no patient identifiable data, patient consent was non required.
3. Results
3.1. Demographic data
A total of 262,394 cases of cutaneous melanoma were identified from the SEER database (1988–2011). G one hundred and six AA patients and 212,721 Caucasians were used to course the current study cohort. SS was the about common melanoma subtype amid Caucasians (33.4% vs 15.6% AAs), while AL was the predominant subtype amongst AAs (18.0% vs 0.91% Caucasians), P < 0.001 (Table ane). Cutaneous melanoma (SS, NM, LM, AL, and NOS) occurred most normally in the sixth to seventh decade of life, with Caucasians presenting slightly younger than AAs (58.nine ± 17.12 vs sixty.5 ± 18.xvi years, P < 0.001). Historic period at presentation was lowest among SS melanoma patients (55.1 ± 16.59 years for Caucasians, 55.49 ± 17.71 years for AAs) and highest in LM melanoma patients (69.nine ± 12.57 years for Caucasians, 66.93 ± 12.28 years for AAs), P < 0.001.
Table 1
Demographic profiles, tumor characteristics, handling, and survival outcomes of 1106 African–Americans and 212,721 Caucasian patients with malignant melanoma from the Surveillance, Epidemiology, and End Results (SEER) database, 1988–2011.
Significantly more Caucasian males and AA females had NM (male to female ratio of 1.62 : 1.0 and 0.81 : 1.0, respectively), P < 0.005. The highest incidence of melanoma diagnoses occurred on the East Coast among AAs (55.7%) and in the West Declension for Caucasians (48.0%), P < 0.001. This variation was consistent for all melanoma subtypes.
iii.two. Tumor characteristics
Overall, more AAs (56.1%) presented with melanomas of the lower extremity than Caucasians (xix.one%) for all tumor depths and stages, P < 0.001 (Table ii). Conversely, Caucasians most usually presented with trunk melanomas (34.5%) for all tumor depths and stages, P < 0.001. The torso was the well-nigh common disease site among Caucasians with both SS and NM (39.1% and 31.7%), while the lower extremity was the primary site for AAs with SS and NM (38.eight% and 49.four%), P < 0.001. The majority of LM occurred on the head and neck in both Caucasians (60.6%) and AAs (48.1%), P < 0.001. AL occurred most commonly on the lower extremities for both Caucasians (76.5%) and AAs (83.five%), P = 0.04. A majority of ulcerated melanomas presented on the lower extremities amongst AAs (71.ii%) and on the trunk among Caucasians (31.iii%), P < 0.001.
Table 2
Melanoma depth, stage, and ulceration rates by location among 1106 African–Americans and 212,721 Caucasian patients with malignant melanoma from the Surveillance, Epidemiology, and Stop Results (SEER) database, 1988–2011.
Overall, AAs presented with deeper tumors than Caucasians for SS (i.26 vs 0.83 mm), NM (3.50 vs two.93 mm), and LM (1.07 vs 0.63 mm) melanoma, respectively, P < 0.001. AL melanomas were too deeper in AAs (two.28 vs. ii.05 mm), although the difference did non reach statistical significance, P = 0.142. Amongst SS melanoma, 8.one% of AAs presented with tumors deeper than 3.00 mm compared to only 3.1% of Caucasians, P < 0.001.
AAs were significantly more likely to present with melanoma tumor ulceration than Caucasians for AL (36.2% vs 26.3%, P < 0.05), but non for the other subtypes. With regard to lymph node invasion, 21.8% of AAs with NM had lymph node positivity compared with 17.eight% Caucasians, P = 0.01. Overall, AAs presented most ordinarily with melanomas of the lower limbs, deeper tumors, greater ulceration rates, college rates of lymph node involvement, and with more avant-garde phase than Caucasians, P < 0.001.
When stratified by disease stage, Caucasians predominantly presented with localized disease in the SS subtype (92.7%), P < 0.001. On the contrary, AAs with SS melanomas had a significantly higher incidence of regionally advanced (10.4%) and afar affliction (one.2%) than Caucasians (5.half dozen% and 0.iv%, respectively), P < 0.05. A similar pattern was observed for NM, where a majority of Caucasians presented with localized disease (59.8%), while AAs presented predominantly with regionally advanced (37.ix%) and distant disease (13.8%) compared with Caucasians (34.two% and 4.4%, respectively), P < 0.001.
3.3. Handling and outcomes
The majority of both ethnic groups were treated surgically (92.8%). A significantly higher proportion of Caucasians (92.9%) were treated surgically than AAs (81.3%), P < 0.001. More Caucasians than AAs underwent surgery for all stages of disease: localized (97.viii% vs 96.0%), regional (95.7% vs 88.ix%), and distant disease (74.i% vs 50.0%), P < 0.001 (Table 3). A greater proportion of Caucasians (97.2%) underwent surgical resection for SS melanoma than AAs (93.6%), P = 0.035. No significant treatment difference was noted among NM, LM, and AL between Caucasians and AAs.
Tabular array 3
Melanoma phase by type of handling received amidst 1106 African–Americans and 212,721 Caucasian patients with malignant melanoma from the Surveillance, Epidemiology, and End Results (SEER) database, 1988–2011.
At that place was no pregnant difference in overall mortality between ethnic groups for all melanoma subtypes. The mean melanoma-specific survival was lower among AAs than among Caucasians (10.8 ± 0.1 vs xiv.six ± 0.1 years, respectively, P < 0.001) for NM. Similarly, melanoma-specific survival was lower for AAs than Caucasians for LM (17.six ± 2.0 vs 21.two ± 0.09 years, respectively, P < 0.050). For NM and LM subtypes, melanoma-specific bloodshed was college in AAs (NM; 35.half dozen%, LM; 14.3%) than Caucasians (NM; 22.1%, LM; 3.1%), P < 0.005. Surgery was associated with prolonged survival among both ethnic groups; however, survival afterward surgery was significantly longer in Caucasians (15.8 years) than AAs (12.8 years), P < 0.001. Two-year melanoma-specific survival was highest for SS melanoma (98.0% in Caucasians and AAs both) and lowest for NM (84.0% in Caucasians and 71.0% in AAs). Similarly, 5-year survival was highest for SS subtype (96.0% in Caucasians and AAs both) and lowest for NM (69.0% for Caucasians and 51.0% in AAs). A significantly lower 5-year melanoma-specific survival was noted amidst AAs compared with Caucasians for certain melanoma subtypes, including NM (69.0% for Caucasians and 51.0% in AAs) and LM (96.0% for Caucasians and 90.0% in AAs), P < 0.05 (Fig. 1).
Kaplan–Meier actuarial survival among 1106 African–Americans and 212,721 Caucasians with (A) superficial spreading melanoma, (B) nodular melanoma, (C) Lentigo maligna melanoma, and (D) acral lentiginous melanoma from the Surveillance Epidemiology and Stop Result (SEER) Database (1988–2011).
three.4. Multivariate analysis
On multivariate analysis of the overall melanoma cohort, male person gender [OR one.4; confidence interval (CI) = 1.three–i.five], AA ethnicity (OR i.5; CI = 1.two–2.0), NM (OR 1.seven; CI = one.6–1.8), and AL (OR 1.8; CI = 1.6–2.2) histology, head and neck (OR 1.4; CI = one.iii–ane.v), and body (OR one.3; CI = 1.2–1.iv) main tumor site, tumor depth >0.75 mm (OR 3.3; CI = 3.1–3.6), regional (OR 3.8; CI = 3.5–4.ane) and distant tumor stage (OR 7.5; CI = 6.3–8.9), ulceration (OR 1.1; CI = 1.0–one.2), and lymph node positivity (OR ane.2; CI = 1.1–ane.3) were identified equally chance factors independently associated with increased mortality, P < 0.001.
Among AA melanoma patients, factors independently associated with increased mortality included male person gender (OR 1.5; CI = one.ane–2.2), regional (OR four.3; CI = 2.five–7.3) and distant phase (OR iii.7; CI = ane.3–10.5), tumor depth >1.51 mm (OR 4.0; CI = ii.0–7.8), NM (OR 2.6; CI = 1.2–v.ix), and AL (OR 1.9; CI = 1.1–3.3), P < 0.05.
Among Caucasian melanoma patients, male gender (OR 1.5; CI = 1.5–1.six), northern plains (OR one.2; CI = 1.1–1.two), tumor depth >0.76 mm (OR 2.i; CI = 2.0–2.2), regional (OR 3.0; CI = 2.viii–3.2), distant disease (OR 4.7; CI = 4.0–5.iv), NM (OR 1.5; CI = 1.five–one.6), LM (OR one.7; CI = 1.six–1.8), and AL (OR ane.9; CI = 1.7–2.1) were all independently associated with increased mortality, P < 0.001. Surgical resection conferred a significant survival reward (OR 0.2; CI = 0.1–0.5), P < 0.001.
4. Discussion
Melanoma is a deadly form of skin cancer derived from pigment-producing melanocytes.[1,16,17] The incidence of cutaneous melanoma has been steadily increasing over the final decade, representing almost 5% of all newly diagnosed cancer cases, and affecting approximately one meg Americans.[1,17] Fair skin and prolonged UV exposure from sunlight have been documented equally major risk factors for developing cutaneous melanoma.[16,17] Although melanoma is far more common among Caucasians, the prognosis for AAs diagnosed with melanoma is substantially worse.[5] Cormier et al[5] reported that the incidence of cutaneous melanoma was significantly lower in indigenous minority populations. Although all minority populations had worse prognosis than Caucasians, AAs showed the greatest ethnic discrepancy.[5] AAs were iv times more likely to present with advanced stage Iv melanoma and 1.5 times more likely to dice from melanoma than Caucasians.[5]
Cutaneous melanoma occurs most commonly in the 6th and seventh decade of life in both Caucasians and AAs. Although melanoma is more common among Caucasian females in the trunk and torso regions, over half of all melanomas amid AA males involve the lower extremities. Numerous prior studies have reported similar results with AA melanomas occurring more often on nonsun-exposed skin, such as the palms and soles of the feet where at that place is less paint and less melanin to protect the melanocytes from UV radiations.[v,16,xviii]
The virtually common form of melanoma in the AA population is acral lentiginous melanoma, whereas superficial spreading melanoma is the most common among Caucasians. This is consistent with previous studies, which report AL melanoma to exist significantly more common amongst AAs than among Caucasians.[5,10] This histological variation and clinical heterogeneity among melanomas stand for an additional contributing factor to the poorer prognosis among AA melanoma patients. The atypical location of these lesions has likewise been reported to delay diagnosis specifically among plantar melanomas that typically nowadays with significantly deeper tumors than nonplantar tumors (ii.55 vs i.22 mm).[19,xx] Franke et al[nineteen] attributed the poorer prognosis of AL to a delay in diagnosis, and reported an boilerplate of iv.8 years before patients sought medical attention, and a vii-month delay before receiving adequate surgical treatment. Shorter survival and higher mortality rates have too been reported with AL melanomas that are as well more common among AAs.[v] A retrospective study involving 1413 patients with AL melanoma demonstrated that the highest proportion of AL melanomas occurred among AAs (36%).[10] AL melanoma is associated with significantly lower v- and 10-year survival rates than all other cutaneous melanomas subtypes (lxxx.three% and 67.5% vs 91.3% and 87.v%, P < 0.001).[10] Moreover, AL melanoma is associated with a 12-fold increase in the run a risk of developing stage Four melanoma and an well-nigh 2-fold increase in the take chances of mortality in both Caucasians and AAs.[5]
Well-nigh melanomas nowadays equally localized disease; however, AA patients are far more likely to present with advanced disease and deeper tumors than Caucasians. AA melanoma patients besides exhibit higher rates of regional and distant illness, and lower rates of localized disease than Caucasians, and are twice equally likely to present with ulcerated lesions, metastatic disease, and lymph node involvement. In the electric current written report, regional and distant disease, as well equally tumor depth >1.51 mm were likewise associated with increased bloodshed for both Caucasian and AAs, which is consistent with prior reports.[5,18]
Surgical resection is the almost mutual treatment modality for patients with localized cutaneous melanoma.[21] In the current study, AAs were far less likely to receive surgical resection compared with Caucasians, even though surgical resection was associated with a significantly improved survival in all patient groups. A prior SEER study involving 151,154 patients with primary cutaneous melanoma reported that Caucasians were significantly more than likely to receive appropriate surgical therapy than AAs (94.5% vs 86.six%, P < 0.05).[13] Among those who received surgical treatment, AAs experienced significantly lower five-year (66.8% vs 84.2%, P < 0.0001) and 10-twelvemonth survival (55.4% vs 74.3%, P < 0.001) than Caucasians, perhaps attributable to more advanced stage and increased rates of ulceration.[13] In add-on, it has been reported that AAs are less likely to receive adequate wide excision surgery (69.three% vs 77.7%) and more than likely to receive local tumor excision (fourteen.5% vs. xi.2%) than Caucasians, P < 0.001.[22] Ethnic disparities and the suboptimal application of cancer-directed treatments, including surgery, radiation, and chemotherapy is non unique to melanoma and has been well documented for a wide multifariousness of malignancies.[13,23–25]
In melanoma, advanced stage at presentation often leads to poor prognosis, and AA melanoma patients feel lower mean survival times besides equally lower overall and cancer-specific 5-year survivals. A retrospective SEER study involving 49,772 melanoma patients demonstrated a significantly lower five-twelvemonth survival among AAs than Caucasians (72.2% vs 89.half-dozen%, P < 0.001).[5]
In addition to the obvious increased difficulty in diagnosing melanoma on the acral surfaces of the body, the more ambitious tumor biology, and more advanced stage at presentation, boosted factors including lower socioeconomic status and limited admission to health care services have also been implicated or potentially contribute to the asymmetric number of cancer deaths among AAs.[v,18,26–28] Low socioeconomic condition has been strongly associated with later stages at melanoma presentation and lower survival rates than college socioeconomic groups.[26–28] A population-based written report involving 29,792 melanoma cases in California reported that the lowest socioeconomic condition group experienced the steepest rise in the incidence of thick melanomas >4 mm.[26] In a separate report past Chang et al,[28] lower socioeconomic status was strongly associated with lower 5-twelvemonth survival among early (83.2% vs 90.9%, P < 0.05) and late-phase melanoma patients (thirty.0% vs 45.five%, P > 0.05). Saraiya et al[27] conducted a survey involving over 75,000 respondents, and reported lower rates of recent skin examinations among AAs than Caucasians in 1992 (5.8% vs 11.iv%) and 2000 (six.2% vs viii.9%). Patients with higher education were besides significantly more than likely to have had a recent skin examination (14.five% of college graduates vs. half dozen.0% of loftier school graduates and 3.iv% of individuals without a high school diploma, P < 0.001).[27] The authors too reported that Caucasian adults >50 years of age (OR i.57), high school education or more (OR 2.84), patients who had consistent health intendance (OR 2.eighteen), and health insurance (OR one.61) were more likely to receive recent pare examinations, P < 0.001.[27]
Understanding differences in the presentation between Caucasians and AAs is crucial to let early diagnosis and treatment for this disease. Increased education and awareness of melanoma among minority populations may provide an opportunity for screening and early detection. Electric current public health education programs and screening are targeted primarily at fair pare Caucasians with prolonged UV dominicus exposure, and exclude AAs entirely.[18] Efforts at educating physicians about the unique features of melanoma amid AA patients are required to successfully provide screening for early detection amid all indigenous backgrounds. Patients who had full body skin evaluations were half dozen times more probable to have a melanoma detected than those who just received partial skin examinations.[29]
There are several limitations to this study that should be taken into business relationship. First, the SEER database did not accurately code for important clinical factors such as socioeconomic status, access to advisable medical facilities, method of diagnostic confirmation, and comorbidities, which may have had an influence on survival. Second, availability of screening programs and follow-up data was lacking. Data on surgical and radiations therapy utilized were available in the SEER database; however, information on surgical resection margins and chemotherapy received was not, and this limits the study's ability to comment on the affect of adjuvant or neoadjuvant therapy. Furthermore, the sample size in some groups (due east.thou., AAs with lentigo maligna melanoma) was minor, making it difficult to draw conclusions. There may also be an element of pick bias in this information prepare, as SEER registries are more likely to sample from urban rather than rural areas. Despite these limitations, the SEER database contains information from 26% of the United States population, and these findings can be generalized to the overall population.
v. Conclusion
Despite the documented rise in the incidence of melanoma in recent decades, cutaneous melanoma remains a rare disease among AA patients. In contrast to Caucasians patients who present near often with superficial spreading melanoma, AAs most commonly nowadays with acral lentiginous melanoma. Moreover, AAs typically have melanomas on the lower extremities, accept tumors with greater depth and ulcer rates, and increased lymph node positive melanoma rates. Surgery is the preferred handling and significantly prolongs survival in all affected patients; however, AAs experience significantly shorter survival and college overall and melanoma-specific mortality. AAs experienced worse survival when stratified past tumor location, depth, stage, and handling type than Caucasians. AAs with NM and LM melanoma accept lower survival than Caucasians; however, AAs with SS melanoma was associated with slightly longer survival than Caucasians. Difficulty associated with diagnosing melanoma on acral surfaces, more ambitious tumor biology, more avant-garde depth and stage at presentation, also as lower socioeconomic status and more limited access to health care services all contribute to the poor prognosis seen with AA melanoma patient population. Educating physicians most the unique features of melanoma amongst AA patients besides equally increasing melanoma awareness among minority populations in crucial to improving screening and early detection rates that can assure appropriate and adequate treatment. Given the high mortality among AA melanoma patients, additional studies investigating the differences in tumor biology and genetic mechanisms between ethnic groups are required to precisely place factors leading to lower survival rates amidst AA melanoma patients and identify optimal treatment for these patients.
Footnotes
Abbreviations: AA = African–American, AL = Acral Lentiginous, ANOVA = assay of variance, LM = Lentigo Maligna, NM = Nodular melanoma, NOS = Not otherwise specified, OR = odds ratio, SEER = Surveillance, Epidemiology, and End Issue, SS = Superficial Spreading, UV = ultraviolet.
Authorship: All authors were involved in the conception and blueprint of the projection, information acquisition and analysis, writing of the manuscript, and approve of this submitted manuscript.
The authors report no conflicts of interest.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5403065/
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