Background The incidence of the T and B-cell cutaneous lymphomas (CL) has been well documented, but information pertaining to racial incidence by age, and by burden of disease (stage) have not been extensively documented. Methods The National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) 2004–2008 public use database was investigated. The relative incidence of CL in different races and age groups was examined. Univariate and multivariate stepwise logistic regression was performed for the likelihood of presenting at a higher stage. Results 4496 patients were diagnosed with CL between 2004–2008; 1713 patients with mycosis fungoides (MF), 1518 with non-MF cutaneous T-cell lymphoma (NMFCTCL), and 1265 patients with cutaneous B-cell lymphoma (CBCL). For MF, there was a trend for females to be less likely to present with a higher T-stage (T3–T4) than males OR 0.73 on multivariate analysis (p=0.06). For race, African Americans (AA) had a significantly increased risk of presenting with higher T-stage (T3–T4) MF, OR 1.72 on multivariate (p=0.02), compared to whites. For whites, AA, Asian/Pacific Islanders and Native Americans/other/unknown, the mean age at diagnosis was 59.2, 51.5, 51.3, and 53.8. These groups presented at a significantly different age than whites (p=0.0001, 0.0001, and 0.0006). Conclusions Non-white racial groups present with MF at an earlier age compared to whites, and AA have increased risk of presenting with higher T-stage compared to whites. These findings have significant implications regarding need for earlier diagnosis and understanding the reasons for racial disparity in age and stage of presentation.
Background This article sought to elucidate how aspects of poverty and culture may contribute to race- and ethnicity-based disparities in cutaneous melanoma outcomes. Methods We identified published studies addressing the social determinants of melanoma. Selected review articles included US-based studies comprised of patients representing adults, children, and adolescents. Results African Americans and Hispanics diagnosed with cutaneous melanoma are more likely to present with more advanced stages of disease at diagnosis and have higher rates of mortality than their nonminority counterparts. These disparities may be a consequence of economic, social, and cultural barriers such as low income, public forms of health insurance, lower levels of education, lower levels of melanoma awareness and knowledge, and lower rates of participation in melanoma screening. No studies in the literature examined the potential impact of social injustice, English proficiency, immigrant status, and health literacy. Conclusions Substantial gaps exist in our knowledge of the pathways linking social determinants and race- and ethnicity-based disparities in melanoma. More studies are warranted to inform the development of effective interventions aimed at narrowing inequities and improving cutaneous melanoma outcomes among minority populations.
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