Impact of Socioeconomic Status and Ethnicity on Melanoma Presentation and Recurrence in Caucasian Patients

Abstract

Objectives: The impact of ethnicity and the socioeconomic status (SES) among Caucasians is not well studied. Here, we examine the impact of income on melanoma presentation and prognosis within a Caucasian cohort, accounting for ethnicity, as some reports suggest increased melanoma incidence in Ashkenazi Jewish (AJ) BRCA mutation carriers. Methods: We studied prospectively enrolled primary melanoma patients at New York University. SES data were estimated using United States' Census Bureau data and patient zip codes. We evaluated associations between ethnicity, SES, and baseline characteristics using the χ² test and multivariate logistic regression. We compared survival distributions using Kaplan-Meier curves, log-rank tests, and Cox proportional hazard ratios. Results: Of the 1,339 enrolled patients, AJ represented 32% (n = 423). Apart from AJ being older at presentation (p < 0.001), no significant differences were observed in baseline characteristics between ethnic groups. Patients with a median household income (MHI) lower than the median of the cohort were significantly more likely to present with advanced stages (p < 0.001) compared to patients with a higher MHI. Shorter overall (p = 0.016) and post-recurrence survival (p = 0.042) was also observed in patients from lower-income households. Conclusion: Data suggest that disparities in melanoma presentation in Caucasians stratify according to income independent of ethnic background.

Understanding the influence of patient demographics on disease severity, treatment strategy, and survival outcomes in merkel cell carcinoma: a surveillance, epidemiology, and end-results study

“…Surprisingly, we note that income quartiles within our cohort are significantly above nationwide median income, which may be in accordance with previous studies showing an increasing rate of developing skin cancer with higher incomes or educational level [ 20 , 24 , 25 , 26 ]. Some have attributed social trends such as perceptions of tanned skin and increased outdoor activity as historical correlations [ 24 ].…”

“…We showed that lesions of the head and neck region, lower income quartiles, and African American race are associated with higher short-term and long-term mortality. Although our data indicates that lower median income predicts shorter survival, correlating with other types of skin cancer [ 18 , 19 , 20 , 21 ], modes of subsequent treatment were not significantly different with univariate analysis of race or income level. This intriguing finding could be confounded by the overall predilection of MCC towards Caucasian patients, potentially resulting in inadequate sample size effects for lower socioeconomic patients.…”

Geographic region: Does it matter in cutaneous melanoma of the head and neck?

“…However, average UV index alone is unlikely to account for the differences in incidence. Ethnicity, race, occupational exposures, recreational activities, socioeconomic status, genetics, and prevalence of sunscreen use are other factors that have been shown to influence the risk of developing melanoma. Although the UV index may correlate with incidence on a population level, histologic evidence of sun damage would be a more direct way to account for the regional differences.…”

“…In particular, factors such as socioeconomic status, insurance status, and facility type, which can vary between regions, should be accounted for in future studies. These factors not only have the potential to influence the quality of treatment melanoma patients receive, but also the degree to which patients have access to follow‐up care …”

“…These factors not only have the potential to influence the quality of treatment melanoma patients receive, but also the degree to which patients have access to follow-up care. 27…”