The ongoing racial disparities in melanoma: An analysis of the Surveillance, Epidemiology, and End Results database (1975-2016)

Qian, Yingzhi; Johannet, Paul; Sawyers, Amelia; Yu, Jae-Hong; Osman, Iman; Zhong, Judy

doi:10.1016/j.jaad.2020.08.097

Cited by 81 publications

(64 citation statements)

References 26 publications

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“…[55][56][57] Before the approval and widespread use of immune checkpoint inhibitors, disparities by socioeconomic and demographic variables in cancer outcomes were already well established. 58,59 A seminal article in 2017 highlighted how individuals living in rural areas had much worse outcomes from cancer than their urban counterparts. 9 Worse outcomes for patients with cancer with limited insurance or from areas with high levels of socioeconomic deprivation have long been observed, [60][61][62] and they have even persisted when patients have had uniform access to protocol-guided care in clinical trials.…”

Section: Practical Applicationsmentioning

confidence: 99%

“…59,67 This alarming trend was confirmed in ethnic minority groups with localized melanoma; the discrepancy between non-Hispanic White and ethnic minority patients increased significantly after the approval of immune checkpoint inhibitors. 58,65 Interestingly, an opposite trend was described in patients with lung cancer; Asian patients had increased relative survival compared with non-Hispanic White patients and other racial/ethnic groups. 68 For many years, inequities were considered to result from a complex interaction of biologic (clinical, pathologic, and molecular features) and social (beliefs/attitudes, access to care, personal motivation, and family support) factors that differed among racial/ethnic groups.…”

Section: Practical Applicationsmentioning

confidence: 99%

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Immune-Based Cancer Treatment: Addressing Disparities in Access and Outcomes

Osarogiagbon¹,

Sineshaw

Unger

et al. 2021

American Society of Clinical Oncology Educational Book

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Avoidable differences in the care and outcomes of patients with cancer (i.e., cancer care disparities) emerge or worsen with discoveries of new, more effective approaches to cancer diagnosis and treatment. The rapidly expanding use of immunotherapy for many different cancers across the spectrum from late to early stages has, predictably, been followed by emerging evidence of disparities in access to these highly effective but expensive treatments. The danger that these new treatments will further widen preexisting cancer care and outcome disparities requires urgent corrective intervention. Using a multilevel etiologic framework that categorizes the targets of intervention at the individual, provider, health care system, and social policy levels, we discuss options for a comprehensive approach to prevent and, where necessary, eliminate disparities in access to the clinical trials that are defining the optimal use of immunotherapy for cancer, as well as its safe use in routine care among appropriately diverse populations. We make the case that, contrary to the traditional focus on the individual level in descriptive reports of health care disparities, there is sequentially greater leverage at the provider, health care system, and social policy levels to overcome the challenge of cancer care and outcomes disparities, including access to immunotherapy. We also cite examples of effective government-sponsored and policy-level interventions, such as the National Cancer Institute Minority-Underserved Community Oncology Research Program and the Affordable Care Act, that have expanded clinical trial access and access to high-quality cancer care in general.

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Section: Practical Applicationsmentioning

confidence: 99%

Section: Practical Applicationsmentioning

confidence: 99%

Immune-Based Cancer Treatment: Addressing Disparities in Access and Outcomes

Osarogiagbon¹,

Sineshaw

Unger

et al. 2021

American Society of Clinical Oncology Educational Book

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“…Melanoma accounts for most deaths caused by skin cancer, which makes its early diagnosis essential. While individuals with SOC have a lower incidence of melanoma, their mortality rates are disproportionately higher than those of White individuals [ 70 – 74 ]. Racial and ethnic disparities in skin cancer mortality often result from delayed diagnosis, which may arise from underutilization of dermatologic care [ 75 , 76 ] and differences in the clinical presentation of skin cancer among SOC patients.…”

Section: Photocarcinogenesismentioning

confidence: 99%

Photoprotection for Skin of Color

Tsai

Chien

2022

Am J Clin Dermatol

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Photoprotection behaviors can mitigate skin damage caused by ultraviolet radiation, and common methods include seeking shade, avoiding sun exposure during peak daylight hours, wearing sun-protective clothing, applying sunscreen, and using sunglasses. While the role of sun protection in preventing sunburns, photoaging, and skin cancer is well established in fair-skinned populations, individuals with skin of color (SOC) are presumed to suffer fewer negative effects from solar radiation. Thus, the importance of photoprotection in this population is understudied and may be underestimated. In SOC populations, sun exposure is known to cause pigmentary disorders, photoaging, and basal cell carcinoma (BCC), highlighting the potential benefits of photoprotection. Although SOC populations tend to practice photoprotection by seeking shade and wearing sun-protective clothing, survey and interview-based studies have consistently found relatively low use of sunscreen among these populations. Common motivators for photoprotection in individuals with SOC include preventing sunburn and pigmentation, with the prevention of skin cancer being a less important reason. As a skin cancer risk behavior, indoor tanning is relatively rare in SOC populations, but its use may increase with acculturation to US norms. While more studies are necessary to clarify whether photoprotection behaviors may decrease skin cancer-related mortality in SOC populations, regular dermatologic care and counseling on photoprotection remain essential in patients with SOC for overall skin health.

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“…Accumulating evidence suggests that epidemiological, anatomical, and clinical differences may exist among melanoma patients with different pathological subtypes (27,28); disparities in the prevalence of pathological subtypes and risk factors among melanoma patients have also been reported (2,29). In addition, treatment response and survival outcomes differ considerably among patients with different melanoma subtypes (30,31).…”

Section: Introductionmentioning

confidence: 99%

Immunotherapy in Acral and Mucosal Melanoma: Current Status and Future Directions

Mao

Zhang

et al. 2021

Front. Immunol.

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Acral and mucosal melanomas are extremely rare in Caucasians; however, they are the predominant melanoma subtypes in Asians and other non-Caucasian populations. Acral and mucosal melanomas share many clinicopathological features, including aggressive phenotypes, similar genetic landscapes, and grim prognoses. In spite of advances in melanoma management, patients with acral and mucosal melanomas show limited benefit from current therapies. The rarity of these subtypes of melanoma is a significant factor contributing to the poor understanding of these pathological subtypes and the lack of effective interventions. Furthermore, the mechanisms contributing to disparities between different types of melanoma remain largely unclear. Herein, we comprehensively review current knowledge on the clinicopathological characteristics and mutational landscapes of acral and mucosal melanomas, as well as providing an overview of current therapies for patients with these aggressive melanoma subtypes, focusing on available immunotherapeutic interventions. We also discuss pathological differences between different melanoma subtypes and summarize current knowledge on melanoma disparities between Asians and Caucasians. Finally, we discuss emerging immunotherapeutic strategies for the treatment of acral and mucosal melanomas, focusing on combination therapies with immune checkpoint inhibitors. Unraveling the unique features of acral and mucosal melanomas is key for their early diagnosis and for the development of effective therapies.

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The ongoing racial disparities in melanoma: An analysis of the Surveillance, Epidemiology, and End Results database (1975-2016)

Cited by 81 publications

References 26 publications

Immune-Based Cancer Treatment: Addressing Disparities in Access and Outcomes

Immune-Based Cancer Treatment: Addressing Disparities in Access and Outcomes

Photoprotection for Skin of Color

Immunotherapy in Acral and Mucosal Melanoma: Current Status and Future Directions

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