Plastic Surgery Research Council

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Melanoma in African American patients: NCDB Analysis from 2004 to 2015
Daniel Boczar1, David J Restrepo1, Andrea Sisti1, Maria T. Huayllani1, Jeremie D. Oliver2, Aaron C Spaulding1, Jordan J Cochuyat1, Brian D RInker1, Antonio Jorge Forte1.
1Mayo Clinic Florida, Jacksonville, FL, USA, 2Mayo Clinic School of Medicine, Rochester, MN, USA.

PURPOSE
Melanoma is rare in African-Americans (AA), and it is associated with a worse prognosis compared to Caucasians. We aimed to analyze the characteristics of patients, hospitals, tumors and treatment in AA diagnosed with melanoma in the United States.
METHODS
National Cancer Database (NCDB) was used to select patients with melanoma between 2004 and 2015. Exclusion criteria were patients with unknown information about race or races other than "White" or "Black." We categorized patients in 2 groups (AA Vs. Caucasian) to assess variables related to characteristics of the patients, hospital, and tumor. Chi-Square and Mann-Whitney test were used to estimate statistical significance. Moreover, we performed multivariate logistic regression to find independent associations adjusted for confounders.
RESULTS
A total of 513855 patients met the criteria of the study. Among them, 3008 African-Americans (0.6%) and 510847 Caucasians (99.4%). Regarding the AA patients, the mean age was 60.92 years (SD 16.92) and 57.6% were female. The mean time for AA to receive any treatment was 20.37 days, compared with 11.25 days for caucasians (P < 0.001) and the mean time most effective surgery 38.86 days, compared to 31.12 days for caucasians (P < 0.001). We noticed a greater proportion of AA in the female group [0.79%; AOR 1.564 (1.449-1.689) P < 0.001] compared to male (0.43%; reference) and lower proportion of AA on private insurance [0.46%; AOR 0.605 (0.509-0.719), P < 0.001) compared to no insurance (1.5%; referencial). Compared to caucasians, AA was an independent factor for higher odds of treatment in Integrated Cancer Programs [0.88%; AOR 1.272 (1.133-1.427), P < 0.001], tumor located on extremities [0.95%; AOR 3.07 [2.834-3.338], P < 0.001), ulceration [1.3%; AOR 1.629 (1.470-1.805) P < 0.001], and diagnosis at autopsy [1.59%; AOR 1.988 (1.634-2.420) P < 0.001]. Moreover, AA was an independent factor to lower odds of being treated in Comprehensive Community Cancer Program [0.44%; AOR 0.632 (0.579-0.69), P < 0.001].
CONCLUSIONS
African American accounted for only 0.6% of melanomas in this study, and we noticed that they have higher odds for diagnosis at autopsy, treatment delay and treatment at an Integrated Cancer Program. Moreover, AA was associated with melanoma located on extremities and ulceration.


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