Black patients experience higher rates of acral melanoma vs. white patients

Key takeaways:

• Of the 48 melanoma cases among Black patients, 28 were located on the feet.
• Of the 13 patients that progressed to stage IV melanoma, 12 died.

Black patients experience higher acral melanoma rates, as well as melanoma-associated mortality rates, compared with white patients, according to a study.

“Most data regarding melanoma in Black patients come from population-based studies that lack details about precise anatomic sites, immunocompromised status, cancer history, sequence variations, disease progression and treatments,” Sophia N. Wix, MPhil, of the department of dermatology at University of Texas Southwestern Medical Center, and colleagues wrote. “We aimed to characterize features of melanoma and melanoma-associated mortality in Black patients to address current knowledge gaps.”

Of the 48 Black patients (median age, 62 years; 63% women) included in the study, 40 had cutaneous melanoma and eight had ocular, mucosal or melanoma of unknown primary.

Results showed that of the 40 melanomas that were cutaneous, 30 were located on acral skin despite 33% of them being histologically classified as acral lentiginous melanomas.

Overall, six patients were immunosuppressed and were only observed in the cutaneous melanoma cohorts. In fact, immunosuppression was more common in nonacral cutaneous melanomas vs. acral disease (40% vs. 7%).

Patients with nonacral disease were also more likely to have a personal history of cancer (60%) vs. patients with those with acral disease (17%). Those with superficial spreading melanoma, however, had a history of both cancer and immunosuppression.

While each patient only had no more than one melanoma, 13 developed stage IV disease. Of the patients that progressed to stage IV, 12 died as none responded to immunotherapy.

Overall, patients with melanoma of unknown primary, mucosal/ocular melanomas and acral melanomas had the worst outcomes with 5-year survival rates of 0%, 40% and 78%, respectively. On the other hand, those with nonacral cutaneous melanoma had a 100% 5-year survival rate.

According to the authors, Surveillance, Epidemiology, and End Results registry data grouped melanoma found on the feet with those on the leg. However, this case series found that melanoma among Black patients is most commonly found on the plantar foot or heel, with a total of 28 of 48 cases being concentrated to the feet.

“Large population registries lack the granular data needed to identify potential risk factors for melanoma in Black patients; multi-institutional studies and a dedicated registry would improve understanding and outcomes,” the authors wrote.