The Interaction Between Comorbidity and Race in the Prognosis of Cutaneous Melanoma

Abstract

Introduction: Hispanic and black patients suffer a worse prognosis of melanoma compared to non-Hispanic whites (NHWs).1 The rising prevalence of comorbidity in advanced metastatic melanoma is emerging as an important determinant in prognosis, treatment, and overall survival.2 Racial minorities are more likely to have comorbid conditions, which could account for their decreased survival rates. Objective: This study analyzes the prevalence of comorbidity among racial and ethnic melanoma populations and its relationship with prognosis. Methods: In this retrospective study, patients from the Texas Cancer Registry database were compared using an unpaired-t-test, Wilcoxon rank sum test, Chi-square test, and Fisher's exact test. Univariate and multivariable cox regressions and a Kaplan-Meier curve examined survivability based on comorbidity status. Mortality risk was based on survival time, which was determined by calculating the difference between date of death and date of diagnosis. Results: Compared to NHWs, Hispanic and Black patients had more comorbidities and a worse prognosis. While in situ CM was higher among NHWs (27.54%), distant metastasis was higher among black patients (14.4%) and Hispanics (10.9%) compared to NHWs (5.07%) (p-value<.001). A greater percentage of black and Hispanic patients had at least one comorbidity (10.31 and 9.45, respectively) vs. NHWs (6.89%) (p-value<.001). After adjusting for gender, ethnicity, race, insurance, treatment and tumor behavior, mortality risk increased by 41% when comorbidity was present (p-value<.001). Conclusion: Comorbidity was higher among Hispanic and Black melanoma patients and contributes to a worse prognosis. Further research on the impact of comorbidity on melanoma is needed to improve outcomes and racial disparities.