Racial Differences in Time to Treatment for Melanoma

Tripathi, Raghav; Archibald, Laura K.; Mazmudar, Rishabh S.; Conic, Rosalynn RZ.; Rothermel, Luke D.; Scott, Jeffrey F.; Bordeaux, Jeremy S.

Abstract Background Longer time from diagnosis to definitive surgery (TTDS) is associated with increased melanoma-specific mortality. Although Black patients present with later stage melanoma and have worse survival than non-Hispanic white (NHW) patients, the association between race and TTDS is unknown. Objective To investigate racial differences in time to melanoma treatment. Methods Retrospective review of the National Cancer Database (2004-2015). Multivariable logistic regression was used to evaluate the association of race with TTDS controlling for sociodemographic/disease characteristics. Results Of the 233,982 melanoma patients identified, 1,221 (0.52%) were Black. Black patients had longer TTDS for stage I-III melanoma (p<0.001) and time to immunotherapy (p=0.01), but not for TTDS for stage IV melanoma or time to chemotherapy (p>0.05 for both). Controlling for sociodemographic characteristics, Black patients had over twice the odds of having TTDS between 41-60 days, over three times the odds of having TTDS between 61-90 days, and over five times the odds of having TTDS over 90 days. Racial differences in TTDS persisted within each insurance type. Patients with Medicaid had the longest TTDS (mean 60.4 days), and those with private insurance had the shortest TTDS (mean 44.6 days; p<0.001 for both). Conclusions Targeted approaches to improve TTDS for Black patients are integral in reducing racial disparities in melanoma outcomes.