Differences in survival by race/ethnicity among cutaneous melanoma patients in the United States over a period from 1982 to 2011

Abdulrahman M. Nasiri, Elharith S. Al-Akeel, Nora H. Rayes


Background: Melanoma is an aggressive skin cancer with a high mortality rate. The incidence of melanoma has increased in recent years from 1:1500 in 1935 to 1:50 in 2011. The aim of this study is to investigate survival by race/ethnicity, taking site into account, among melanoma patients in the United States.

Methods: This study is a secondary analysis of the Surveillance, Epidemiology, and End Results (SEER) Program. SEER collects data through a non-concurrent cohort study design. The sample size was 185219 participants. The chi-square test was used to examine the association between categorical variables. Kaplan-Meier survival analysis was used to estimate the overall survival curve and to estimate the survival curve per race/ethnicity. Collinearity was assessed using Pearson correlation. Cox proportional hazards regression was used to calculate the unadjusted and adjusted hazard ratios (HR).

Results: Non-Hispanic White (NHW) and Other patients were older in age (70 years or older), while non-Hispanic Black (NHB) and Hispanic patients were younger (30-39 years). Melanoma in NHW patients was mostly located in trunk whereas melanoma for NHB, Hispanic and Other patients was mostly located in the lower limbs. For all races/ethnicities except for NHB, more individuals were diagnosed between 2002 and 2011. Patients with melanoma in upper limbs lived more frequently. Fewer women died (6.8%) compared to men (17.1%). Patients who were diagnosed between the ages of 30-39 were more likely to die. NHB had an adjusted HR of 3 (95% CI 2.7, 3.3) compared to NHW. The adjusted HR of lower limb was 1.6 (95% CI 1.5, 1,6) compared to the reference group (Head and Neck). The hazard for trunk and lower limb were about the same as the reference. Those who were 70 years or older had an adjusted HR of 2.2 (95% CI 2.0, 2.4). Women had an adjusted HR of 0.4 (95% CI 0.4, 0.5), and diagnosis during the decade 1982-1991 had an adjusted HR of 2.6 (95% CI 2.4, 2.7).

Conclusions: NHB patients and patients of ages 30-39 years were more likely to die. The poorest survival was for diagnosis between 1982 and 1991. However, more individuals were diagnosed between 2002 and 2011. The lower limb had a worse prognosis with adjusted HR of 1.6 (95% CI 1.5, 1,6), and more men were diagnosed than women.


Cancer, Epidemiology and end results (SEER) program, Incidence, Melanoma, Mortality, Races/ethnicities

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Higgins HW, Lee KC, Galan A, Leffell DJ. Melanoma in situ: part I. Epidemiology, screening, and clinical features. J Ame Academy Dermatol. 2015;73(2):181-90.

Ferri F. Ferri's Clinical Advisor: Expert Consult; 1st Edition. Elsevier. 2015:777-779.

Simard EP, Ward EM, Siegel R, Jemal A. Cancers with increasing incidence trends in the United States: 1999 through 2008. CA: Cancer J Clinicians. 2012;62(2):118-28.

Hawryluk EB, Fisher DE. Melanoma Epidemiology, Risk Factors, and Clinical Phenotypes, Advances in Malignant Melanoma - Clinical and Research Perspectives, Dr. April Armstrong (Ed.), In Tech; 2011. Available from:

Lachiewicz AM, Berwick M, Wiggins CL, Thomas NE. Survival differences between patients with scalp or neck melanoma and those with melanoma of other sites in the Surveillance, Epidemiology, and End Results (SEER) program. Archives Dermatol. 2008;144(4):515-21.

Zell JA, Cinar P, Mobasher M, Ziogas A, Meyskens Jr FL, Anton-Culver H. Survival for patients with invasive cutaneous melanoma among ethnic groups: the effects of socioeconomic status and treatment. J Clinical Oncol. 2008;26(1):66-75.

National Cancer Institute. The Surveillance, Epidemiology, and End Results (SEER) Program. Available at Accessed July 28, 2015.

Thörn M, Adami HO, Ringborg U, Bergström R, Krusemo U. The association between anatomic site and survival in malignant melanoma. An analysis of 12,353 cases from the Swedish Cancer Registry. Euro J Cancer Clinic Oncol. 1989;25(3):483-91.

Reintgen DS, McCarty KM, Cox E, Seigler HF. Malignant melanoma in black American and white American populations: a comparative review. Jama. 1982;248(15):1856-9.

Hu S, Soza-Vento RM, Parker DF, Kirsner RS. Comparison of stage at diagnosis of melanoma among Hispanic, black, and white patients in Miami-Dade County, Florida. Archives Dermatol. 2006;142(6):704-8.

Crombie IK. Racial differences in melanoma incidence. Brit J Cancer. 1979;40(2):185-93.

Linos E, Swetter SM, Cockburn MG, Colditz GA, Clarke CA. Increasing burden of melanoma in the United States. J Investigative Dermatol. 2009;129(7):1666-74.

Jemal A, Devesa SS, Hartge P, Tucker MA. Recent trends in cutaneous melanoma incidence among whites in the United States. J National Cancer Inst. 2001;93(9):678-83.

Cormier JN, Xing Y, Ding M, Lee JE, Mansfield PF, Gershenwald JE, et al. Ethnic differences among patients with cutaneous melanoma. Archives Internal Medic. 2006;166(17):1907-14.

Cress RD, Holly EA. Incidence of cutaneous melanoma among non-Hispanic whites, Hispanics, Asians, and blacks: an analysis of California cancer registry data, 1988-93. Cancer Causes and Control. 1997;8(2):246-52.

Garbe C, Leiter U. Melanoma epidemiology and trends. Clinics in dermatology. 2009;27(1):3-9.

Hall HI, Miller DR, Rogers JD, Bewerse B. Update on the incidence and mortality from melanoma in the United States. J Ame Academy Dermatol. 1999;40(1):35-42.

Gillgren P, Månsson‐Brahme E, Frisell J, Johansson H, Larsson O, Ringborg UA. Prospective Population‐Based Study of Cutaneous Malignant Melanoma of the Head and Neck. Laryngoscope. 2000;110(9):1498-504.

Garbe C, Büttner P, Bertz J, Burg G, D'Hoedt B, Drepper H, et al. Primary cutaneous melanoma. Prognostic classification of anatomic location. Cancer. 1995;75(10):2492-8.

Wu XC, Eide MJ, King J, Saraiya M, Huang Y, Wiggins C, et al. Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006. J Ame Academy Dermatol. 2011;65(5):S26-e1.