Acral Lentiginous Melanoma: Incidence and Survival in the United States, 2006-2015, an Analysis of the SEER Registry.
Acral lentiginous melanoma (ALM) is one of the four major subtypes in cutaneous malignant melanoma (CMM). We aimed to study the incidence and survival of ALM in the United States in recent 10 y and compare the survival between ALM and nonacral CMM. In the meantime, racial disparity and prognostic factors associated with survival were investigated.
All the cases of ALM registered in the Surveillance, Epidemiology, and End Results registry from 2006 to 2015 were retrieved, including non-Hispanic whites (NHW), black Americans (blacks), Asian/Pacific Islanders, and Hispanic whites. Age-adjusted incidence was calculated. Clinicopathologic data, including age, gender, race, geographic location, Breslow thickness, ulceration, pathologic staging, sentinel lymph node status, and surgical approach, were collected and analyzed. Melanoma-specific survival (MSS) was analyzed in patients with ALM and CMM. The Kaplan-Meier method was used to estimate the influence of clinicopathologic data on ALM MSS. Only cases with complete staging and active follow-up were included in prognostic factor analysis.
A total of 1724 ALM and 87,442 nonacral CMM patients were included in the study. For ALM patients, the age-adjusted incidence rate was 2.0 per million person-years. The proportion of ALM among all melanoma subtypes was greatest in blacks (32.6%). The 5-y MSS rates of ALM were lower than CMM overall (80.6% versus 93.0%, P < 0.001, respectively). When controlled by stage, the difference was significant in patients diagnosed at stages I and III. ALM 5-y MSS rates were highest (84.3%) in NHW, intermediate in Asian/Pacific Islanders (76.6%), Hispanic white (72.0%), and lowest in blacks (66.9%). Blacks were elderly, male predominant, located in East and Middle American, and had thicker, more ulcerated, advanced disease as compared with NHWs. When controlled by stage, survival difference was significant between NHWs and blacks in stage I (P = 0.004) and stage III (P = 0.005) patients. Gender, race, sentinel lymph node status, and pathologic stage were identified as independent risk factors in multivariate analysis.
The incidence of ALM has been steady in recent 10 y and more prevalent in aged people. ALM is associated with a worse prognosis than CMM. Black Americans have the worst prognosis, and survival difference is significant between NHW and blacks.
Huang K
，Fan J
，Misra S
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Racial differences in three major NHL subtypes: descriptive epidemiology.
NHL (non-Hodgkin lymphoma) consists of over 60 subtypes, ranging from slow-growing to very aggressive. The three largest subtypes are DLBCL (diffuse large B-cell lymphoma), FL (follicular lymphoma), and CLL/SLL (chronic lymphocytic leukemia/small lymphocytic lymphoma). For each subtype, different racial groups have different presentations, etiologies, and prognosis patterns.
SEER (Surveillance, Epidemiology, and End Results) data on DLBCL, FL, and CLL/SLL patients diagnosed between 1992 and 2010 were analyzed. Racial groups studied included NHW (non-Hispanic whites), HW (Hispanic whites), blacks, and API (Asians and Pacific Islanders). Patient characteristics, age-adjusted incidence rate, and survival were compared across races. Stratification and multivariate analysis were conducted.
There are significant racial differences for patients' characteristics, including gender, age at diagnosis, stage, lymph site, and age, and the patterns vary across subtypes. NHWs have the highest incidence rates for all three subtypes, followed by HWs (DLBCL and FL) and blacks (CLL/SLL). The dependence of the incidence rate on age and gender varies across subtypes. For all three subtypes, NHWs have the highest five-year relative survival rates, followed by HWs. When stratified by stage, racial difference is significant in multiple multivariate Cox regression analyses.
Racial differences exist among DLBCL, FL, and CLL/SLL patients in the U.S. in terms of characteristics, incidence, and survival. The patterns vary across subtypes. More data collection and analysis are needed to more comprehensively describe and interpret the across-race and subtype differences.
Li Y
，Wang Y
，Wang Z
，Yi D
，Ma S
... -
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Trends by race and ethnicity in incidence and mortality of acral lentiginous melanoma: analysis of Surveillance, Epidemiology, and End Results 2000-2020.
Limited data describe the epidemiology and risk factors of acral lentiginous melanoma (ALM). In this retrospective analysis, we examined trends in incidence and mortality of ALM among racial and ethnic minoritized populations. We queried 22 Surveillance, Epidemiology, and End Results registries for cases of ALM among Hispanics, non-Hispanic Asians or Pacific Islanders (NHAPIs), non-Hispanic Blacks (NHBs), and non-Hispanic Whites (NHWs) from 2000 through 2020. Age-adjusted incidence and annual percentage changes (APCs) were estimated. Kaplan-Meier curves were stratified by race and ethnicity and compared with log-rank tests. Cox proportional hazard regression models were adjusted for age, sex, race, ethnicity, income, urban-rural residence, stage, and treatment. Of 4188 total cases of ALM with complete data, our study cohort was comprised of 792 (18.9%) Hispanics, 274 (6.5%) NHAPIs, 336 (8.0%) NHBs, and 2786 (66.5%) NHWs. The age-adjusted incidence of ALM increased by 2.48% (P < 0.0001) annually from 2000 to 2020, which was driven by rising rates among Hispanics (APC 2.34%, P = 0.001) and NHWs (APC 2.69%, P < 0.0001). Incidence remained stable among NHBs (APC 1.15%, P = 0.1) and NHAPIs (APC 1.12%, P = 0.4). From 2000 through 2020, 765 (18.3%) patients died from ALM. Compared to NHWs, Hispanics, NHAPIs, and NHBs had significantly increased ALM-specific mortality (all P < 0.0001). Unadjusted and adjusted cause-specific mortality modeling revealed significantly elevated risk of ALM-specific mortality among Hispanics (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.22-1.75; adjusted hazard ratio [aHR] 1.38, 95% CI 1.14-1.66), NHAPIs (HR 1.80, 95% CI 1.41-2.32; aHR 1.58, 95% CI 1.23-2.04), and NHBs (HR 1.98, 95% CI 1.59-2.47; aHR 2.19, 95% CI 1.74-2.76) (all P < 0.001). Our study finds rising incidence of ALM among Hispanics and NHWs along with elevated risk of ALM-specific mortality among racial and ethnic minoritized populations. Future strategies to mitigate health inequities in ALM are warranted.
Ansbro B
，Riley JM
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ResearchGate
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