Sex disparities in Hispanic melanoma patients: A retrospective cohort analysis of the 2000–2020 Surveillance, Epidemiology and End Results database

Melanoma ranks among the most common malignancies in the United States, with an estimated 100 640 new melanoma cases projected for 2024.1 Previous studies analysing melanoma-specific survival have established poor outcomes in Hispanic patients compared to non-Hispanic White individuals.2 However, there is a paucity of literature investigating sex differences in disease presentation and outcomes in Hispanic individuals diagnosed with cutaneous melanoma. Thus, the purpose of this study is to further examine differences in melanoma characteristics and disease-specific survival (DSS) between Hispanic males and females diagnosed with cutaneous melanoma. In this retrospective cohort study, the Surveillance, Epidemiology, and End Results database was queried to identify Hispanic individuals of any race diagnosed with biopsy-proven cases of cutaneous melanoma (ICD-O-3 histology codes 8720/3–8780/3; primary site codes C44.0–C44.9) from 2000 to 2020. Statistical tests including Chi-squared, Mann–Whitney U, Kaplan–Meier and log-rank, and multivariate Cox proportional hazards were conducted using SPSS version 29 (significance p < 0.05). Between 2000 and 2020, 12 328 cases were identified, with 43.3% identifying as male and 56.7% identifying as female (Table 1). There was a significant association between sex and age (p < 0.001), where the greatest number of males were aged 60–79 (39.7%) and females were aged 40–59 (39.0%). There was also a significant association between sex and primary tumour site (p < 0.001), with the most common primary site being the trunk for males (31.4%) and the lower extremity for females (35.2%). Females were diagnosed with localized disease at higher rates (80.3% vs. 70.2%), while males were diagnosed with regional (18.5% vs. 13.8%) and distant disease (11.3% vs. 5.9%) (p < 0.001). Men exhibited higher proportions of tumours with increased Breslow thickness in the ranges of 1.01–2.00 mm (16.4% vs. 15.3%), 2.01–4.00 mm (14.9% vs. 10.9%), and >4.00 mm (16.6% vs. 11.4%) compared to women (p < 0.001), as well as higher rates of regional lymph node positivity (16.2% vs. 10.6%; p < 0.001). On conducting univariate Kaplan–Meier analysis, males demonstrated significantly reduced 5- and 10-year DSS rates (75.0% and 66.0%, respectively) compared to females (86.0% and 81.0%, respectively; p < 0.001). After adjusting for potential confounders including age, race, disease stage, annual income, rural versus urban living, and primary tumour site, male sex independently increased disease-specific mortality compared to females (reference: females; adjusted hazard ratio 1.36; 95% CI 1.23–1.51; p < 0.001). In this study, we provide an in-depth analysis of sex disparities in Hispanic patients diagnosed with cutaneous melanoma. Consistent with previous literature examining overall melanoma sex differences,3, 4 our study found that Hispanic males also tend to receive melanoma diagnoses at an older age, exhibit advanced-stage disease, and present with melanoma of the trunk compared to lower extremities for females. Furthermore, our findings indicate a significantly reduced DSS in Hispanic males compared to females, even after adjusting for potential confounders. This observation aligns with previous research studies on sex differences in melanoma, although such disparities in DSS have not been specifically discussed for Hispanic individuals. There appears to be an interplay of behavioural factors and immunological, hormonal, or genetic causes that may be contributing to the observed sex differences.5 These results underscore the importance of tailored interventions, targeted screening strategies, and enhanced educational initiatives to address the unique needs of Hispanic individuals, particularly males, in mitigating the burden of melanoma within this population. Future research and interventions are warranted to improve early detection, access to care, and ultimately survival outcomes among Hispanic individuals diagnosed with cutaneous melanoma. Limitations to this study include missing data regarding immunotherapy and use of a national database, which may not fully represent the broader Hispanic population in the United States. Nevertheless, this study highlights important tumour behaviours in the Hispanic population, emphasizing sex-specific differences in presentation and DSS. This article received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. None to declare. Mitchell A. Taylor: Conceptualization (equal); data curation (equal); formal analysis (lead); investigation (equal); methodology (equal); software (equal); visualization (equal); writing – original draft (equal); writing – review & editing (equal). Anjali Mishra: Conceptualization (equal); data curation (equal); formal analysis (supporting); investigation (equal); methodology (equal); validation (equal); visualization (equal); writing – original draft (equal); writing – review & editing (equal). Bianca Ituarte: Conceptualization (supporting); methodology (supporting); validation (supporting); writing – review & editing (supporting). Michaela Clausen: Data curation (supporting); methodology (supporting); writing – original draft (supporting); writing – review & editing (supporting). Erin X. Wei: Conceptualization (supporting); formal analysis (supporting); investigation (supporting); methodology (supporting); resources (supporting); supervision (lead); validation (lead); visualization (supporting); writing – original draft (supporting); writing – review & editing (supporting). This article received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Review by the University of Nebraska Medical Center Institutional Review Board (IRB) was not deemed necessary for this study. Not applicable. The data underlying this article will be shared on reasonable request to the corresponding author.