This retrospective cohort study evaluated disparities across insurance types, racial groups, and socioeconomic status (SES) in acral lentiginous melanoma (ALM). We analyzed adults diagnosed with ALM in the National Cancer Database from 2016–2020. Cox proportional hazards model assessed associations between demographic and clinical variables with ALM-specific survival. Kaplan–Meier curves analyzed 1-, 3-, and 5-year survival. A total of 3446 patients with ALM were identified. Uninsured patients presented with advanced-stage cancers, experienced longer time to treatment, and were more likely to undergo major amputations compared with privately insured patients ( P < 0.001). Survival analysis indicated lower probabilities for uninsured patients at 1, 3, and 5 years, although the differences did not reach statistical significance. Black patients were more likely uninsured, had higher Charlson–Deyo comorbidity scores, resided in areas of lower income and education, experienced longer time to treatment ( P < 0.001), and had significantly lower survival at 3 and 5 years compared with White patients ( P < 0.01). Patients in SES Q1 traveled further for care, had longer time to treatment, were less likely to be treated with Mohs surgery ( P < 0.001), and had worse survival at 1, 3, and 5 years compared with patients in SES Q4 ( P < 0.001). In conclusion, significant disparities in disease presentation, access to care, and health outcomes in patients with ALM exist based on insurance status, race, and SES, emphasizing the need for targeted interventions to enhance early diagnosis and equitable treatment.
Chang et al. (Tue,) studied this question.