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KEY POINTS
The impact of melanoma varies considerably depending upon race, class, and ethnicity.
There is an inverse relationship between the incidence of melanoma and skin color.
Melanoma in African Americans and Asians most commonly occurs on palms, soles, and nail beds.
Acral tumors constitute 30% to 70% of melanomas in African Americans, Asians, and Hispanics, whereas only 1% to 9% of Caucasians have acral melanomas.
Subungual melanoma exhibits a preponderance in dark-skinned individuals.
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Melanoma represents a significant disease burden in the United States, with an estimated 89,474 new diagnoses in 2012 and a predicted 9180 deaths.1 This impact varies considerably along the lines of race, class, and ethnicity as expressed in the broader social context, and as such, the relationship between these variables and melanoma outcome in minority populations is of clinical and social importance. Because melanoma is predominantly a cancer of white populations, it is perhaps expected that the majority of clinical research and public awareness campaigns promulgate the melanoma experience in Caucasians. This body of knowledge includes such risk factors as red hair, inability to tan, and propensity to freckle and to sunburn, as well as such prototypic clinical presentations as the irregular, changing pigmented lesion on the trunks of men and lower legs of women. Although important for the public health, these data may not be specifically relevant to the melanoma experience in people with skin of color and, furthermore, may inadvertently suggest that melanoma is not a health threat to these populations. U.S. Census data regarding increasing racial heterogeneity underscore the need for research focusing on the clinical and epidemiologic features of melanoma in various populations. By 2050, Hispanic, African, and Asian Americans will compose 24%, 15%, and 8% of the U.S. population, respectively, whereas Caucasians will compose approximately 50%.2 Considering the time period from 2000 to 2050, these figures represent a population percentage increase of 188% for Hispanics, 71% for African Americans, 213% for Asian Americans, and only 7% for Caucasians.2 Internationally, 20% of the world’s melanoma occurs in black and Asian populations.3 In coming years, knowledge of the clinical expression of melanoma in people with skin of color will become increasingly relevant for dermatologists and others interested in the health status of minorities. This chapter covers the epidemiology, clinical features, treatment, and prognosis of acral melanoma in various populations. The findings of our review suggest that the expression of melanoma in minority populations is distinct from that in Caucasians and is typified by lower incidence rates, a characteristic anatomic distribution, advanced stage at presentation, and poorer overall prognosis.
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An inverse relationship exists between melanoma incidence and degree of skin pigmentation. Incidence is highest among Caucasians, intermediate among Hispanics, and lowest among Asians and African Americans.4,5,6,7,8,9 According to U.S. National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) data, the U.S. melanoma incidence from ...