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The Link Between Melanoma And TTDS

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Written By Kevin Kerfoot / Reviewed By Ray Spotts

A study – led by researchers at Case Western Reserve University and University Hospitals Cleveland Medical Center – reveals that African-American patients with one of the deadliest forms of skin cancer are likely to experience a longer delay from diagnosis to surgery than non-Hispanic white (NHW) patients. The time from diagnosis to definitive surgery (TTDS) for melanoma was 23.4 days on average for black patients, compared to 11.7 days for NHW patients.

Black patients were twice as likely to have a TTDS of 41 to 60 days, three times as likely to have a TTDS of 61 to 90 days and five times as likely to have a TTDS of 91 days or longer.

Melanoma And TTDS Study

The study – published in the Journal of the American Academy of Dermatology - is based on National Cancer Database statistics from 2004 to 2015 and found that the disparities persisted despite controlling for various demographic characteristics including insurance type and income level.

“We already knew that black patients with melanoma have a worse prognosis and that longer time to treatment is associated with worse survival, but we didn’t fully understand the relationship between race and time to treatment after controlling for various other factors,” says the study’s first author Raghav Tripathi, a medical student at Case Western Reserve’s School of Medicine and a researcher at UH. “A more thorough understanding of the factors associated with worse outcomes for black patients is critical in reducing racial disparities in melanoma outcomes.”

The study builds on several research projects conducted in recent years involving different aspects of melanoma and racial disparities. The current study identified nearly 234,000 people with melanoma - 1,221 (0.52%) of whom were black.

Because the incidence of melanoma in black populations is relatively low, using large health-care databases and sample sizes allows researchers to include a sufficient number of black patients to investigate racial disparities in skin cancers.

Patients with Medicaid had the longest TTDS - an average of 60.4 days - and those with private insurance had the shortest - 44.6 days. Racial differences in TTDS persisted in each insurance group, suggesting that insurance status doesn’t fully account for these disparities.

The precise nature of the association between TTDS and race is not known, however, black patients typically develop more aggressive melanomas and require more complex surgeries that can take longer to arrange, particularly if they involve coordination among several clinicians.

“Ultimately, we hope this study will draw attention to the importance of further understanding the various components of TTDS and worse outcomes for black melanoma patients,” Tripathi added. “Additionally, this study suggests that targeted approaches to improve TTDS for black melanoma patients are integral in reducing racial disparities in melanoma outcomes.”

Diagnosing And Treating Dermatologic Conditions

The majority of skin problems including acne occur in people of every ethnicity and skin color. However, the amount of melanin an individual has can greatly influence their risk of and reaction to many different conditions.

“Ethnicity and skin tone can make a big difference in terms of diagnosis and treatment options with a number of different skin conditions,” says Amy McMichael, M.D., professor and chair of dermatology at Wake Forest Baptist Medical Center.

A fair-skinned person with a low level of melanin is far more likely to get sunburn than someone with a melanin-rich dark complexion, but that doesn’t mean darker-skinned people are immune to sun damage. Their higher levels of melanin offer greater, but not total, protection from the sun’s ultraviolet rays.

However, those same melanin levels also make darker skin more reactive to inflammation and injury, resulting in problems such as the development of long-lasting or permanent dark spots at the sites of even relatively minor irritations such as insect bites.

Hyperpigmentation And Other Dermatologic Conditions

Hyperpigmentation or dark spots are among the dermatologic conditions that occur more frequently and are more severe or appear differently in people with skin of color. They broadly include those of African, Asian, Hispanic, Middle Eastern, Native American and Pacific Island heritage than in individuals of Caucasian descent.

“There are a lot of myths out there about which groups are or are not affected by certain conditions,” McMichael added. “That African-Americans don’t get psoriasis is a big one.

“We’ve found that a number of people of African descent not only have it but that it can be a lot worse and a lot more extensive. And psoriasis is one of the conditions that can look so different in people with darker skin that it’s confusing and often not recognized by family physicians or even people trained in dermatology.”

Society For Dermatology Needs

The Skin of Color Society (SOCS), an international organization of physicians dedicated to advancing dermatology in people with pigmented skin, says that members of these populations often have an inadequate understanding of the root causes of skin diseases that commonly affect them.

“There’s probably more than one factor playing a role there, but I think a lot of it is cultural,” continued McMichael. “I think if you’re told ‘This is what we get’ you think ‘This is what we get’ and that’s it.

“There’s no understanding there that the condition can be treated, or maybe even prevented. There’s also the problem of ‘We don’t get that.’ For example, many people in the Hispanic community feel they’re not at risk for skin cancer. That’s not true. Hispanics come in all shades of the spectrum, but people of Hispanic descent who work outdoors and never put on sunscreen or a hat can definitely end up with skin cancer down the line.”

Pigmented Skin Conditions

Many people with darker skin have misconceptions about potential cures for skin conditions and spend considerable financial resources on ineffectual non-prescription or home therapies.” “For some people, cocoa butter fixes everything and that’s a common cultural thing with African-Americans,” McMichael continued.

“The problem is that cocoa butter has fragrances and other chemicals in it and can be very irritating. It can be a good moisturizer, that’s basically what it is, but some people will slather it on just about anything, and they shouldn’t.”

McMichael added that the field of dermatology would benefit if it were more diverse as it currently ranks near the very bottom among medical disciplines in terms of minority representation. “There are efforts by the American College of Dermatology to improve that,” she said.

“That’s not to have more minority dermatologists who’d just see minority patients. It would ideally mean there’d be more dermatologists aware of and sensitive to the factors involved with skin and hair conditions in people with skin of color and how to properly identify and treat them.”

Looking for 100% chemical-free, all-natural nourishing face and body oils? Check out Earth & Elm Nourishing Face Oil and Earth & Elm Nourishing Body Oil. Subscribe to our Trusted Health Club newsletter for more information about natural living tips, natural health, oral health and skincare. If you are looking for more health resources make sure to check out the Trusted Health Resources list. 

Written By:

With over 30 years of writing and editing experience for newspapers, magazines and corporate communications, Kevin Kerfoot writes about natural health, nutrition, skincare and oral hygiene for Trusted Health Products’ natural health blog and newsletters.

Reviewed By:

Founder Ray Spotts has a passion for all things natural and has made a life study of nature as it relates to health and well-being. Ray became a forerunner bringing products to market that are extraordinarily effective and free from potentially harmful chemicals and additives. For this reason Ray formed Trusted Health Products, a company you can trust for clean, effective, and healthy products. Ray is an organic gardener, likes fishing, hiking, and teaching and mentoring people to start new businesses. You can get his book for free, “How To Succeed In Business Based On God’s Word,” at www.rayspotts.com.

Photo by National Cancer Institute on Unsplash


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