Black patients with Merkel cell carcinoma (MCC) were more likely to present with advanced disease compared to White and Hispanic patients but had similar survival outcomes, according to new findings.¹

MCC—a rare and aggressive skin cancer that mostly affects patients that are White—is more and more common, and the majority of research shows that Black MCC patients have higher rates of presenting advanced disease.²

The purpose of this study was, in part, to assess whether Black patients with MCC have worse overall survival than White patients, for which available data is conflicting.³ The research was authored by Noreen Mohsin, BS, with the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

“The composition of the US population is rapidly changing,” Mohnsin and colleagues wrote. “As such, it is imperative to understand how disease characteristics and outcomes differ by race and ethnicity. Accordingly, in this cohort study we sought to characterize racial and ethnic differences among patients with MCC.”

Background and Findings

The investigators analyzed patient data from March to November of 2022, conducting a retrospective cohort analysis of 9,557 patients with MCC diagnoses. The team collected data from 2000 through to 2018, using 18 population-based cancer registries at the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program.

The researchers conducted a Cox proportional hazards regression to assess the different associations between demographics such as race, age, sex, income, and ethnicity and clinical information such as diagnosis stage, primary site of MCC, and year of diagnosis.

Overall, the investigators noted that the majority of the 9,557 MCC patients were male and aged 70 years or older. Among them, 89.9% were reported as White, 5.7% Hispanic, 1.5% Black, and 2.3% Asian American or Pacific Islander.

The biggest findings the team reported were that Hispanic patients had better MCC-specific survival than White patients, whereas Black patients technically had the lowest MCC-specific survival. That said, the difference was not statistically significant and despite Black patients showing advanced disease earlier, the rates were roughly the same.

Additionally, the investigators noted that Hispanic and Black patients were less likely to have the primary site of the head and neck compared to White patients, and they confirmed that Black patients were more likely to have advanced disease at diagnosis than Whites (40.4% versus 29.2%, respectively; P = .004).

“Although MCC incidence was lower among AAPI patients than White patients, the disease presentation and prognosis were generally similar,” they wrote. “The finding that lower income was independently associated with worse MCC outcomes was consistent with prior studies and suggests there are socioeconomic disparities in MCC care.”

References

1. Mohsin N, Martin MR, Reed DJ, et al. Differences in Merkel Cell Carcinoma Presentation and Outcomes Among Racial and Ethnic Groups. JAMA Dermatol. Published online March 15, 2023. doi:10.1001/jamadermatol.2023.0061.
2. Trofymenko O, Zeitouni NC, Kurtzman DJB. Factors associated with advanced-stage Merkel cell carcinoma at initial diagnosis and the use of radiation therapy: results from the National Cancer Database. J Am Acad Dermatol. 2018;79(4):680-688. doi:10.1016/j.jaad.2018.03.019.
3. Sridharan V, Muralidhar V, Margalit DN, et al. Merkel cell carcinoma: a population analysis on survival. J Natl Compr Canc Netw. 2016;14(10):1247-1257. doi:10.6004/jnccn.2016.0134.