Examining the role of socioeconomic status on severity and outcomes in acral lentiginous melanoma

Summary: Abstract Body: Acral lentiginous melanoma (ALM) is a form of cutaneous melanoma (CM) that develops in the palms, soles, and nails. ALM comprises most CM cases in people with skin of color. Further, these populations present with more severe tumors (Breslow thickness, staging, ulceration) and higher melanoma-specific mortality (MSM) rates. Socioeconomic status (SES) has been proposed as a contributor to ALM disparities across racial/ethnic groups, but the evidence is inconclusive. Here, we aimed to identify differences in ALM outcomes across SES groups. We used the SEER 22 database with census tract-level attributes to obtain clinicopathologic and treatment data for patients diagnosed with ALM from 2010-2020. We collected and analyzed age at diagnosis, race/ethnicity (non-Hispanic White (NHW), non-Hispanic Black (NHB), non-Hispanic Asian and Pacific Islanders (NHAPI), and Hispanic), sex, SES quintiles, environment, Breslow thickness, mitotic rate, ulceration, stage, surgery, chemotherapy, and radiation. We then compared clinicopathologic characteristics and outcomes for 2,178 ALM cases across SES quintiles, where the first quintile represents the lowest SES and the fifth represents the highest SES. Patients belonging to SES quintiles 1 and 2 presented with a larger proportion of ulcerated tumors (43% and 40%), as well as a higher median Breslow thickness (2.1 and 1.9 mm) and mitotic rate (2 mitoses/mm2) compared to patients from SES quintiles 4 and 5. Our multivariate Cox proportional hazard model showed no significant difference in risk for MSM across SES. When stratifying racial and ethnic groups by SES, the risk of MSM was higher among NHB (HR 2.76, p=0.002) and Hispanic patients (HR 1.49, p=0.06) from higher SES (quintiles 3, 4, and 5) compared to those from lower SES (quintiles 1 and 2). Our results show that SES may not contribute to differences in ALM outcomes across minority populations. Further research is needed to elucidate ALM etiology and pathogenesis and to identify the underlying factors driving differences across diverse groups. Faith Simmonds¹, Diddier Prada², Rolando Perez-Lorenzo¹ 1. Columbia University, New York, NY, United States. 2. Icahn School of Medicine at Mount Sinai, New York, NY, United States. Minoritized Populations and Health Disparities Research