Sex, Racial Disparities Persist Across Melanoma Care Continuum

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Demographic gaps persist in both early melanoma detection and access to palliative care, with men experiencing significantly worse survival outcomes than women across US counties and minority patients less likely to die at home or in hospice.^1,2

These findings, reported in 2 posters presented at the 2026 American Academy of Dermatology Annual Meeting, highlight enduring inequities across the melanoma care continuum, from diagnosis to end of life, and point to critical areas where care delivery continues to fall short.

Sex Disparities Persist Across US Melanoma Outcomes

Investigators of the first poster noted that prior research has consistently shown higher melanoma incidence and mortality among men vs women, underscoring the need to better understand and address these disparities.¹

To further explore this issue, the researchers assessed whether sex-based disparities in melanoma outcomes exist at the county level and where they may be most pronounced. The retrospective ecological study used 5-year average melanoma incidence and mortality data from both the Surveillance, Epidemiology, and End Results Program and the National Program of Cancer Registries, spanning from 2017 to 2021.

A total of 208 urban counties with complete data were included, representing a combined population of 183,398,728. Incidence and mortality rates were stratified by sex for each county, with mortality-to-incidence ratios (MIR) calculated for both sexes. A male-to-female MIR ratio was then used to quantify disparities between groups.

The findings confirmed substantial gaps across both incidence and outcomes. Average male melanoma incidence was 30.76 per 100,000, compared with 19.84 per 100,000 in women (P < .0001), a difference of more than 50%. Men also had a higher mean MIR than women (0.106 vs 0.076), yielding a mean male-to-female MIR ratio of 1.43 (P < .0001); this indicated that men diagnosed with melanoma are significantly more likely to die from the disease relative to their incidence than women.

Among counties with the highest male MIRs, Spokane County, Washington, reached 0.27, and Jackson County, Oregon, reached 0.23. The most pronounced male-to-female MIR disparities were concentrated in the Western United States, with Multnomah County, Oregon, recording a ratio of 2.49 and Placer County, California, recording 2.30, meaning men in those counties were more than twice as likely to die from melanoma relative to their diagnosis rate compared with local women.

“The data from 200+ US counties further supports the findings that significant disparities exist in melanoma mortality for men compared to women,” the authors concluded. “These findings emphasize the need for early detection and efforts to eliminate the underlying causes of observed sex-related disparities in outcomes.”

Where Patients With Melanoma Die Differs by Race

The second poster focused on disparities at the end of life, investigating racial differences in the location of death among patients with melanoma.² The researchers explained that survival disparities are well-studied, but less is known about inequities in end-of-life care, particularly in the location of death. They added that understanding demographic patterns in death location may offer insights into palliative care access.

Consequently, the researchers conducted a study to identify inequities and inform strategies to promote equitable, compassionate end-of-life care for patients with melanoma. They analyzed melanoma mortality data from the CDC WONDER Multiple Cause of Death dataset, spanning 2018 to 2023.

Locations of death were categorized as inpatient medical facilities, nursing homes or long-term care, hospice, outpatient or emergency departments, and home. Additionally, the researchers performed multinomial logistic regression with home as the reference category to estimate relative risk ratios (RRRs) and 95% CIs.

A total of 47,117 deaths were included. White patients comprised the majority of cases (n = 45,882), with African American (n = 737), Asian (n = 314), multiracial (n = 96), and American Indian/Alaska Native (n = 88) patients representing smaller subgroups.

Compared with White patients, both African American and Asian patients were significantly more likely to die in inpatient settings. African American patients carried the greater risk (RRR, 1.81; 95% CI, 1.53-2.14; P < .001), but Asian patients also showed elevated inpatient mortality (RRR, 1.46; 95% CI, 1.14-1.86; P = .003).

African American patients were also nearly 3 times more likely than White patients to die in outpatient or emergency settings (RRR, 2.94; 95% CI, 1.94-4.45; P < .001), which is a pattern that the researchers noted may reflect both reduced hospice engagement and structural barriers to timely ambulatory follow-up. By contrast, Asian patients were less likely to die in nursing homes or long-term care facilities (RRR, 0.45; 95% CI, 0.28-0.75; P = .002).

As a result, the authors concluded that minority patients with melanoma are less likely to die at home or in hospice compared with White patients, suggesting inequitable access to comfort-focused end-of-life care.

“These patterns indicate limited access to preferred, high-quality palliative care and greater exposure to aggressive treatments near death,” they wrote. “Efforts to address disparities in end-of-life care must include equitable access to palliative services for melanoma patients across backgrounds.”

References

1. Adler R, Auerbach E, Mehta M, et al. Unequal outcomes: sex-based disparities in melanoma mortality. Presented at: 2026 AAD Annual Meeting; March 27-31, 2026; Denver, CO. Poster 75477.
2. Zieneldien T, Ma S, Busot D, Cohen B. End-of-life care inequities and demographic patterns in melanoma mortality. Presented at: 2026 AAD Annual Meeting; March 27-31, 2026; Denver, CO. Poster 76250.