Black Patients With Merkel Cell Carcinoma Experience Treatment Delays

African American black woman female patient with White doctor
African American black woman female patient with White doctor
Factors associated with delays in treatment for patients with Merkel cell carcinoma were investigated.

Black patients with Merkel cell carcinoma (MCC) experience a significantly longer time from diagnosis to definitive surgical treatment (TTDS) compared with non-Hispanic White patients with MCC, according to study findings published in the Journal of the American Academy of Dermatology.

This retrospective study included 26,237 patients with MCC who were registered in the National Cancer Database from 2004 to 2015. The investigators used multivariable logistic regression to assess differences in time from diagnosis to definitive surgical treatment (TTDS) for MCC by sociodemographic characteristics and primary site. In addition, multivariable linear regression analyses examined the contribution of each disease and sociodemographic characteristic to TTDS.

Black patients more often presented with later stage, anaplastic, poorly differentiated/undifferentiated, and truncal MCC than patients who were non-Hispanic White (P <.001). The TTDS was significantly greater for Black patients than non-Hispanic White patients (58.9 vs 46.3 days, respectively; P <.05). The time to radiation was also longer for Black patients by 18.9 days (P <.001). These differences were surprising, noted the researchers, given that Black patients lived closer to the hospital compared with non-Hispanic White patients (23.2 vs 41.7 miles, respectively; P <.05).

Black patients also had longer TTDS for stages 1 through 3 disease (P <.05). Persisting racial differences were observed for private insurance and Medicare (P <.01), and no differences were found for Medicaid (P =.8986) or uninsured patients (P =.7510).

In the multivariable analysis adjusted for primary site, stage, and socioeconomic characteristics, Black race was associated with significantly greater odds of having a TTDS of 61 to 90 days (adjusted odds ratio [aOR], 1.97) or greater than 90 days (aOR, 2.11; P <.001).Also, eyelid tumors were associated with increased odds of TTDS of 31 to 60 days (aOR, 1.39), 61 to 90 (aOR, 2.12), and greater than 90 days (aOR, 1.47; P <.001). Black race (aOR, 11.1), eyelid lesions (aOR, 6.24), and Medicaid (12.17) were uniquely associated with additional days from diagnosis to surgical treatment (P <.01).

Limitations of this study included its retrospective nature as well as the lack of patients representative of other racial/ethnic groups.

The investigators noted that “better understanding the components underlying disparities in treatment delays is integral in developing interventions to improve MCC outcomes.”


Tripathi R, Bordeaux JS, Nijhawan RI. Factors associated with time to treatment for Merkel cell carcinoma. Published online November 7, 2020. J Am Acad Dermatol. doi:10.1016/j.jaad.2020.10.090