{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T08:22:40Z","timestamp":1781857360314,"version":"3.54.5"},"reference-count":34,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Backgrounds and Methods<\/jats:title>\n                    <jats:p>American Indian and Alaska Native (AI\/AN) populations face significant health disparities across multiple cancer types, yet melanoma\u2010specific outcomes remain under\u2010investigated. A comprehensive search of Embase, Scopus, and PubMed identified 20 studies meeting inclusion criteria. Three meta\u2010analyses were conducted using random effects models to assess: (1) adjusted hazard ratios for mortality risk, (2) adjusted odds ratios for late\u2010stage diagnosis, and (3) age\u2010adjusted incidence rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The meta\u2010analysis revealed significant disparities in melanoma outcomes for AI\/AN patients. AI\/AN patients demonstrated a 43% higher mortality risk compared to white patients (pooled aHR\u2009=\u20091.43, 95% CI: 1.12\u20131.82,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0041) and a 75% higher likelihood of late\u2010stage diagnosis (pooled adjusted OR\u2009=\u20091.75, 95% CI: 1.16\u20132.65,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0080). AI\/AN patients consistently presented with worse prognostic factors including higher Breslow thickness, increased ulceration rates, and more advanced disease stages.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provides the first meta\u2010analytic evidence demonstrating statistically significant disparities in melanoma outcomes among AI\/AN populations. Systemic barriers include insurance disparities, geographic isolation, treatment delays, and limited access to specialized dermatologic care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These findings justify targeted interventions including enhanced screening programs, improved healthcare infrastructure, and policy reforms to address insurance and access barriers affecting AI\/AN communities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70136","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T11:51:47Z","timestamp":1763985107000},"page":"54-72","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Disparities in Cutaneous Melanoma Diagnosis and Survival Among American Indian and Alaskan Native Patients: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"133","author":[{"given":"Rena A.","family":"Li","sequence":"first","affiliation":[{"name":"Northwestern University Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3375-3818","authenticated-orcid":false,"given":"Antoinette T.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"University of Rochester School of Medicine and Dentistry Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kethan","family":"Bajaj","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigid M.","family":"Coles","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9552-6483","authenticated-orcid":false,"given":"Robert D.","family":"Galiano","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Mayo Clinic. 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