Disparities in Patients with Choroidal Melanoma between Black and Hispanic versus Non-Hispanic White Patients

Introduction Choroidal melanoma is the most common primary intraocular malignancy in adults. Early detection through ophthalmic screening, increases the likelihood of globe-preserving treatment and may reduces metastasis while maximizing survival. Racial and ethnic disparities in access to care may influence outcomes, metastasis, and mortality. Methods This retrospective cohort study used data from 2004-2025 within a federated electronic health record database. Adult patients (≥18 years) with choroidal melanoma were identified. Race/ethnicity was categorized as Non-Hispanic White (NHW) or Black/Hispanic. The primary outcomes were primary enucleation, development of liver metastasis, and all-cause mortality within 1, 3, or 5 years from the time of choroidal melanoma diagnosis. Propensity score matching (PSM) was performed to balance cohorts. Multivariate Cox proportional hazards models were used to identify factors associated with enucleation, metastasis, and mortality. Results A total of 17,436 patients with choroidal melanoma were identified, of whom 659 (6.3%) were Black/Hispanic and 9883 (93.7%) were NHW. After PSM, primary enucleation within 90 days of diagnosis occurred in 5.2% of Black/Hispanic patients versus 3.8% of NHW patients (risk ratio [RR] 1.36, 95% confidence interval [CI] 0.821–2.253, p=0.2305). Cumulative rates of liver metastasis in the Black/Hispanic group were significantly higher than NHW at 1 year (RR 2.42, CI 1.336-4.387), 3 years (RR 1.96, CI 1.246-3.083), and 5 years (RR 1.77, CI 1.195-2.611) (p<0.01 for each). All-cause mortality was higher in the Black/Hispanic cohort at 1 year (RR 1.96, CI 1.212-3.163), 3 years (RR 1.75, CI 1.249-2.453), and 5 years (RR 1.48, CI 1.105-1.976) (p<0.01 for each). On multivariate Cox analysis, male sex (hazard ratio [HR] 1.49, CI 1.275-1.736, p<0.0001) was associated with higher risk of enucleation, while a history of choroidal nevus was protective (HR 0.59, CI 0.424-0.831, p=0.0024). For metastatic risk, Black/Hispanic race/ethnicity (HR 1.54, CI 1.242–1.904) and enucleation (HR 3.27, CI 1.845–5.780) were associated with an increased risk, whereas prior nevus was protective (HR 0.43, CI 0.324–0.577). All-cause mortality was elevated with older age (HR 1.03, CI 1.021-1.031), male sex (HR 1.22, CI 1.084-1.373), Black/Hispanic race/ethnicity (HR 1.42, CI 1.135-1.769), metastatic liver disease (HR 7.49, CI 6.051-9.269), among other comorbidities. Prior nevus history conferred a survival benefit (HR 0.59, CI 0.458-0.762). Conclusion In patients with newly diagnosed choroidal melanoma, Black/Hispanic patients had higher rate of metastatic disease and mortality. Previous history of choroidal nevus was associated with a lower risk of primary enucleation, metastatic disease and mortality.