Roman C, Lugo-Somolinos A, Thomas N. Skin Cancer Knowledge and Skin Self-examinations in the Hispanic Population of North Carolina: The Patient's Perspective. JAMA Dermatol. 2013;149(1):103-104. doi:10.1001/2013.jamadermatol.263
Author Affiliations: Case Western Reserve University, Cleveland, Ohio (Ms Roman); and Department of Dermatology, University of North Carolina, Chapel Hill (Drs Lugo-Somolinos and Thomas).
The incidence rates of melanoma in Hispanics are on the rise, and melanoma presents at a more advanced stage among Hispanics than other ethnic groups.1 Delay in diagnosis may be owing to a low index of suspicion for melanoma in Hispanics among both medical professionals and the Hispanic population.2 It has previously been shown that comprehensive skin self-examination (SSE) may lead to earlier melanoma diagnosis.3 Despite this evidence, the percentage of patients in the Hispanic population performing SSE has been reported to be low, 15% compared with 32% in non-Hispanic whites (NHWs).4 Several studies have reviewed skin cancer screening practices among Hispanics, but these studies have all been retrospective, and the conclusions are mainly speculative.1 Our objectives were to determine the percentage of Hispanics who undergo skin examination by a physician and perform regular SSE and to explore reasons why they might not. Additional focus was placed on participants older than 40 years because skin cancer screenings are recommended for patients in this age group owing to increased risk of melanoma with older age.
Design Setting and Participants. Patients of Hispanic descent (N = 301) were recruited from the Piedmont Health Services in Carrboro, North Carolina; the University of North Carolina (UNC) Dermatology Clinics; and the Hispanic advocacy group El Pueblo in Raleigh, North Carolina. All self-reported Hispanics from any Hispanic country of origin and older than 18 years were invited to complete a survey. The study was approved by the institutional review board of the UNC at Chapel Hill.
Questionnaire and Statistical Analysis. Surveys were prepared using Teleform software (Autonomy/Cardiff) and scanned using a Scantron machine. Data analysis was performed using GraphPad Prism).
Most of our patients were women (72%), with a mean age of 35 years (Table). Most of the participants reported their country of origin as Mexico, although 9 other countries were also represented. Of the Hispanics in our study, 23% reported knowing the risk factors for skin cancer; 9% received a regular skin examination; and 22% performed SSEs. No difference was seen in the group older than 40 years.
Of 273 subjects who did not get regular skin examinations (91%), 32% felt that they did not have ample time with the physician, and an additional 32% reported that they did not think to ask or did not know how to ask for a skin examination, partly because a skin examination was not the primary reason for the visit. It should be mentioned that all the physicians at Piedmont Health Services and some at the UNC Dermatology clinic are fully bilingual. Of the 236 participants who did not perform an SSE yearly (78%), most responded either that they were not told to do so (49%) or that they did not know what to look for (29%).
Although a disparity has been reported in knowledge and sun-protective behaviors among Hispanics and NHWs,5 we know of no published literature discussing the reasons why Hispanics do not perform regular SSEs or ask their physician for a skin examination at their regular visits. This study addresses those questions and stresses the importance of education to this growing population. Cultural perceptions of modesty, especially among female patients, were not a significant factor, reported by only 7% of participants. Physicians should take a more active role in educating their patients about safe skin practices, including sun avoidance and SSE. Safe skin practices are as important as regular exercise and smoking cessation and should be included in routine health education counseling.
With evidence suggesting the importance of SSE, it is concerning that most of the Hispanic participants did not report performing them. Physicians should educate their patients, demonstrate for them how to perform a proper SSE, explain what to look for, and provide resources with examples. Physicians should also teach their Hispanic patients to pay particular attention to acral areas and extremities because there is a higher incidence of melanoma on those areas in Hispanics.2
Correspondence: Dr Lugo-Somolinos, Department of Dermatology, University of North Carolina School of Medicine, 410 Market St, Ste 400, Chapel Hill, NC 27516 (firstname.lastname@example.org).
Accepted for Publication: July 26, 2012.
Author Contributions: Ms Roman and Dr Lugo-Somolinos had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Roman, Lugo-Somolinos, and Thomas. Acquisition of data: Roman and Thomas. Analysis and interpretation of data: Roman. Drafting of the manuscript: Roman and Thomas. Critical revision of the manuscript for important intellectual content: Lugo-Somolinos and Thomas. Obtained funding: Roman. Administrative, technical, and material support: Roman and Thomas. Study supervision: Lugo-Somolinos and Thomas.
Conflict of Interest Disclosures: None reported.
Funding/Support: This study was supported in part by Case Western Reserve University.
Role of the Sponsors: The sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; or in the preparation, review, or approval of the manuscript.
Additional Contributions: We thank the staff of El Pueblo and Carrboro Piedmont Health Center for allowing us to conduct this study in their facilities.