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Hu S, Kirsner RS. Practice Gaps—Suboptimal Skin Cancer Screening and Delayed Melanoma Diagnosis in HispanicsComment on “Cutaneous Melanoma and Other Skin Cancer Screening Among Hispanics in the United States”. Arch Dermatol. 2011;147(6):745–746. doi:10.1001/archdermatol.2011.141
Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011
Melanoma among Hispanics is becoming an increasingly critical public health issue as the US Hispanic population rapidly expands, and the incidence of melanoma among Hispanics steadily increases. Mounting evidence suggests that both prevention and diagnosis of melanoma need to be improved in the Hispanic community. Andreeva et al highlight 2 important screening deficiencies: (1) the rates of skin self-examinations and clinical examinations are low among Hispanics, and (2) there is limited research on skin cancer screening efforts among Hispanics. Suboptimal screening likely contributes to the disparate melanoma outcome among Hispanics who have a substantially higher proportion of melanomas diagnosed at a later stage than non-Hispanic whites.1
While socioeconomic factors impede access to care, lower knowledge and awareness of melanoma risks among Hispanics likely delay access as well.2 During clinic visits, additional barriers to appropriate melanoma screening may include providers' lack of awareness of melanoma risk in Hispanics and failure to inquire about risk factors such as family history, sun-exposure history, and changing or bleeding moles. Lack of consensus on effective early detection strategies for Hispanic patients poses another challenge, as do differences in language and cultural and/or social values that may exist between the provider and the patient.
These challenges represent opportunities for intervention, several of which can be easily implemented by dermatologists. First we need to educate ourselves and our colleagues on melanoma risk in Hispanics and dispel the public misconception that melanoma only occurs in whites. Since 1 of every 4 Americans will be Hispanic by 2020 according to the Census Bureau, heightened awareness of melanoma disparity among Hispanics is essential.
During encounters, sensitivity to potential language and cultural barriers between non-Hispanic physicians and Hispanic patients should be addressed, in part by offering an interpreter when needed. Importantly, skin cancer screening questions such as family history, tanning bed use, history of blistering sunburns, and the presence of changing or “funny-looking” moles should be included as part of the encounter to focus on the need for full-body skin examination (FBSE). These questions are important because Hispanic and non-Hispanic whites share melanoma risk factors. Dermatologists should offer an FBSE to patients at risk and should have the competency to perform FBSE using both visual and dermoscopic inspection. Particular attention should be paid to acral areas because there is a higher incidence of acral lentiginous melanoma and melanoma on extremities among Hispanics.
Occasionally, a Hispanic patient may not feel comfortable with or recognize the importance of an FBSE. Patient education using interpreter services when necessary can help establish a rapport and explain the rising melanoma problem among Hispanics and the need for FBSE.
While more research is needed to provide evidence-based guidelines on how best to screen for and diagnose melanoma in Hispanics, implementing these suggested strategies into daily practice can improve melanoma diagnosis in Hispanic patients. Educating our Hispanic patients on melanoma prevention may also have a “ripple effect” to their families, communities, and health care providers and hopefully improve melanoma outcome in this population.
Correspondence: Dr Kirsner, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave, RMSB, Room 2023-A, Miami, FL 33136 (RKirsner@med.miami.edu).
Financial Disclosure: None reported.
Funding/Support: This work was supported in part by a Career Development Award in Health Care Policy from the Dermatology Foundation (Dr Hu).