Minorities Not Aware of Their Melanoma Risk; Archives of Dermatology Study
Researchers in the Department of Dermatology and Cutaneous Surgery at the University of Miami Leonard M. Miller School of Medicine have published an important study that found melanoma is diagnosed later among blacks and Hispanics compared to white patients, which suggests a lack of awareness among blacks and Hispanics about their melanoma risk. These patients, while at less risk than whites, tend to present with more advanced melanoma and suffer higher mortality rates from the deadliest skin cancer. “We found that there are more late stage diagnoses in minorities,” said Robert Kirsner, M.D., Ph.D., professor and vice chairman of Dermatology and Cutaneous Surgery at the UM Miller School and a member of the Bio-Behavorial Oncology and Cancer Control Program at the University of Miami Sylvester Comprehensive Cancer Center. “Our hypothesis is that this is due to a lack of screening and a lack of awareness. While it is possible the biology of melanoma is more aggressive in certain populations, we believe more likely it is a public health issue.”
Kirsner and his colleagues studied 1,690 cases of melanoma diagnosed in Miami-Dade County from 1997 to 2002, recorded in the Florida Cancer Data System. The overwhelming majority of cases, 69.5 percent, were in non-Hispanic white patients, with 28.5 percent in Hispanics and 2 percent in black patients. But Hispanics were nearly twice as likely as whites to have a late-stage diagnosis – blacks were three times more likely to be diagnosed with advanced melanoma. The study is published in the June issue of the Archives of Dermatology and it is one of only a handful of studies of any kind in the academic literature on melanoma in minorities.
“Ethnic minorities, who are often darker-skinned individuals, think it’s almost impossible for them to get skin cancer, especially melanoma,” said co-author Shasa Hu, M.D., dermatology resident at the University of Miami/Jackson Memorial Hospital and former fellow in Dermatology and Cutaneous Surgery at the UM Miller School. “There is a lower awareness among ethnic minorities, especially those who have more natural pigmentation in terms of whether they can actually get skin cancer, including melanoma,” said Hu. Melanoma strikes about 60,000 people a year in the United States and claims nearly 8,000 lives, according to the American Cancer Society. In Florida alone roughly 4,600 people can expect to be diagnosed with melanoma, which is more deeply invasive and more likely to spread than more common squamous and basal cell skin cancers. Nationwide, only California has more cases of melanoma than Florida.
“I think the current message about melanoma should be extended beyond just light-skinned, white populations to Hispanic and darker-pigmented populations,” said Kirsner, who co-authored a study in 2004 showing minorities in Sunbelt states are at much higher melanoma risk than their peers in northern states. “In our earlier study we found that melanoma in blacks and Hispanics is associated with ultraviolet (sun) light exposure similar to whites, though to a lesser extent. Unfortunately, these populations are often excluded from the emerging public health message regarding sun exposure and therefore may not learn about sun protective behaviors and, as the data suggests from our current study, life-saving skin cancer screening. They are at lower risk – but they’re still at risk.”
The hope is that this study will fuel an increase in awareness among minorities and their physicians to improve early detection. “Screening is different from early detection,” said Kirsner. “Screening is a mass process but early detection often is driven by the patient and occurs one on one with their physician.” Many Hispanic and black patients don’t regularly check their skin to look for moles that are suspicious, for example those that are asymmetrical or that change over time. If minority patients can be educated about the importance of self exams they could improve early detection – and save their own lives.
When melanoma is caught at an early stage before it has spread the 5-year survival rate is 98 percent. If it isn’t caught until it has metastasized, or spread far from where it began, survival dwindles to 16 percent. Awareness campaigns have had a dramatic impact in the white community, improving survival from 68 percent to 92 percent over the last 30 years. The gains have been less pronounced among Hispanics and blacks. “There is public education but in general it’s focused on white populations,” said Kirsner. “Because of that the incidence is rising in some areas among Hispanic populations and when people are diagnosed later they have worse survival rates.” South Florida’s diversity presented the UM researchers with a unique environment to conduct this study, given the large Hispanic, African-American and Caribbean populations. “We kind of are the sentinel region for these findings,” said Kirsner.
The study, which was also co-authored by Rita M. Soza-Vento, Ph.D., and Dorothy F. Parker, M.H.S., in the UM/Sylvester Population Research Core, is available online at this address: http://archderm.ama-assn.org/.