For melanoma, patient and physician education is key. Laser treatment for hyperpigmentation in darker skin effective. Teledermatology could replace office visits in this underserved population.
Is there a melanoma crisis in the Hispanic community?
Maritza Perez, M.D., a clinical professor of dermatology at Icahn School of Medicine at Mount Sinai in New York City, says there may be. She is seeing more cases in her practice and cites statistics showing a 20% increase of melanoma cases among Hispanics in the last two decades.
“Unfortunately, Hispanics do not know that they have a propensity to skin cancer because they think they are immune, due to their darker skin,” Dr. Perez tells Dermatology Times.
Skin health issues in people of Latin American descent can be complicated due to their heterogeneous genetic make-up. In some families, it can include a mix of European, Native American and African heritages. Skin colors within immediate family members can range from very light to brown tones.
Many of these patients are under the impression that they are not at risk for melanoma, which is a false premise that even some doctors abide by despite evidence to the contrary, she says. As a result, these doctors fail to conduct skin exams in patients of darker skin tones.
“If you don’t look, you don’t find,” Dr. Perez says.
A study published in a June issue of the Journal of Cancer Epidemiology explored why Hispanics who are diagnosed with cutaneous melanoma are more likely to present at advanced stages. The researchers, led by Valerie M. Harvey, M.D., of Eastern Virginia Medical School in Virginia, examined the predictors for a late-stage melanoma diagnosis in California, Texas, and Florida. The reasons they found for a late-stage diagnosis was complex.
“The influence of contextual predictors on a late-stage melanoma diagnosis varied in magnitude and strength by state, highlighting both the cosegregation of social adversity and poverty and the complexity of their interactions,” the researchers wrote.
This was a cross-sectional study of a state cancer registry. The study included 12,493 cases from California, Texas and Florida. In California, late stage cases were significantly more likely to occur among Hispanics and immigrants. In Texas, the late-stage cases were more likely to occur among immigrants and the poor. In Florida, areas of low education attainment, high levels of poverty, and a high percentage of Hispanic residents was significantly associated with late-stage melanoma cases.
The increasing prevalence of a late-stage melanoma diagnosis is particularly alarming to Dr. Perez because these patients are increasingly being diagnosed at a younger age with more advanced disease and lymph node involvement.
“The challenge for us as dermatologists is to teach Hispanics and doctors,” says Dr. Perez, who participated in a forum on dermatologic concerns among various ethnic skin types at the Skin of Color Seminar Series (SOCSS) in New York City in May.
Dr. Perez has become a healthcare information crusader for the Hispanic community. In addition to participating in the seminar series, she has appeared on Spanish-language Univision television and she’s been targeting sun-worshipping teens.
She’d like to convene monthly meetings of community dermatologists where information on how best to treat the Hispanic community can be disseminated.
Disclosures: Dr. Perez is a trainer for Cutera.
Valerie M. Harvey, Clinton W. Enos, Jarvis T. Chen, Hadiza Galadima, and Karl Eschbach. “The Role of Neighborhood Characteristics in Late Stage Melanoma Diagnosis among Hispanic Men in California, Texas, and Florida, 1996–2012,” Journal of Cancer Epidemiology. June 18, 2017. https://doi.org/10.1155/2017/8418904