Many patients and physicians have the misconception that the Hispanic population is not prone to skin cancer. As a result, these patients are not being diagnosed early.
The latest CDC statistics show that, among men in 2011, white men had the highest melanoma rate, followed by American Indian/Alaska Native, Hispanic, Asian/Pacific Islander and African Americans. Among women, white women had the highest melanoma rate, followed by Hispanic, American Indian/Alaska Native, Asian/Pacific Islander and African Americans.
What’s most important, according to Maritza Perez, M.D., a dermatologist who practices in New Canaan, Conn, is that melanoma incidence has risen 20% in the Hispanic population in the past two decades. And studies have shown that Hispanics are more likely than Caucasians to present at the time of diagnosis with thicker tumors, regional lymph node involvement, and distant metastases. Hispanic patients are also likely to have worse survival rates than Caucasians.
In one study1, researchers did a cross-sectional retrospective analysis of melanoma cases documented in Florida from 1990 to 2004. They found that, of 41,072 melanoma cases, 39,670 were among white non-Hispanics, 1,148 were white Hispanics and 254 were African Americans. Melanoma incidence remained stable among black men and women, but increased 3.4% among white Hispanic women and 0.95 among white Hispanic men.
Hispanics and blacks in the study population had more advanced melanoma at presentation: “18% of [white Hispanics] and 26% of black patients had either regional or distant-stage melanoma at diagnosis compared with 12% of [white non-Hispanics] patients. The proportion of distant-stage melanoma diagnosed among [white Hispanics] and blacks changed little from 1990 to 2004, compared with a steady decrease in the percentage of melanoma cases diagnosed at distant stage among [white non-Hispanics]…,” according to the study.
The authors called for closer examination of secondary prevention efforts in the Hispanic and black populations, given the persistent disparity in melanoma stage at diagnosis.
“The most common presentations among Hispanics are superficial spreading melanoma and acral lentiginous melanoma,” Dr. Perez says, emphasizing that “we need to evaluate these patients.”
Incidence rates of non-melanoma skin cancer in Hispanics fall between Caucasians and African Americans, according to Dr. Perez.
“The lowest incidence is in blacks, which is one in 100,000; in Hispanics, it’s 50 to 171 per 100,000; and in Caucasians, it’s 185 to 340 in 100,000,” she said.2
Research indicates that Hispanics are less likely than Caucasians to use sunblock and wear protective clothing. They’re also more likely to go to tanning beds. These choices stem from a mistaken perception that they are less likely to get skin cancer, according to Dr. Perez.
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Researchers in Miami, Fla., conducted a pilot survey looking at skin cancer awareness and sun protection behaviors in white Hispanic and white non-Hispanic local high school students. Their survey of 369 students (221 of whom were white Hispanics) revealed that the Hispanic students were more likely to tan deeply but were also 60% less likely to have heard of skin self-examination and 70% less likely than white non-Hispanics to have ever been told to perform skin self-examinations. White Hispanics were 1.8 times more likely to never or rarely wear sun-protective clothing or use sunscreen. And Hispanics reported 2.5-fold higher tanning bed use in the past year. Hispanic students believed their chances of skin cancer development were less than their Caucasian counterparts. 3
“Many physicians also have the preconception-erroneous as it is-that this population is not prone to skin cancer. As a result, Hispanics are not being diagnosed early, and they’re dying,” Dr. Perez said. “We know that melanoma and non-melanoma skin cancers are related to sun exposure, yet we’re not reaching Hispanics with this message.”
Hu S, Parmet Y, Allen G, et al. Disparity in melanoma: a trend analysis of melanoma incidence and stage at diagnosis among whites, Hispanics, and blacks in Florida. Arch Dermatol. 2009;145(12):1369-74.
Gloster HM, Neal K. Skin cancer in skin of color. J Am Acad Dermatol. 2006;55(5):741-60.
Ma F, Collado-mesa F, Hu S, Kirsner RS. Skin cancer awareness and sun protection behaviors in white Hispanic and white non-Hispanic high school students in Miami, Florida. Arch Dermatol. 2007;143(8):983-8.