Alternate Approaches Needed for Melanoma Diagnosis for Black Patients Due to Screening Disparities

Article

This data on a large racial and ethnic minority cohort indicated that low melanoma incidence and detection rates and more aggressive nature of cancer shows the need for greater attention.

Laura K. Ferris, MD, PhD,

Credit: UPMC

Laura K. Ferris, MD, PhD,

Credit: UPMC

Alternative methods outside of routine skin cancer screening may be more useful in addressing screening disparities for patients of color, specifically Black patients, according to recent findings regarding the variable presentation of melanomas in racial and ethnic minority groups.1

These findings were the results of a study which was designed to examine melanoma detection characteristics among those with minority backgrounds, especially given that while melanoma incidence is known to be highest among non-Hispanic Whites, minority populations are known to have lower rates of melanoma survival.2

The research was authored by Laura K. Ferris, MD, PhD, from the Department of Dermatology at the University of Pittsburgh School of Medicine in Pennsylvania.

“Proposed strategies to address this difference include expanded education and skin cancer screening, although no data exist to support either approach,” Ferris and colleagues wrote. “We examined characteristics of melanoma detection in a large racial and ethnic minority (REM) cohort.”

Background and Findings

In a previous report, this study’s investigators had examined the incidence of melanoma among individuals (representing all ethnicities and races) who participated in a primary care–based quality initiative conducted at the University of Pittsburgh Medical Center during the first 5 years of the initiative.3

For this new study, the research team’s focus was on 60,680 participants who self-identified as Black, Hispanic, American Indian, Alaska Native, Asian, or Pacific Islander. Among this group, 12,738 individuals (8.8% of all ethnicities and races) underwent skin cancer screening, while 47,942 individuals (10.6%) did not undergo such a screening.

The team’s cohort study was done with the approval of the University of Pittsburgh Institutional Review Board, which waived the requirement for informed consent due to the minimal risk posed to participants. They adhered to the SQUIRE reporting guideline for this study, and the data was assessed from January of 2020 to May of 2023.

Among the cohort of 60,680 total individuals in the study, from a diverse racial and ethnic background known as the REM cohort, the median age of the participants was found to be 51 years (with an interquartile range of 42 - 62 years). Among the cohort, 59.6% were shown to be female, and 40.4% male.

Additionally, the investigators noted that the racial distribution of the trial included 1.2% Alaska Native or American Indian, 77.9% Black, 14.5% Asian, 6.8% Hispanic, and 0.4% Pacific Islander.

During the study period, 8 total cases of melanoma were diagnosed by the investigators from among the REM cohort, with 3 having been detected at the time of screening visits and 5 being found in unscreened individuals. The number needed to screen to detect one melanoma in the REM cohort was found to be more than 12,000 individuals.

In contrast, among 124,747 screened non-Hispanic White participants, 334 melanomas were diagnosed by the research team, resulting in a much lower number needed to screen (373 total individuals).

The investigators reported that overall incidence and detection rates of melanoma were found to be somewhat low in the REM cohort, even among those who underwent skin cancer screening. The study's strengths included its large population size and comprehensive data obtained from medical records.

That being said, the research team noted that certain limitations should be acknowledged, including the limited follow-up period, nonrandomized study design, generally smaller proportion of REM individuals, and a study population that may not fully represent the sociodemographic diversity of other types of geographic areas.

Additionally, the investigators had focused exclusively on those with primary care clinicians, which they acknowledge may not be fully representative of all patient populations.

“The low absolute number of melanomas but their more aggressive nature, particularly in Black individuals (one nodular and one acral lentiginous subtype), suggests that approaches other than routine skin cancer screening may be more useful in addressing screening disparities, including physician and public education…timely access to high-quality care, and improved diagnostic tools for non–UV-induced melanomas (eg, acral lentiginous lesions),” they wrote.

References

  1. Smith B, Matsumoto M, Wang H, Baskin ML, Kirkwood JM, Ferris LK. Melanoma Detection in Alaska Native, American Indian, Asian, Black, Hispanic, and Pacific Islander Patients in a Large Skin Cancer Screening Initiative. JAMA Dermatol. Published online July 26, 2023. doi:10.1001/jamadermatol.2023.2067.
  2. Brunsgaard E, Jensen J, Grossman D. Melanoma in Skin of Color: Part II. Racial disparities, role of UV, and interventions for earlier detection. J Am Acad Dermatol. 2022;S0190-9622(22)00784-8. doi:10.1016/j.jaad.2022.04.057.
  3. Matsumoto M, Wack S, Weinstock MA, et al. Five-year outcomes of a melanoma screening initiative in a large health care system. JAMA Dermatol. 2022;158(5):504-512. doi:10.1001/jamadermatol.2022.0253.
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