As experts in the diagnosis and management of skin
cancer, dermatologists know the two greatest tools
in the fight against cutaneous malignancy are prevention
and early detection. Melanomas and non-melanoma
skin cancers (NMSC) diagnosed at an early stage are
more easily treated and associated with reduced morbidity
and mortality compared to those detected at a later stage.
Yet data continue to show, as described by Dr. Hu in this
edition, that many patients may not be adopting preventive
strategies and are not undergoing regular skin exams.
The medical community overall and dermatologists
specifically have recognized that as the Baby Boomer generation
ages, the incidence of diseases like skin cancer will
increase. In the 14-year period from 1992 to 2006, the number
of procedures performed to treat NMSCs among
Medicare patients rose by 76 percent (Arch Dermatol;
146:283-287). Treatment of melanomas also increased.
The dermatology community may not be prepared, however,
to address the rising tide of skin cancers in other populations,
notably ethnic minorities. In the US over the past
15 years annual rates of melanoma diagnoses among
Hispanic individuals have increased at almost the same rate
as in non-Hispanic whites: 2.9 percent versus 3.0 percent. In
some areas, the rates of melanomas among Hispanics are
increasing even more quickly (p. 5).
Some argue that the perceived increase in skin cancer
rates is due to improved diagnosis or more thorough
reporting, not necessarily a true increase in the occurrence
of skin cancers. Some even implicate a “diagnostic drift,”
where benign lesions are now being classified as malignant
by overzealous clinicians (Br J Dermatol;161(3):630-4). In the
case of America's ethnic minority populations, which historically
have experienced disparities in healthcare provision,
observers may charge that the increase in skin cancer diagnoses
reflects increased access to care for these patients.
Increased access to care for historically underserved populations
is welcome and critical to effectively diagnosing,
treating, and preventing skin cancers. Alone, it does not
account for the alarming increase in skin cancer incidence
in ethnic minorities. Issues such as length-time and leadtime
bias may play a role, too (see p. 13). But increased
incidence of skin cancer in America's Black and Hispanic
patients is a reality. So, too, are lingering disparities in care.
These disparities present a challenge to the healthcare system
that dermatologists must actively work to address.