Rates of non-melanoma skin cancers (NMSCs) are on the rise among Hispanics and Asians in the US. Interestingly, while most cases of NMSCs in whites occurred in men, among Hispanic and Asian subjects, women had higher rates of skin cancers. Hispanics had significantly more skin cancers occurring in the “central face.”1
A review of population-based cancer incidence data from the National Program of Cancer Registries and the Surveillance, Epidemiology and End Results (SEER) Program shows that melanoma incidence rates have decreased slightly among Hispanic men and women, but the data nonetheless offer cause for concern:
• Although Hispanic males overall had higher rates of melanoma than females, women younger than 55 had higher rates of melanoma than males.
• Melanomas with poorer outcomes, such as nodular (NM) and acral lentiginous melanoma (ALM), were more common among males.
• Incidence rates for later-stage diagnosis and thicker tumors were significantly higher among Hispanic men than among women.2
Other analyses have found that nonwhites are more likely to have advanced and thicker melanomas at diagnosis and lower melanoma-specific survival compared with whites.3 The incidence rate of acral lentiginous melanoma was significantly higher among Hispanics than among whites, and higher than this diagnosis for any other ethnic group.
A delay in diagnosis among non-white patients is leading to increased mortality for these individuals. In one study, approximately 7.3 percent of Hispanic patients with melanoma died as a result of their skin tumors, versus 4.8 percent of non-Hispanic patients. Researchers cited later stage at diagnosis as the primary explanation for the difference in death from melanoma between Hispanic and non-Hispanic Whites.4
Multiple factors, including potential disparities in access to healthcare, may account for delayed diagnosis of skin cancers among Hispanic patients.5 However, research shows that, among Hispanic individuals, attitudes toward sun protection and self-examination are potentially putting patients at risk —thus an area where community education and intervention by the dermatology community may be able to make a big impact.
A survey of outdoor workers found that sixty-nine percent never or rarely wore sunscreen while working outdoors. Those more likely to wear sunscreen were females, had a higher level of education, and resided at a higher latitude.6
Hispanics performed self-skin exams at a lower rate than non-Hispanics.7 In one study, fewer than 10 percent of Hispanics in the US reported ever having a physician skin exam (PSE). Individuals born outside of the US and those who did not speak mostly or only English had lower rates of PSEs. Interestingly, individuals of Mexican or Dominican descent were less likely to have undergone PSEs, while those of Cuban or Puerto Rican descent were more likely to have undergone PSEs.8
Just roughly 10 to 30 percent of Hispanics report wearing sunscreen either most of the time or always. Non-Hispanic whites report sunscreen rates of 16.5-35.9 percent. Roughly 25 percent of Hispanics reported wearing hats (A rate slightly higher than for whites).9
There appears to be a belief among many Hispanic individuals that a darker skin tone protects from melanoma and NMSC. While darker pigmentation provides protection relative to more lightly pigmented skin, that protection is nominal. Non-white patients can and do develop skin cancers, and dermatologists must educate them about this reality.
It is imperative that we as skin care physicians take the opportunity to instruct all patients on sun protection strategies and appropriate use of sunscreens. Encourage patients to undergo annual skin self-exams and instruct them how to conduct skin self exams.
Joel L. Cohen, MD is Director, AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, CO, and is Chief Editor of DermTube.com and ModernAesthetics.tv.
1. Loh TY, Ortiz A, Goldenberg A, Brian Jiang SI. Prevalence and Clinical Characteristics of Nonmelanoma Skin Cancers Among Hispanic and Asian Patients Compared With White Patients in the United States: A 5-Year, Single-Institution Retrospective Review. Dermatol Surg. 2016 May;42(5):639-45.
2. Garnett E, Townsend J, Steele B, Watson M. Characteristics, rates, and trends of melanoma incidence among Hispanics in the USA. Cancer Causes Control. 2016 May;27(5):647-59.
3. Wu XC, Eide MJ, King J, Saraiya M, Huang Y, Wiggins C, Barnholtz-Sloan JS, Martin N, Cokkinides V, Miller J, Patel P, Ekwueme DU, Kim J. Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006. J Am Acad Dermatol. 2011 Nov;65(5 Suppl 1):S26-37.
4. Merrill RM, Pace ND, Elison AN. Cutaneous malignant melanoma among white Hispanics and non-Hispanics in the United States. Ethn Dis. 2010 Autumn;20(4):353-8.
5. Rouhani P, Arheart KL, Kirsner RS. Differences in melanoma outcomes among Hispanic Medicare enrollees. J Am Acad Dermatol. 2010 May;62(5):768-76.
6. Day AK, Stapleton JL, Natale-Pereira AM, Goydos JS, Coups EJ. Occupational sunscreen use among US Hispanic outdoor workers. BMC Res Notes. 2015 Oct 17;8:578.
7. Amber KT, Bloom R, Abyaneh MY, Falto-Aizpurua LA, Viera M, Zaiac MN, Nouri K, Hu S. Patient Factors and Their Association with Nonmelanoma Skin Cancer Morbidity and the Performance of Self-skin Exams: A Cross-Sectional Study. J Clin Aesthet Dermatol. 2016 Sep;9(9):16-22.
8. Coups EJ, Stapleton JL, Hudson SV, Medina-Forrester A, Goydos JS, Natale-Pereira A. Skin cancer screening among Hispanic adults in the United States: results from the 2010 National Health Interview Survey. Arch Dermatol. 2012 Jul;148(7):861-3.
9. Weiss J, Kirsner RS, Hu S. Trends in primary skin cancer prevention among US Hispanics: a systematic review. J Drugs Dermatol. 2012 May;11(5):580-6.