Dermatologists Must Actively Address Disparities in Skin Cancer Diagnosis

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.