Education Can Help Address Racial Disparities in Skin Cancer Diagnosis, Treatment, Says Dr Sancy Leachman

Addressing racial disparities in skin cancer involves education, understanding rates of risk and ethnicity, and knowledge of the different types of melanoma, which makes skin cancer disparities complex to attack, said Sancy Leachman, MD, PhD, professor and chair in the Department of Dermatology and director of the Melanoma Research Program at the Knight Cancer Institute at Oregon Health and Science University.

Transcript

There are known racial disparities in skin cancer regarding diagnosis, treatment, and prognosis. What is being done or should be done going forward to address these disparities?

The answer to that question: you'll get as many answers to that as people you ask. The reason for that is because the answer is not completely clear what the right path is to effect that change. We know that the majority of melanomas—by a longshot—most of the melanomas that people get in the country are in the White/Caucasian population. Unfortunately, though, in people with skin of color, the melanomas that happen are more deadly. They're not outnumbering the number of deaths that happen in the White/Caucasian population, but it really illustrates lack of access to care, potentially; hesitancy in not wanting to get care because of a lack of trust, potentially; a lack of knowledge.

I've given you that spectrum; it's not only a lack of knowledge in the lay person, but a lot of times the melanomas are different on people with skin of color. I think they aren't aware that you need to look at the palms of the hands and the soles of the feet and under the nail and the nail beds. Those are the places where you get acral lentiginous melanoma, and that's not an ultraviolet light–induced cancer, like melanomas on the cutaneous skin in most Caucasians are. Caucasians can also get acral lentiginous melanoma, but it's only a small subset of what they get, whereas people with skin of color have a much higher chance of getting the acral lentiginous form.

In some ways, it's almost 2 different kinds of melanoma that you can think about. The key is that you're educating the right person about the right problem. At the end of the day, I believe that the greatest good that we can do in terms of overcoming the problem is to educate everyone about the differences between the types of melanoma, and where you look in people of skin of color, and that you don't overlook it. Just because it's rare, doesn't mean it's something that you shouldn't be on the lookout for.

But it doesn't mean that you should overdiagnose it either. Because if you start looking everywhere on the skin in a person who has low risk for that kind of melanoma, then what's going to happen is you're going to have a lot of extra biopsies that may lead to an overdiagnosis problem, and then that can feed back into the problem of lack of trust, if you're taking things off of people that really weren't a melanoma and didn't need to be taken off.

It's a mixed bag of education and rates of risk and ethnicity and race and skin color. It's a mixed bag that makes it very complex to attack. But I think education is the best chance we've got to do it quickly and effectively.