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Racial disparities in health care are troublesome. In dermatology, like other specialties, examining the impact of these discrepancies is imperative. That’s particularly true in the case of a serious condition such as skin cancer.
Several studies have been published in recent years on racial disparities in different facets of skin cancer. Observing these findings may yield significant benefits to patients who are ethnic minorities and help pave the way for a better standard of care. What can health care professionals learn about racial disparities in skin cancer care, particularly in its diagnosis, treatment, and prognosis?
Racial Disparities in Skin Cancer Diagnosis
The stage of skin cancer upon diagnosis plays a large role in survival, and some studies have suggested there is a difference in how likely the cancer is to have spread at diagnosis based on the patient’s race.
A 2021 study in Clinical, Cosmetic and Investigational Dermatology examined the racial disparities in patients with melanoma. The investigators concluded that time of diagnosis was among the reasons there were disparities in melanoma mortality.¹ The researchers studied data from patients with melanoma in Wayne County, Michigan from 2000 to 2016. Non-Hispanic white patients were diagnosed at an earlier stage than non-Hispanic Black patients: 34% of white patients were diagnosed before age 50 compared to 26% of Black patients, and 19% of white patients were diagnosed from age 60 to 69 compared to 26% of Black patients. In addition, Black patients were far less likely to receive a diagnosis at a localized stage of melanoma (55% compared to 86% of white patients). Instead, 25% of Black patients had “regional” melanoma and 20% had “distant” melanoma, compared to 10% and 4% of white patients, respectively.
Another 2021 study, this one in the International Journal of Women’s Dermatology, examined the skin cancer disparities in women of color and found that while skin cancers tended to be less prevalent in these communities, the cases often involved more advanced stages of cancer upon diagnosis.² Patients with cutaneous malignant melanoma often presented with a thicker melanoma, and the researchers found that African American women often had delayed diagnoses of squamous cell carcinoma, the most common skin cancer in that demographic.
Racial Disparities in Skin Cancer Treatment
In some cases, there are not only delays in diagnosis but in treatment as well. A 2020 study published in the Journal of the American Academy of Dermatology looked at the time from diagnosis to treatment for patients with melanoma, and found concerning disparities.³ The study examined 233,982 patients with melanoma, 1221 (0.52%) of which were Black. Compared to non-Hispanic white patients, Black patients had a longer mean time to definitive surgery (23.42 days to 11.72 days), chemotherapy (123.26 days to 100.41 days), and immunotherapy (129.79 days to 108.31 days).
These delays occurred despite Black patients in the study being more likely to have an advanced stage of melanoma than non-Hispanic white patients, and despite often living closer to a hospital. In addition, these disparities existed despite sociodemographic factors being controlled for and factors like melanoma stage and insurance type being stratified.
Racial Disparities in Skin Cancer Prognosis
These significant disparities in both diagnosis and treatment play a significant role in patient prognosis. In the aforementioned study from Clinical, Cosmetic and Investigational Dermatology, 30% of non-Hispanic Black patients died due to their melanoma, compared with 11% of non-Hispanic white patients.¹ Another 2020 study in the Journal of the American Academy of Dermatology found that not only are there still racial disparities in melanoma-specific survival, but the disparities may have actually worsened from 2000 to 2010 for Hispanic, non-Hispanic Black, and non-Hispanic Asian or Pacific Islander patients.⁴
These studies conclude with similar messaging about the importance of addressing these racial disparities. If these patients’ conditions are not taken seriously, and diagnoses and treatments continue to be delayed, prognosis and survival rates will continue to stagnate.
References
1. Brady J, Kashlan R, Ruterbusch J, Farshchian M, Moossavi M. Racial disparities in patients with melanoma: a multivariate survival analysis. Clin Cosmet Investig Dermatol. 2021;14:547-550. doi:10.2147/CCID.S311694
2. Davis DS, Robinson C, Callender VD. Skin cancer in women of color: epidemiology, pathogenesis and clinical manifestations. Int J Womens Dermatol. 2021;7(2):127-134. Published 2021 Feb 2. doi:10.1016/j.ijwd.2021.01.017
3. Tripathi R, Archibald LK, Mazmudar RS, et al. Racial differences in time to treatment for melanoma. J Am Acad Dermatol. 2020;83(3):854-859. doi:10.1016/j.jaad.2020.03.094
4. Qian Y, Johannet P, Sawyers A, Yu J, Osman I, Zhong J. The ongoing racial disparities in melanoma: an analysis of the Surveillance, Epidemiology, and End Results database (1975-2016). J Am Acad Dermatol. 2021;84(6):1585-1593. doi:10.1016/j.jaad.2020.08.097
