Increased skin cancer screenings may not reduce disparities in the survival rates of patients with melanoma who have darker skin tones, according to a recent study published by Smith et al in JAMA Dermatology.
Background
Although melanoma—the leading cause of skin cancer mortality—is most common among White patients, the survival outcomes of melanoma are often poorer among patients with darker skin tones. Although individuals often think of melanoma as a type of cancer caused by sun exposure, certain types of melanoma can arise on the palms of the hand, soles of the feet, and places that are always covered by clothes—and they tend to be more common in patients with darker skin tones.
“In this study, we asked whether screenings could address this disparity by helping detect melanoma early,” explained senior study author Laura Ferris, MD, PhD, Professor of Dermatology at the University of Pittsburgh School of Medicine and Director of the Clinical Trials Unit at UPMC. “Our findings suggest that regular skin checks are not the answer, but that doesn’t mean that we should be offering less care or that our work is done. We need to investigate other approaches to improve outcomes for melanoma in patients with [darker] skin [tones],” she added.
Study Methods and Results
In this study, the investigators analyzed data on 60,680 patients who self-identified as Hispanic, Alaska Native, American Indian, Asian, Black, or Pacific Islander. Among the study participants, 21% (n = 12,738) underwent skin cancer screenings, and 79% (n = 47,942) did not.
After a follow-up of 5 years, the investigators found that eight patients developed melanoma—only one of which was detected during a screening visit. The additional four and three instances of melanoma were identified by health-care professionals during other types of visits and by the patients or their family members, respectively.
To detect one melanoma case among racial and ethnic minority patients, the investigators noted that more than 12,000 screenings would need to be performed. For comparison, the number of screenings needed to screen White patients would be 373. “This is an almost unfathomable number of [screening] visits to find one melanoma,” Dr. Ferris emphasized.
Conclusions
The investigators revealed that beyond early detection, better treatments for melanoma may also help address disparities in survival rates. Most of the current therapies for the disease were tested in nondiverse, mostly White populations; therefore, it’s important that future clinical trials include diverse participants.
“Rather than screening everyone, educating physicians about [the] presentation of melanoma in [patients with darker] skin [tones], educating the public about their risk of melanoma, and making sure that [individuals] have access to a dermatologist when they have a suspicious lesion could be more effective [at] improving early detection,” Dr. Ferris underscored. “[Ultraviolet radiation] exposure is the biggest modifiable risk factor for melanoma, so sun protection is incredibly important, but it’s not the only factor. If [individuals] have a suspicious lesion somewhere that is always covered by a shirt, it could still be melanoma. We encourage patients to seek care regardless of their perceived risk,” she concluded.
Disclosure: The research in this study was supported by the University of Pittsburgh Melanoma and Skin Cancer Program. For full disclosures of the study authors, visit jamanetwork.com.
