Access to dermatologic care in Indigenous American communities

Melanoma Incidence Rates Among Non-Hispanic American Indian/Alaska Native Individuals, 1999-2019

“…Access to specialty care services, including dermatology, may also be limited among American Indian/Alaska Native people who rely on the IHS system for health care . Health care for American Indian/Alaska Native people has been historically underfunded, and access to dermatology services may be limited due to priority for referrals that need immediate attention . In 1 study, American Indian/Alaska Native people were more likely to be treated in the emergency department for dermatologic conditions, indicating access to appropriate dermatologic care may be a substantial barrier .…”

“…28,30,31 Health care for American Indian/Alaska Native people has been historically underfunded, and access to dermatology services may be limited due to priority for referrals that need immediate attention. 27,28,31 In 1 study, American Indian/ Alaska Native people were more likely to be treated in the emergency department for dermatologic conditions, indicating access to appropriate dermatologic care may be a substantial barrier. 32 Additionally, fewer American Indian/Alaska Native people report receiving a skin examination.…”

Retrospective Cohort Analysis of Sex Differences in American Indians and Alaska Natives With Invasive Melanoma From the National Cancer Database

“…3 The median age at diagnosis is older for men than women (61 vs 55 years) in the general population of primarily “fairer skinned” individuals, 4 and American Indian and Alaska Native men were also diagnosed later than women (57 vs 52 years), but American Indian and Alaska Native patients of both sexes were diagnosed 4 to 5 years earlier than the general population. This could be due to earlier onset of melanoma or more aggressive tumor behavior in American Indian and Alaska Natives compared with the general population, rather than earlier detection, which is less likely given limited access to dermatologic care among American Indian and Alaska Native patients, 2 and later stages at diagnosis in American Indian and Alaska Native than “fairer skinned” patients. 3 The primary site distribution by sex in American Indian and Alaska Natives corroborates previous research in predominantly “fairer skinned” patients, with the most common location on the lower extremities for women and the trunk for men.…”

“…However, studies have shown that long-term exposure to UV radiation from indoor artificial light sources can lead to cumulative skin damage. 1,2 The inclusion of UVB in grow lights is especially concerning. UVB is estimated to cause more than 90% of all cutaneous squamous cell carcinomas and can cause measurable DNA damaging events in doses as low as 4 to 50 mJ/cm 2 .…”

“…The Indian Health Services provides care to 2.56 million of the approximately 5.2 million members of federally recognized American Indian and Alaska Native tribes in the United States. 1 Only 1% of American Indian and Alaska Native homelands have the recommended number of dermatologists to adequately care for the population, 2 limiting access to skin cancer screening and surveillance which can perpetuate health disparities in American Indian and Alaska Native individuals. Compared with “White” individuals (as defined by the National Cancer Database [NCDB] and other United States–based cancer registries including the Surveillance, Epidemiology, and End Results [SEER] registry, hereafter referred to as “fairer skinned”), American Indian and Alaska Native individuals with melanoma are more likely to present with later stages and they have worse melanoma-specific survival.…”