Cutaneous Melanoma and Other Skin Cancer Screening Among Hispanics in the United States: A Review of the Evidence, Disparities, and Need for Expanding the Intervention and Research Agendas

Abstract

S kin pigmentation and sun sensitivity vary widely among US Hispanics, 1 whose median number of nevi (the strongest melanoma risk factor) is somewhat lower than in whites yet higher than in Asians or blacks. 2 The correlation between number of nevi and age is stronger in Hispanics and non-Hispanic whites than in other ethnoracial groups. 2 Among Hispanics, acculturation to the United States might lead to decreased sun safety practices. 3 Nationwide data from 1992 through 2007 reveal that melanoma incidence among Hispanics increased by more than 22%. 4,5 Hispanics display higher rates of thick melanoma at diagnosis, and in the absence of cure, targeted prevention might be the best strategy for countering the epidemic. 6 Hence, our objective was to synthesize the evidence about skin cancer screening among US Hispanics. Methods. We identified observational populationbased US studies on melanoma or other skin cancer screening that evaluated participants of Hispanic descent, without any age, time, or language restrictions. Hispanic or Latino ethnicity was defined as Mexican, Puerto Rican, Cuban, or Central or South American heritage regardless of race. 7 Screening techniques included skin self-examination (SSE), clinical skin examination (CSE), dermoscopy, and biopsy. We conducted an extensive literature search through October 2010 using MEDLINE (from 1950), EMBASE (from 1974), CancerLit (from 1963), and Lilacs (from 1982) and reviewed the bibliographies of all relevant articles. The following keywords and indexing terms were used: melanoma, skin neoplasms, self-examination, early detection of cancer, and mass screening. From the 1029 retrieved articles, we excluded duplicates, reviews, non-US studies, and those with patient or survivor samples, selecting 138 articles for detailed review. Studies with missing ethnoracial data were excluded. Nine studies met all inclusion criteria, and from each we extracted the age range, population type, health care access status, setting, number and/or percentage of Hispanics with reported melanoma or other skin cancer screening, year of assessment and measurement method.

Epidemiology of Anorectal Melanoma in the United States

“…23 Other studies have indicated that Hispanics are under-screened for skin cancer compared to other ethnic groups despite the increasing incidence of melanoma in this population. 24,25 To our knowledge, our study is the first that has analyzed the incidence of anorectal melanoma in Hispanic whites and non-Hispanic whites. Although this may suggest a role for improved screening among those with Hispanic ethnicity, additional studies must be done to corroborate these results and further elucidate the association of Hispanic ethnicity with anorectal melanoma.…”

Total body skin examination for skin cancer screening among U.S. adults from 2000 to 2010

“…Enhancing primary prevention strategies, such as targeted education, may be important during this period of uncertainty on screening guidelines (Andreeva and Cockburn, 2011). …”

Characteristics, rates, and trends of melanoma incidence among Hispanics in the USA

“…Sun protection can reduce the risk of skin cancer [2]. However, use of sun protection is low among Hispanics, and Hispanics have less knowledge of skin cancer risk factors and lower perceived risk of getting skin cancer compared to NHWs [21,22,13,23]. …”