Differences in health care resource utilization and costs for keratinocyte carcinoma among racioethnic groups: A population-based study

Sierro, Tiffany; Blumenthal, Laura; Hekmatjah, Joshua; Chat, Vipawee S; Kassardjian, A.; Read, Charlotte; Armstrong, April W.

doi:10.1016/j.jaad.2021.07.005

Cited by 9 publications

(7 citation statements)

References 16 publications

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“…When comparing histology across racio‐ethnic groups, there was a higher prevalence of nodular histology in Hispanics compared to the NHW, though this did not meet statistical significance. While previous studies suggest that Hispanics may have less aggressive histological features of BCC, 10,19,36 this is contradicted by the fact that Hispanics with BCC have worse clinical outcome 10,11,31,36 . Additionally, we also found 58% of BCC in Hispanics were pigmented as opposed to less than 16% in NHW.…”

Section: Discussioncontrasting

confidence: 86%

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Clinicopathologic comparison of basal cell carcinoma among a diverse patient population in Los Angeles County

Choi,

Oberg,

Hijazi

et al. 2024

Skin Health and Disease

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IntroductionBasal cell carcinoma (BCC) is the most common malignancy in the United States. The majority of cases are identified in Non‐Hispanic Whites (NHW) and are far less demonstrated in patients of colour (POC). However, the Hispanic population represents a large and growing proportion of the US population, and skin cancer diagnoses in Hispanics are rising. Thus, the goal of this study is to examine clinicopathologic differences between BCC in Hispanics versus NHW.MethodsA retrospective chart review of Hispanic and NHW patients with BCC at Los Angeles County + USC Medical Center from January 2018 to March 2020 was performed. In total, 101 BCC samples from the first 100 patients identified of Hispanic ancestry, as well as 50 BCC samples identified from the first 50 patients identifying as NHW, were included for analysis. Patient characteristics (age, sex, medical history, and ethnicity), as well as tumour characteristics (location, subtype, tumour depth, and perineural invasion), were collected. We used between subjects t‐tests for continuous variables, and chi‐square tests for categorical variables.ResultsIn total, 151 specimens were collected amongst 122 subjects (79 Hispanics and 43 NHW patients). Among NHW, the majority of patients (74.4%) were men, but among the Hispanic population, the majority (68.4%) were female (p < 0.001). Prior history of other skin cancer was more common among NHW (67.4%) than Hispanics (31.6%) (p=<0.001). The Hispanic population had a significantly higher proportion of head and neck tumours (p = 0.0004) but a lower proportion of extremity tumours (p = 0.001) compared to NHW. Pigmented BCC was significantly more common among Hispanic patients (p < 0.01). Finally, within the Hispanic group, there was a significant association between sex and histology (p = 0.004), with Hispanic men demonstrating more aggressive mix histology compared to Hispanic women.DiscussionOur study supports the notion that BCC disparities occur among POC compared to NHW. This includes variations in epidemiologic factors such as sex and past medical history, primary tumour location, and pathologic characteristics. Further research should be conducted to identify additional differences in skin cancer presentation in POC to reduce the gaps in skin cancer knowledge and care.

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Section: Discussioncontrasting

confidence: 86%

“…The vast majority (90.1%) of BCC tumours among Hispanics were located at the head/neck, significantly higher than among NHW. This percentage is also higher than that reported by other studies 10,12,31 . Chronic ultraviolet (UV) exposure in head/neck regions make this anatomical location more vulnerable to BCC 32 .…”

Section: Discussionmentioning

confidence: 70%

Clinicopathologic comparison of basal cell carcinoma among a diverse patient population in Los Angeles County

Choi,

Oberg,

Hijazi

et al. 2024

Skin Health and Disease

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“…In the current dermatology workflow, there are disparities in skin cancer diagnosis and outcomes, with patients with skin of color getting diagnosed at later stages, leading to increased morbidity, mortality, and costs ( 17 , 18 ). To alleviate disparities rather than exacerbate them, dermatology datasets used for AI training and testing must include dark skin tones.…”

Section: Discussionmentioning

confidence: 99%

Disparities in dermatology AI performance on a diverse, curated clinical image set

et al. 2022

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An estimated 3 billion people lack access to dermatological care globally. Artificial intelligence (AI) may aid in triaging skin diseases and identifying malignancies. However, most AI models have not been assessed on images of diverse skin tones or uncommon diseases. Thus, we created the Diverse Dermatology Images (DDI) dataset—the first publicly available, expertly curated, and pathologically confirmed image dataset with diverse skin tones. We show that state-of-the-art dermatology AI models exhibit substantial limitations on the DDI dataset, particularly on dark skin tones and uncommon diseases. We find that dermatologists, who often label AI datasets, also perform worse on images of dark skin tones and uncommon diseases. Fine-tuning AI models on the DDI images closes the performance gap between light and dark skin tones. These findings identify important weaknesses and biases in dermatology AI that should be addressed for reliable application to diverse patients and diseases.

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“…The literature suggests minority patients experience delayed diagnosis and poorer outcomes compared to their Caucasian counterparts for a variety of dermatologic conditions, including melanoma. [55][56][57][58] A concerted effort must be put forth to avoid perpetuating these disparities in the development of AI software for utilization in teledermoscopic evaluation. 59 Recent studies have commented on the image collections used to train AI software, pointing out a distinct paucity in reference images containing darker skin tones.…”

Section: Future Directionsmentioning

confidence: 99%

Teledermoscopy – An Emerging Technology for Skin Cancer Detection

Delans

2023

THMT

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Dermatology faces a worsening scarcity of providers, especially since the onset of the COVID-19 pandemic. With lengthening waiting periods for skin cancer screening examinations, there is a distinct need for alternatives to in-person evaluation. Delayed diagnosis is associated with poorer outcomes, especially in melanoma. Teledermatology has the potential to prevent the increased morbidity and mortality associated with late-stage diagnosis, especially when utilized with dermoscopy. In the literature, this novel field of 'teledermoscopy' has exhibited accuracy and reliability comparable to face-to-face visits, and it is a promising alternative intervention for those who require triaging or for patients who are unable to access in-person care (rural, underserved populations). Although early data are promising, formal guidelines for acquisition and interpretation of dermatoscopic images must be established before wider implementation is possible. With standardization, use at home or in primary care offices might relieve some of the pressure on an overburdened dermatologic care system and help patients requiring urgent care to be seen more expediently.

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Differences in health care resource utilization and costs for keratinocyte carcinoma among racioethnic groups: A population-based study

Cited by 9 publications

References 16 publications

Clinicopathologic comparison of basal cell carcinoma among a diverse patient population in Los Angeles County

Clinicopathologic comparison of basal cell carcinoma among a diverse patient population in Los Angeles County

Disparities in dermatology AI performance on a diverse, curated clinical image set

Teledermoscopy – An Emerging Technology for Skin Cancer Detection

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