Qualitative exploration of melanoma awareness in black people in the USA

Abstract

ObjectiveAlthough black patients are more likely to have advanced melanomas at diagnosis, with a 5-year survival rate among black patients of 70% compared with 92% for white patients, black people are generally not the focus of melanoma public health campaigns. We sought to explore awareness and perspectives of melanoma among black people to inform the development of relevant and valued public health messages to promote early detection of melanoma.DesignInductive thematic analysis of in-depth semistructured interviews.SettingInterviews were conducted with participants via video software or telephone in the USA.ParticipantsParticipants were adults from the USA who self-identified as African American or black. Recruitment flyers were posted around the San Francisco Bay Area and shared on our team Facebook page, with further participants identified through snowball sampling.ResultsWe interviewed 26 participants from 10 different states. Overall, 12 were men and 14 were women, with a mean age of 43 years (range 18–85). We identified five key themes regarding melanoma awareness in black people: (1) lack of understanding of term ‘melanoma’ and features of skin cancer; (2) do not feel at risk of melanoma skin cancer; (3) surprise that melanoma can occur on palms, soles and nails; (4) skin cancer awareness messages do not apply to or include black people; and (5) Importance of relationship with healthcare and habits of utilisation.ConclusionsAnalysis of these in-depth semistructured interviews illuminate the pressing need for health information on melanoma designed specifically for black people. We highlight two key points for focused public health messaging: (1) melanoma skin cancer does occur in black people and (2) high-risk sites for melanoma in black people include the palms, soles and nail beds. Therefore, public health messages for black people and their healthcare providers may involve productively checking these body surface areas.

The New Media Landscape and Its Effects on Skin Cancer Diagnostics, Prognostics, and Prevention: Scoping Review

“…Similarly, a review demonstrated that 100% of skin cancers depicted on SM advertisements had a background of Fitzpatrick type I or II skin [ 54 ]. SM representation is critical, as a study that interviewed 27 African American individuals found SM to be a primary means by which people with darker pigmentation are exposed to public health messages related to skin cancer [ 55 ]. Participants also stated it would be important for skin cancer awareness messages on SM to feature Black communities to feel that the information is relevant to them [ 55 ].…”

Insufficient Evidence for Screening Reinforces Need for Primary Prevention of Skin Cancer

“…The reason for this disparity is multifactorial. Contributing factors include a higher proportion of acral lentiginous melanoma, which is more aggressive than other types of melanoma; lack of patient education regarding melanoma; lack of clinician awareness; and disparities in access to medical care …”

“…In general, public health campaigns do not effectively incorporate messages for Black individuals. As a result, awareness of the possibility of developing melanoma may be very low . Along with important and widely disseminated UV-focused skin cancer prevention messages aimed at fair-skinned individuals, messages should be specifically tailored to reflect the nuance and specifics of the presentation of melanoma in Black individuals.…”

“…The specific content should focus on early detection of melanoma: (1) emphasize the specific body locations that melanoma most commonly presents in Black individuals, including the palms, soles, and nails; (2) describe how melanoma typically presents (eg, a new brown streak under a nail that is not from an accident or bruise, or a changing or growing dark spot on the palm or sole that persists); (3) explain the need for patients to consult with their primary care clinician if a concerning lesion is noticed; and (4) include visual representation of diverse skin types to increase the salience of the message. Skin cancer prevention messages tailored for Black individuals should not (1) emphasize protective measures that are likely not protective in this population, such as use of sunscreen or sun protective clothing, or (2) generate fear or overestimate the effects of skin cancer on this community …”

“…In contrast, the most common subtype of melanoma in Black individuals is acral lentiginous melanoma, which occurs on the palms, soles, and nail units—areas that are not typically exposed to the sun. The fact that melanoma develops in sun-protected areas in Black individuals and other racial and ethnic minority groups suggests that UV radiation is not a substantial risk factor for these cancers . Yet, on the American Academy of Dermatology Association’s website, in a video titled Skin of Color: How to Prevent and Detect Skin Cancer, sunscreen is emphasized as a key protective strategy .…”