Hispanic Tattoo Artists Could Provide Skin Cancer Prevention via Aftercare Instructions and Social Media

December 2019 | Volume 18 | Issue 12 | Original Article | 1237 | Copyright © December 2019

Cristian D. Gonzalez MD,a Adrian Pona MD,a Barbara J. Walkosz PhD,b
Robert P. Dellavalle MD PhD MSPHa,c

aDepartment of Dermatology, University of Colorado School of Medicine, Aurora, CO
bKlein Buendel, Inc, Golden, CO
cUS Department of Veterans Affairs Rocky Mountain Regional VA Medical Center Dermatology Service, Aurora, CO

Abstract
BACKGROUND: The incidence of melanoma and non-melanoma skin cancer in the Hispanic population has increased. Hispanics are more likely to present with advance-staged melanoma and worse overall prognosis. Thus, public health campaigns are necessary to target the underrepresented Hispanic population.

OBJECTIVE: To explore Hispanic tattoo artists’ skin cancer knowledge, sun safety recommendations, and their willingness to implement primary and secondary skin cancer prevention in their daily work routines.

METHODS: We conducted an in-depth semi-structured interview study with ten Hispanic tattoo artists. Interviews were conducted at multiple tattoo studios in Salt Lake City, Utah.Data was coded by a third-party. Thematic analysis identified recurrent sub-themes from the transcript.

RESULTS: Majority of Hispanic tattoo artists had a high percentage of Hispanic clientele (mean: 51%, range: 25-93%) and repeat customers (mean: 73%, range: 50-90%). All tattoo artists had suboptimal skin cancer knowledge. Most Hispanic tattoo artists provide inadequate sun protective information in their aftercare instructions including a specific Sun Protection Factor, sunscreen reapplication, and protective clothing. However, all tattoo artists were willing to provide sun protective information on their social media profiles and undergo primary and secondary skin cancer prevention training.

CONCLUSION: Hispanic tattoo artists could serve as public health allies and influence early detection of skin cancers in the Hispanic population by implementing preventative skin cancer behaviors in their daily work routines and providing comprehensive sun safety information through aftercare instructions and social media.

J Drugs Dermatol. 2019;18(12):1237-1243.

INTRODUCTION

The incidence of melanoma and nonmelanoma skin cancers (NMSC) have grown exponentially. Although the incidence of melanoma affects 22.8 patients per 100,000 in the United States (U.S.), the incidence of melanoma in the Hispanic population in the U.S. is 4.4 patients per 100,000.1-4 Furthermore, since Hispanics do not represent the majority of the U.S. population, per population basis, the incidence of melanoma in Hispanics is further underrepresented.5 To prevent the increasing melanoma and NMSC incidence, public health campaigns were introduced to prevent melanomas and NMSCs, increase melanoma and NMSC awareness, and detect early stages of melanoma and NMSC.6 Although melanoma and NMSC public health campaigns were introduced irrespective to a specific ethnicity, cultural and language barriers exist, and melanoma and NMSC public health campaigns targeting Hispanics in the U.S. are limited. Furthermore, the ability of healthcare providers to convey high quality skin cancer information in a culturally sensitive approach to the Hispanic community is scarce.7 Increased melanoma and NMSC awareness has influenced medical professionals to implement skin cancer prevention into their clinical routine, although nonmedical professionals can also provide primary and secondary skin cancer prevention.8-10 In a survey study exploring a massage therapists role in skin cancer prevention, a majority of massage therapists have previously recognized suspicious lesions on their clients and referred them to a medical professional.8 Although some traditional nonmedical professionals, including hair dressers and massage therapists, offer skin cancer prevention, tattoo artists are also cognizant of skin cancer prevention; as they refrain from tattooing suspicious lesions and refer some of their clients to a healthcare provider.11 Tattoo artists could incorporate skin cancer prevention in their daily work routine by providing full-body, comprehensive sun protection advice to their clients, and refer suspicious moles to a healthcare professional.

The purpose of this study was to investigate Hispanic tattoo artist’s knowledge of skin cancer and their willingness to