Skin Cancer in Hispanics in the United States

March 2019 | Volume 18 | Issue 3 | Supplement Individual Articles | 117 | Copyright © March 2019

Maritza I. Perez MD

Mount Sinai Icahn School of Medicine, New York, NY

Ultraviolet radiation is the single most common cause of skin cancer including NMSC and malignant melanomas (MM).9 UVA and UVB cause DNA mutations -thymidine dimers - that are the footprint for most skin cancers.10 Chronic sun exposure is associate with NMSC and acute or seasonal sun exposure with MM in Caucasians and is undetermined in darker skin.11 Reported risk factors for MM in darker skin patients include albinism, radiation therapy, trauma, immunosuppression, and preexisting moles.11 Tanning bed users increase their melanoma risk by 15% as compared to non-users, while doubling their risk for SCC.12,13 Basal cell carcinoma (BCC) is the most common skin cancer in Caucasians, Hispanics, Chinese Asians, and Japanese, estimated at 3.5 million diagnosed annually.14 And, it is the second most common in African Americans and Asian Indians. The incidence is 1/100,000 in African Americans, 6 in Chinese, 15-17 in Japanese, 50-171 in Hispanics, and 185-340 in Caucasians. Thirty-six percent arise in an actinic keratosis.14,15 There is a significantly increased incidence in Hispanics in New Mexico.Squamous Cell Carcinoma (SCC) is the most common cutaneous malignancy in African Americans and Asian Indians. It is the second most common skin malignancy in Caucasians, Hispanics, Chinese Asians, and Japanese; and most nations around the world. The incidence is 17-360/100,000 in Caucasians, 14-33 in Hispanics, 3 in African Americans and Chinese Asians, and tends to be more aggressive in African Americans in non-sun exposed areas of chronic inflammation or scarring with a 20-40% risk of metastasis. Sixty-five percent will arise in an actinic keratosis.15 Malignant melanoma (MM)is the sixth most common cancer in U.S. and the most common skin cancer among 25-29 years old and second most common among 15-29 years old. Melanoma incidence rates in the U.S. are lower among Hispanics (4.5 per 100,000) than among NHWs (21.6 per 100,000), 0.5-1.5 for Asians and African Americans. However, early stage diagnosis is less among African Americans (48%) and Hispanics (74%) than among Caucasians (91%).15,16 The most common type in Hispanics and Caucasians is superficial spreading melanoma; acral lentiginous melanomas (ALM) is the most common for African Americans and Japanese.11-16 In the past two decades, melanomas incidence among Hispanics has risen by 20%. Hispanics are younger at diagnosis, present with thicker tumors (>1mm, 35% to 25%), regional involvement (12 to 8%), and distant metastasis (7 to 4%), having the worst survival rate as compared to whites.17-19 A cross-sectional and retrospective analysis of melanoma cases, with known stage and ethnicity reported from 1990-2004, was done to evaluate any disparity in melanoma incidence among different ethnicities. All cases were obtained from Florida cancer data system.18 There were 41,072 cases identified. The incidence of MM was found increased in white non-Hispanic women (3%) and men (3.6%), respectively, and white Hispanic women (3.4%).18 However, the most concerning finding was that regional and distant metastasis were documented in 12% of Caucasians as compared to 18% of Hispanics. Another study compared the incidence of MM in people of color in Florida with incidence of MM in the rest of the U.S. The incidence of MM was found to be 20% higher in Hispanic males as compared to their male counterparts in other regions of the U.S.19 In general, even though increasing, the incidence of NMSC and MM is lower in Hispanics than Caucasians, however, the mortality is higher. The later stage at diagnosis and worse prognosis in Hispanics have been attributed to several factors: 1.) Less awareness of risks or symptoms leading to a lack of linguistically or culturally targeted screening efforts.20 2.) Declines in sun?safe behaviors because of increasing acculturation.21, 22 3.) Less access to health insurance– more than 15% Hispanics in last census lack medical coverage causing delays in seeking treatment.23 Many of these factors may be associated with lower socioeconomic status (SES).24 A survey concerning weekly sun exposure and sun-protective behavior was conducted in a city clinic that services AA, Hispanics and Asians. A hundred patients were asked about sun exposure practices, evidence of sunburn, self-examination and awareness of skin cancer potential. Although 43% reported their ability to sunburn, less than 35% perceived some risk of developing skin cancer.20 A large subset of Hispanics in these group perceived that despite sun burning they were not at risk for skin cancer. Multivariate analysis of race and ethnicity and awareness of skin cancer potential had reveal that Hispanics rarely perform self-skin exams, rarely go to the doctor for skin exams, that despite knowing that skin cancer can happen in skin of color, they do not perceive that they are at risk and only half of the Hispanics surveyed apply sunblock regularly as compared to 96% of Caucasians.21 Three-hundred and sixty-nine high school students were surveyed in Florida, 148 white non-Hispanics and 221 white Hispanics, for behavior under the sun. These two populations with comparable skin phototypes and thus comparable risk of cutaneous malignancy, had totally different perceptions of skin cancer risk. Less than 40% of the Hispanics were aware of self-skin exams, were less aware of protective clothing, sunblock protection, were 2.5x more likely to have used tanning beds in the last year and were tanned. More than 43% of Hispanics never or rarely use sunscreens. Only a third of children with ethnic skin use sunscreen.20-22 Previous research by the U.S. Centers for Disease Control and Prevention has shown that Hispanics are twice as likely as non-Hispanic blacks and three times as likely as non-Hispanic whites to lack a regular health care provider.23 The Pew Hispanic Center/Robert Wood Johnson Foundation Latino Health