Skin Cancer Diagnosis Disparities: Preventable yet Prevalent

Authored By: Maia Phillips

Art By: Chloe Lee

According to the American Cancer Society, melanoma is a skin cancer that is highly preventable, so why do almost 105,000 people get diagnosed with melanoma and over 8,000 die per year [1]? The field of melanoma has made major strides since 2000, going from a largely incurable disease to having many treatment options [2]. Despite these improvements, there are still prevalent socioeconomic and racial disparities.

A major tool of melanoma prevention is screening. The Prevent Cancer Foundation did a survey of seven thousand Americans and found that seven out of ten adults are behind on their cancer screening [3]. Whether insurance covers skin checks depends on the plan, and many individuals do not have access to coverage at all [4]. 

Some racial and ethnic groups are disproportionately impacted by both melanoma and nonmelanoma skin cancers, despite the disease being highly preventable [5]. Not only is their rate of diagnosis higher, but their prognoses are worse–minority groups have on average later stage diagnoses and higher mortality rates due to melanoma [6]. These inequities stem from insurance and access to quality medical care [5]. Additionally, socioeconomic factors impact disparities, as well as language barriers and education level [6].

Addressing these structural barriers is complex, but scientists have made efforts to promote equal access to routine skin checks. One of the main arguments promoting equal access to skin checks is that these preventative techniques ultimately cost the patient and the healthcare system less than treating melanoma [7]. While there are observational studies determining that skin cancer screenings lower the rate of mortality, there has yet to be a randomized control trial of this issue, preventing policy change and awareness [8].

Many of these problems stem from deeply rooted structural issues, making it difficult to make policy change. However, there are tangible ways to close the disparities in skin cancer incidence and severity. Beyond the fact that preventative skin cancer screening should be more widely available, it is important that the general public has an understanding of the prevention and warning signs of melanoma [9] Beyond being exposed to the sun, having a family history of melanoma can increase risk, making preventative skin cancer screening even more important for those populations [10]. Understanding family history of melanoma is therefore an important tool in determining a course of action to best prevent the disease. Having a weakened immune system can also contribute to melanoma development [2]. Additionally, the melanoma warning signs are simple and effective by using the ABCDE method (Asymmetry, Border, Color, Diameter, Evolving) [11]. 

All in all, improving access to preventative skin cancer screenings is complex due to the lack of scientific research. Next steps in the field should involve generating more concrete research of skin cancer screenings. In the meantime though, improving education for the general public on skin cancer prevention and warning signs, while targeting groups with limited access to education and medical care, is an easier tool that could improve prognoses and close the skin cancer incidence and mortality gaps.

Works Cited

1. American Cancer Society. (2023, January 12). Melanoma Skin Cancer Statistics. Www.cancer.org. https://www.cancer.org/cancer/types/melanoma-skin-cancer/about/key-statistics.html

2. KUSHNIR, I., & MERIMSKY, O. (2012). The evolution in melanoma treatment as a reflection of precision-oriented medicine. Oncology Letters, 5(2), 424–426. https://doi.org/10.3892/ol.2012.1065

3. Staff, W. (2024, May 9). More than half of Americans are behind on skin cancer screenings. Here’s why you should get checked. WTOP News. https://wtop.com/health-fitness/2024/05/more-than-half-of-americans-are-behind-on-skin-cancer-screenings-heres-why-you-should-get-checked/

4. Skin Cancer Foundation. (2023, June). Ask the Expert: How Can I Get a Skin Cancer Screening if My Insurance Won’t Cover It? The Skin Cancer Foundation. https://www.skincancer.org/blog/how-can-i-get-a-skin-cancer-screening-if-my-insurance-wont-cover-it/

5. Shao, K., & Feng, H. (2022). Racial and Ethnic Healthcare Disparities in Skin Cancer in the United States: A Review of Existing Inequities, Contributing Factors, and Potential Solutions. The Journal of Clinical and Aesthetic Dermatology, 15(7), 16. https://pmc.ncbi.nlm.nih.gov/articles/PMC9345197/

6. Harvey, V. M., Patel, H., Sandhu, S., Wallington, S. F., & Hinds, G. (2014). Social Determinants of Racial and Ethnic Disparities in Cutaneous Melanoma Outcomes. Cancer Control, 21(4), 343–349. https://doi.org/10.1177/107327481402100411

7. Levy, D. (2024, December 29). Preventing Skin Cancer with Routine Skin and Mole Checks- Dermatology of Seattle & Bellevue. Dermatology of Seattle & Bellevue - Your Skin & Surgery Center. https://dermatologyseattle.com/preventing-skin-cancer-with-routine-skin-and-mole-checks-a-guide/

8. Johnson, M. M., Leachman, S. A., Aspinwall, L. G., Cranmer, L. D., Curiel-Lewandrowski, C., Sondak, V. K., Stemwedel, C. E., Swetter, S. M., Vetto, J., Bowles, T., Dellavalle, R. P., Geskin, L. J., Grossman, D., Grossmann, K. F., Hawkes, J. E., Jeter, J. M., Kim, C. C., Kirkwood, J. M., Mangold, A. R., & Meyskens, F. (2017). Skin cancer screening: recommendations for data-driven screening guidelines and a review of the US Preventive Services Task Force controversy. Melanoma Management, 4(1), 13–37. https://doi.org/10.2217/mmt-2016-0022

9. Terzian, T., Box, N., Nicklawsky, A., Nern, K., & Torchia, E. C. (2024). Awareness of skin cancer screening coverage in U.S. healthcare plans: Is there a need to better educate the public? Preventive Medicine Reports, 46, 102862. https://doi.org/10.1016/j.pmedr.2024.102862

10. NHS Choices. (2023, March 6). Causes - Skin cancer (melanoma). NHS. https://www.nhs.uk/conditions/melanoma-skin-cancer/causes/

11. Salamon, M. (2023, August). Screening advice that’s not just skin deep - Harvard Health. Harvard Health. http://health.harvard.edu/cancer/screening-advice-thats-not-just-skin-deep