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MEDICAL YEAR
IN REVIEW

crease of 92%. 4,5,6 The cause of this notable disparity is multifactorial. References
One reason for increased mortality in SOC patients is late detection of 1. Higgins S, Nazemi A, Chow M, Wysong A. Review of Nonmelanoma Skin
skin cancers. As discussed previously, symptoms are not easily visible, as Cancer in African Americans, Hispanics, and Asians. Dermatologic Surg.
they present differently in people of color. In addition, SOC patients may 2019;44(7):903-910. doi: 10.1097/DSS.0000000000001547.
2. Higgins S, Nazemi A, Feinstein S, Chow M, Wysong A. Clinical Presenta-
not fully understand their risk for skin cancer as there is a false belief that
tions of Melanoma in African Americans, Hispanics, and Asians. Dermatol
7
darker skin is protected from UV rays. While increased melanin and
Surg. 2019 Jun;45(6):791-801. doi: 10.1097/DSS.0000000000001759.
dispersed melanosomes absorb and deflect UV rays more efficiently, it is PMID: 30614836.
8
still possible for people of color to develop skin cancer. Another reason 3. Cancer Facts and Figures 202. American Cancer Society. https://www.can-
for increased mortality is attributed to lack of access to medical care. cer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/an-
SOC patients have the least percentage of medical coverage, thus decreas- nual-cancer-facts-and-figures/2021/cancer-facts-and-figures-2021.pdf.
Accessed October 30, 2021.
ing access to required care and accounting for poorer prognosis. Other
4. Merrill SJ, Subramanian M, Godar DE. Worldwide cutaneous malignant
factors to consider are the lack of resources available in the past decades
melanoma incidences analyzed by sex, age, and skin type over time (1955-
of medical training, which provide insight on evaluating skin cancer le- 2007): Is HPV infection of androgenic hair follicular melanocytes a risk
sions in SOC individuals. This poses diagnostic challenges, including factor for developing melanoma exclusively in people of European-ancestry?
identifying specific characteristics like variation of color in lesions. Dermatoendocrinol. 2016 Jul;8(1):e1215391. doi: 10.1080/19381980.
9
There has been increasing recognition of the need for more repre- 2016.1215391. PMID: 27588159
5. Wu XC, Eide MJ, King J, Saraiya M, Huang Y, Wiggins C, Barnholtz-Sloan
sentation of people of color in the field of dermatology. A study found
JS, Martin N, Cokkinides V, Miller J, Patel P, Ekwueme DU, Kim J. Racial
that African American and Hispanic patients are less likely to receive
and ethnic variations in incidence and survival of cutaneous melanoma in
outpatient dermatological treatments compared to Caucasians. Po- the United States, 1999-2006. J Am Acad Dermatol. 2011 Nov;65(5 Suppl
10
tential resources that can help minimize this health disparity and im- 1):S26-37. doi: 10.1016/j.jaad.2011.05.034. PMID: 22018064.
prove visibility include dermatology free-clinics. In San Antonio, two 6. Gohara MA. Skin cancer in skins of color. J Drugs Dermatol. 2008
free dermatology clinics that exist are Travis Park Dermatology Clinic May;7(5):441-5. PMID: 18505135.
7. Jacobsen AA, Galvan A, Lachapelle CC, Wohl CB, Kirsner RS, Strasswim-
and Haven For Hope. Both clinics are student and faculty-led clinics
mer J. Defining the Need for Skin Cancer Prevention Education in Unin-
supported by the University of Texas at San Antonio Health Science
sured, Minority, and Immigrant Communities. JAMA Dermatol. 2016
Center, which provide free dermatologic care to people of all back- Dec;152(12):1342-1347. doi: 10.1001/jamadermatol.2016.3156. PMID:
grounds — including those who are homeless and uninsured. Many 27626892.
people within these communities are people of color. According to a 8. Cummins DL, Cummins JM, Pantle H, Silverman MA, Leonard AL,
2019 Racial Indicator Equity Report in San Antonio, 22.5% of African Chanmugam A. Cutaneous malignant melanoma. Mayo Clin Proc. 2006
Apr;81(4):500-7. doi: 10.4065/81.4.500. PMID: 16610570.
Americans and 21.3% of Hispanics live in poverty compared to 11.2%
9. Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M,
of the Caucasian population. As a result, free clinics can help not only
11
Roberts WE, Draelos ZD, Bhushan R, Taylor SC, Lim HW. Skin cancer
provide quality skin care to these marginalized communities but also and photoprotection in people of color: a review and recommendations for
educate patients about how to properly take care of their skin to min- physicians and the public. J Am Acad Dermatol. 2014 Apr;70(4):748-762.
imize the occurrence of preventable skin diseases. Additionally, from doi: 10.1016/j.jaad.2013.11.038. PMID: 24485530.
the provider’s perspective, treating melanated skin further improves ed- 10.Tripathi R, Knusel KD, Ezaldein HH, Scott JF, Bordeaux JS. Association
of Demographic and Socioeconomic Characteristics With Differences in
ucation for medical students and residents by exposing them to the
Use of Outpatient Dermatology Services in the United States. JAMA Der-
morphologic differences of common skin conditions that are often mis-
matol. 2018;154(11):1286–1291. doi:10.1001/jamadermatol.2018.3114
diagnosed in people of color. 11.City of San Antonio Office of Equity. 2019 Racial Equity Indicator Report.
SOC dermatology has become more prevalent in recent years, changing A Report by City of San Antonio Office of Equity, San Antonio, TX.
the landscape of how providers practice medicine and address disparities. 2019;16.
While there are many unique cutaneous conditions which affect people
of color, skin cancer remains an important topic due to its vast prevalence Marie Vu, Alexandra Mont-
and malignant potential. The increased morbidity and mortality associ- gomery and Tue “Felix” Nguyen are
ated with skin cancer in SOC individuals can be attributed to many fac- medical students at UT Health San
tors. Public awareness of skin cancer education and prevention, combined Antonio who are interested in dermatology. They all serve as officers for
with increased accessibility to care and comprehensive medical training the medical school’s Dermatology Interest Group.
for providers, may be the key to a timely diagnosis and treatment.

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