Abstract IA18: The unnecessary epidemic: Skin cancer in Hispanics and what we need to do about it
Authors: Cockburn Myles , Unger Jennifer , Miller Kimberly 
Published: September 2020

Abstract
Melanoma is a highly complex disease with multifaceted etiology, whose incidence is on the rise, over and above the impact of screening. Hispanics represent an underserved and understudied population when it comes to melanoma occurrence and outcome. Hispanics are diagnosed with melanoma at later stages than their non-Hispanic white (NHW) counterparts, leading to increased likelihood of metastasis and worse survival. Hispanics are the largest ethnic group in the United States and have rising rates of melanoma, and in particular, increases in tumors with the worst prognosis. While histologic type of melanoma varies by ethnicity (Hispanics tend to get more acral lentiginous melanomas, which tend to present at a later stage), histology does not explain the poorer experience of Hispanics: they are diagnosed with later-stage disease regardless of histology. In our recent analysis, while the risk of presenting with a late-stage melanoma was higher for Hispanics (OR:1.65 [95% CI:1.52-1.79]) than NHW, the overall risk of death from melanoma after accounting for stage at diagnosis was similar for Hispanics and NHW (HR: 0.99 [95% CI: 0.94-1.04]), implying that the overall poorer prognosis for Hispanics is due almost entirely to their later stage of disease at diagnosis, rather than response to treatment or other factors (e.g., ability to access treatment) once they are diagnosed. However, the key question remaining to be answered is why Hispanics are diagnosed at a later stage: without answering that question, we cannot begin to design, test, and implement effective interventions to reduce the melanoma burden in Hispanics. A later stage of diagnosis among Hispanics (compared to NHWs) could be due to a multitude of factors, all of which are modifiable: a lack of access to appropriate screening, lack of adherence to screening recommendations, lack of understanding of appropriate screening approaches in the primary care setting (among both patients and physicians), or a combination of these factors. Addressing the epidemic of melanoma among Hispanics is not limited to investigation of factors resulting in delayed diagnosis: we also lack an understanding of the primary drivers of Hispanics’ lower overall incidence of melanoma (roughly 7 times lower than non-Hispanic whites). Melanoma risk factors either have similar frequency in Hispanics and NHWs (e.g., many large nevi) or are less frequent in Hispanics but do not explain a high proportion of disease variation (e.g., red hair). Considering current knowledge of risk factor prevalence, melanoma incidence rates should actually be similar in Hispanics and non-Hispanic whites. Understanding the factors leading to the lower overall rate of melanoma in Hispanics could help inform prevention strategies for non-Hispanic whites—or determine new genetic pathways as yet undiscovered. While it is possible that Hispanics’ rates of melanoma are lower because they practice better sun-exposure behaviors, we have recently shown that Hispanic children, while frequently engaging in some sun-protective behaviors, also had a high rate of sunburn (59%). U.S.-acculturated Hispanic children reported less shade-seeking at school (P = .001). The surprisingly high rate of sunburn in Hispanic children suggests that the way in which they are practicing sun protection is not preventing sunburns and is an alarming early warning sign for future increases in melanoma rates among Hispanics. Sun safety interventions should be targeted toward Hispanic youth to provide them with practical methods of effective sun protection, in addition to education on the risks of high sun exposure. The contrast in melanoma experience between Hispanics and NHW implies that we already know how to reduce the occurrence of late-stage melanoma in Hispanics, and a better understanding of the differing rates of melanoma among Hispanics and NHW might actually provide insight into enhanced melanoma primary prevention in both groups.
Citation Format: Myles Cockburn, Jennifer Unger, Kimberly Miller. The unnecessary epidemic: Skin cancer in Hispanics and what we need to do about it [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA18.