Skin Cancer Risk Extends Beyond Fair Skin, With Persistent Early Detection Disparities: Vishal A. Patel, MD

With February marking National Cancer Prevention Month, The American Journal of Managed Care® (AJMC®) spoke with Vishal A. Patel, MD, associate professor of dermatology at the GW School of Medicine & Health Sciences and director of the cutaneous oncology program at the GW Cancer Center, about the importance of prevention and early detection in skin cancer. In part 1 of his conversation with AJMC, he discussed which populations are at the highest risk for skin cancer and where disparities in prevention and early detection persist.

While individuals with phenotypes such as fair skin, blue eyes, and blonde hair are more susceptible to UV radiation damage, Patel noted that people with darker skin are also at risk for skin cancer. However, these patients are more likely to be misdiagnosed or experience delayed diagnoses, often resulting in more advanced disease and poorer outcomes.

Vishal A. Patel, MD, explains that delayed skin cancer diagnoses contribute to more advanced disease and poorer outcomes in patients with darker skin. | Image Credit: GW Medical Faculty Associates

This transcript has been lightly edited for clarity.

AJMC: Why is skin cancer an important focus during Cancer Prevention Month?

Patel: Skin cancer is one of the most preventable and treatable malignant conditions. Early identification is key to good outcomes, so awareness of screening and treatment is key for both providers and patients.

For Cancer Prevention Month, skin cancer is the low-hanging fruit that we can tackle as a medical community.

AJMC: Who is at the highest risk for skin cancer?

Patel: Patients with lighter skin, fair skin, blue eyes, and blonde hair types of phenotypes tend to have more damage from UV radiation and are more likely to sunburn. As a result, they have DNA damage from sun exposure, prolonged sun exposure, and unprotected sun exposure. So, those are the patients who are more susceptible.

Also, patients who take chronic immunosuppressants or are solid organ transplant recipients, because their immune systems are suppressed on purpose to preserve their organ transplants, or because of other autoimmune conditions we're suppressing immune systems for and utilizing immunosuppressants. That puts them at a much higher risk, and they’re much more susceptible to DNA damage; it inhibits the surveillance of the immune system of the skin. So, those are the major groups who are most susceptible.

AJMC: Where do disparities in prevention and early detection still exist?

Patel: Skin cancer is different than other malignancies in that it really focuses on patients where socioeconomic discrepancies are not necessarily as high. What I mean by that is the vast majority of those who suffer from skin cancer have white skin or lighter skin, and, historically speaking, have access to care, whereas in high UV radiation areas, the South, and more rural areas with migrant workers, farmers, and people who can’t regularly access health care, skin cancer can progress and become a bigger problem for patients. These are sometimes the ones who have much more challenging cases to treat.

Also, a lot of people with darker skin, Black or brown skin, do not believe they are susceptible to skin cancer, and, oftentimes, may not get evaluations, may not be suspected to have cutaneous malignancies by either themselves or their physician, and so they can have a delay in care.

It's very common in melanoma in darker-skinned, Black skin patients, who are misdiagnosed or have a delay of diagnosis, and, as a result, have much more serious disease, advanced disease, and poor outcomes compared with their skin counterparts. So, it's a unique disease in that way.