The Skin Cancer Foundation Journal

MAY 2014

The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.

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Lifestyle 44 common skin cancer in Hispanics, 3 and melanomas the third. Evidence suggests that the trunk and legs are the most likely sites in fair-skinned Hispanics, and the feet the most common location in dark-skinned Hispanics. 4 The latter are prone to a rare, virulent form of melanoma called acral lentiginous melanoma, found most often on the palms of the hands, soles of the feet, and under the skin of toenails. Light and medium- skinned Latinos, on the other hand, are more likely to have the more common superfcial spreading melanoma. 5 Cultural Complexities in Learning Sun Safety O nly if Hispanics come to understand that they are at risk will they fully embrace their need for sun protection. A recent survey showed they are giving short shrift to sun safety: • More than 43 percent reported that they never or rarely use sunscreen. • Only 24 percent said they wear sun-protective clothing. • Nearly 40 percent said they sunbathe, and one in three said they sunburned in the past year. 1 Oddly, rather than gaining knowledge about the need for sun protection, more assimilated Hispanics in the US appear to be embracing this culture's tanning obsession. The study, appearing in JAMA Dermatology, compared sun protection behaviors among Hispanics in the Southern and Western US who used English as their primary language (and thus were more assimilated), and those who spoke only Span- ish; assimilated Hispanics engaged in more risky sun be- haviors. English-speaking Hispanics were less likely to seek shade and wear sun-protective clothing and more likely to report sunbathing and indoor tanning, according to the study. 1 "The English-acculturated Hispanics are more likely to be exposed to prevailing beliefs and behaviors in the US that sometimes promote sunbathing and the tanning expe- rience," said the study's lead author Elliot Coups, PhD, of the Rutgers Cancer Institute of New Jersey at Rutgers, The State University of New Jersey. The study also indicated that messaging to the Hispanic community needs to be tailored to varied language and cul- tural backgrounds. Some Hispanics respond to "family-based" messaging as opposed to individualized messaging, noted Coups. Fotonovelas, photo-based com- ics used throughout Latin American to spread public health messages, may espe- cially appeal to some US Hispanics, and in general, skin cancer materials should include images of Hispanics. "Otherwise, they may think 'this may not apply to me because I don't see anyone like me,'" said Coups. Coups' team is starting a project to study the sun-protective habits of His- panic day laborers in New Brunswick, NJ, with the goal of developing an educational curriculum for this population. Earlier Detection: a Matter of Life or Death E ven fewer Hispanics are doing or seeking skin exams than are protecting their skin from the sun. A recent study in North Carolina found that more than three-quarters of His- panic patients are not performing skin self-exams and only nine percent receive a regular skin exam from their doctors. 5 "We found that patients felt they didn't have enough time with physicians to ask about preventive care such as skin exams," said Aida Lugo-Somolinos, MD, professor of derma- tology at the University of North Carolina at Chapel Hill. "We also learned that physicians were not taking the oppor- tunity to raise the subject with their patients." One thing that would help physicians in reaching out to Hispanics would be ofering materials in Spanish, asserts Maritza I. Perez, MD, Director of Cosmetic Dermatology at St. Luke's Roosevelt Medical Center and Associate Di- rector of Procedural Dermatology at Beth Israel Medical Center in New York City. "There is a lack of informa- tion," notes Dr. Perez. "If they need to hear it in Spanish, we need to have materials in their language." But frst, she says, health care practitioners working in heavily populated Hispanic communities need to be better educated them- selves about Hispanics' risk of skin cancer and their need for skin exams. To date, the knowledge gap is leading to later detec- tion. A recent study of melanoma cases in Dade County, FL, found that late-stage melanoma diagnoses were more common in Hispanic (26 percent) and black (52 percent) patients than in non-Hispanic white patients (16 percent). 6 The racial disparity suggests that Hispanics (and blacks) are not engaging in secondary prevention measures such as skin exams, and that they lack sufcient access to health care. Hispanics, Heal Thyselves! A s skin cancer rates rise among Hispanics, it's imperative for them to understand they are at risk even if they have dark complexions, notes Dr. Lugo-Somolinos. That will make them more likely to practice sun protection. "Hispanics have to take responsibil- ity for their own skin health," adds Dr. Perez, Associate Clinical Professor of Der- matology at Mount Sinai Icahn School of Medicine."They need to examine their whole skin monthly, see a dermatologist once or twice a year, use sun protection for anti-aging and anti-cancer purposes, and educate their children to do the same." For Spanish-language information on skin cancer prevention and early detection, visit the Skin Cancer Foundation's newest website, CancerdePiel.org. References available on p.96 S K I N C A N C E R F O U N D A T I O N J O U R N A L

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