JAMA Dermatology

<jats:sec id="ab-doi250048-4"><jats:title>Importance</jats:title><jats:p>While mortality from melanoma has decreased in non-Hispanic White individuals over the last decade due to new and effective therapies, disparities in survival remain for Latino populations. Latino patients have lower overall incidence of melanoma than non-Hispanic White patients but are more likely to be diagnosed with thicker, more advanced tumors, leading to higher mortality.</jats:p></jats:sec><jats:sec id="ab-doi250048-5"><jats:title>Objective</jats:title><jats:p>To identify the facilitators and barriers Latino patients face prior to melanoma diagnosis and treatment and to inform strategies that expedite care and improve survival rates in this population.</jats:p></jats:sec><jats:sec id="ab-doi250048-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This qualitative study used reflexive thematic analysis of interviews with Latino patients with melanoma of any stage at diagnosis conducted in Los Angeles County, California, between May and November 2023. Patients were identified from the California Cancer Registry, part of the Surveillance, Epidemiology, and End Results Program.</jats:p></jats:sec><jats:sec id="ab-doi250048-7"><jats:title>Main Outcomes and Measures</jats:title><jats:p>A semistructured interview guide designed to explore multiple themes related to potential barriers and facilitators to timely diagnosis of melanoma among Latino patients.</jats:p></jats:sec><jats:sec id="ab-doi250048-8"><jats:title>Results</jats:title><jats:p>Of 20 included Latino patients with melanoma, 13 (65%) were female, and the median (range) age was 56.5 (41-79) years. Half of the interviews were conducted in Spanish, and 15 participants (75%) were diagnosed at an early stage (in situ or regional). A total of 6 themes were identified: 2 facilitators, including patients as advocates for their health care and linguistically appropriate care, and 4 barriers, including barriers to timely care due to health insurance procedures, delays in accessing specialty referral, low awareness of melanoma prior to diagnosis, and a lack of linguistically appropriate care.</jats:p></jats:sec><jats:sec id="ab-doi250048-9"><jats:title>Conclusions and Relevance</jats:title><jats:p>This qualitative study identified multifaceted challenges faced by Latino patients as they seek both diagnosis and treatment of melanoma. Findings suggest several recommendations to accelerate time to diagnosis and prompt initiation of treatment to reduce disparities experienced by this patient population.</jats:p></jats:sec>

New systematic therapies and trends in cutaneous melanoma deaths among US Whites, 1986-2016.

Am J Public Health

The ongoing racial disparities in melanoma: an analysis of the Surveillance, Epidemiology, and End Results database (1975-2016).

J Am Acad Dermatol

Racial differences in the prognosis and survival of cutaneous melanoma from 1990 to 2020 in North America: a systematic review and meta-analysis.

J Cutan Med Surg

Diagnosis and treatment of melanoma: European consensus-based interdisciplinary guideline.

Eur J Cancer

Determination of the impact of melanoma surgical timing on survival using the National Cancer Database.

Overcoming obstacles to skin cancer examinations and prevention counseling for high-risk patients: results of a national survey of primary care physicians.

J Am Board Fam Pract

Psychosocial mediators of a nurse intervention to increase skin self-examination in patients at high risk for melanoma.

Cancer Epidemiol Biomarkers Prev

Examining the pathways linking lower socioeconomic status and advanced melanoma.

Cancer

Racial disparities in melanoma survival.

The role of spatially-derived access-to-care characteristics in melanoma prevention and control in Los Angeles county.

Health Place

Association of delays in surgery for melanoma with insurance type.

JAMA Dermatol

Disparities in time-to-treatment for patients with melanoma.

Anticancer Res

Barriers and facilitators to skin cancer prevention among Hispanics: a qualitative study.

BMC Public Health

Melanoma awareness and prevention among Latinx and non-Latinx White adults in urban and rural California: a qualitative exploration.

Cancer Med

Skin cancer in Hispanics in the United States.

J Drugs Dermatol

Ethnic differences among patients with cutaneous melanoma.

Arch Intern Med

Skin cancer in skin of color: an update on current facts, trends, and misconceptions.

Skin cancer screening among Hispanic adults in the United States: results from the 2010 National Health Interview Survey.

Arch Dermatol

Skin cancer risk perceptions: a comparison across ethnicity, age, education, gender, and income.

Racial differences in skin cancer awareness and surveillance practices at a public hospital dermatology clinic.

Melanoma knowledge, perception, and awareness in ethnic minorities in Chicago: recommendations regarding education.

Psychooncology

Skin cancer awareness in suburban employees: a Hispanic perspective.

Linguistic acculturation and skin cancer-related behaviors among Hispanics in the southern and western United States.

Sun protection beliefs among Hispanics in the US.

J Skin Cancer

Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

Int J Qual Health Care

Using thematic analysis in psychology.

Qual Res Psychol

Why does patient activation matter? an examination of the relationships between patient activation and health-related outcomes.

J Gen Intern Med

Raising low ‘patient activation’ rates among Hispanic immigrants may equal expanded coverage in reducing access disparities.

Health Aff (Millwood)

Incorporating the cultural value of respeto into a framework of Latino parenting.

Cultur Divers Ethnic Minor Psychol

Physician language ability and cultural competence. an exploratory study of communication with Spanish-speaking patients.

A systematic review of the impact of patient-physician non-English language concordance on quality of care and outcomes.

A pilot program in collaboration with community centers to increase awareness and participation in skin cancer screening among Latinos in Chicago.

J Cancer Educ

California Medicaid enrollment and melanoma stage at diagnosis: a population-based study.

Am J Prev Med

A qualitative exploration of Latinos’ perceptions about skin cancer: the role of gender and linguistic acculturation.

Behavioral counseling to prevent skin cancer: US Preventive Services Task Force Recommendation Statement.

JAMA

Age-appropriate cancer screenings through a dermatology len.

Quantitative associations between health insurance and stage of melanoma at diagnosis among nonelderly adults in the United States.

Changes in insurance coverage and stage at diagnosis among nonelderly patients with cancer after the Affordable Care Act.

J Clin Oncol

Association of health insurance with outcomes in adults ages 18 to 64 years with melanoma in the United States.

Disparities in access for melanoma screening by region, specialty, and insurance: a cross-sectional audit study.

JAAD Int

While mortality from melanoma has decreased in non-Hispanic White individuals over the last decade due to new and effective therapies, disparities in survival remain for Latino populations. Latino patients have lower overall incidence of melanoma than non-Hispanic White patients but are more likely to be diagnosed with thicker, more advanced tumors, leading to higher mortality.
To identify the facilitators and barriers Latino patients face prior to melanoma diagnosis and treatment and to inform strategies that expedite care and improve survival rates in this population.
This qualitative study used reflexive thematic analysis of interviews with Latino patients with melanoma of any stage at diagnosis conducted in Los Angeles County, California, between May and November 2023. Patients were identified from the California Cancer Registry, part of the Surveillance, Epidemiology, and End Results Program.
A semistructured interview guide designed to explore multiple themes related to potential barriers and facilitators to timely diagnosis of melanoma among Latino patients.
Of 20 included Latino patients with melanoma, 13 (65%) were female, and the median (range) age was 56.5 (41-79) years. Half of the interviews were conducted in Spanish, and 15 participants (75%) were diagnosed at an early stage (in situ or regional). A total of 6 themes were identified: 2 facilitators, including patients as advocates for their health care and linguistically appropriate care, and 4 barriers, including barriers to timely care due to health insurance procedures, delays in accessing specialty referral, low awareness of melanoma prior to diagnosis, and a lack of linguistically appropriate care.
This qualitative study identified multifaceted challenges faced by Latino patients as they seek both diagnosis and treatment of melanoma. Findings suggest several recommendations to accelerate time to diagnosis and prompt initiation of treatment to reduce disparities experienced by this patient population.

Facilitators and Barriers to the Timely Diagnosis and Treatment of Melanoma in Latino Persons.

Facilitators and Barriers to the Timely Diagnosis and Treatment of Melanoma in Latino Persons

Facilitators and Barriers to the Timely Diagnosis and Treatment of Melanoma in Latino Persons

Clinical Summary

What was studied

Key findings

Clinical implications

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