Review Exposes Disparities in Skin Cancer Care for Vulnerable Populations

Recent findings from the Huntsman Cancer Institute at the University of Utah, published in the Surgical Clinics of North America, reveal significant disparities in skin cancer care affecting older adults, rural inhabitants, and individuals with limited access to regular medical services. This comprehensive review emphasizes the challenges these demographics face regarding early diagnosis and treatment for severe forms of skin cancer, such as melanoma, Merkel cell carcinoma (MCC), and advanced squamous and basal cell cancers.

The study highlights that while early detection can lead to successful treatment outcomes, not all patients receive the same opportunities for timely diagnosis or access to innovative therapies. Among the key observations:

• Older Adults: This group has the highest mortality rates from aggressive skin cancers yet is less likely to receive standard treatment options. Factors contributing to this trend include other health complications, difficulties in attending appointments, and a lack of awareness regarding skin changes.
• Rural Residents: Individuals residing in rural areas often endure lengthy travel distances to consult with dermatologists or cancer specialists. Furthermore, they may have limited access to educational resources on skin cancer prevention and treatment.
• Delayed Diagnoses: Many patients are diagnosed only when their cancer has progressed to an advanced stage. This is often attributed to a lack of knowledge about skin cancer symptoms, absence of regular medical providers, or cancer locations that are not easily visible, such as the soles of the feet.

According to Dr. Elliot Asare, a surgical oncologist at the Huntsman Cancer Institute and the study's lead author, understanding the demographic groups most affected by these disparities is crucial for improving health outcomes. The review underscores that the impact of high-risk skin cancers is not uniform across the population.

Age plays a critical role in skin cancer incidence, with the majority of melanoma cases diagnosed in individuals over 55 years old, while only about 11% occur in those under 45. The United States sees approximately 3,000 cases of MCC annually, primarily in individuals over 65. Although Medicare becomes available at age 65, many elderly patients encounter barriers such as poor health or transportation difficulties, which hinder their access to adequate treatment options.

Location is another significant factor affecting skin cancer care. Residents in remote areas often lack nearby specialists and are less inclined to utilize preventive measures like sunscreen. Research indicates that these populations are more prone to using tanning beds and are frequently diagnosed at more advanced stages of cancer, resulting in worse treatment outcomes.

The review proposes several strategies to enhance skin cancer care accessibility:

• Expanding telehealth services to reach more patients
• Facilitating patient eligibility for clinical trials
• Increasing public awareness about skin cancer risks and signs
• Encouraging individuals to monitor suspicious skin lesions on themselves and their family members
• Training healthcare providers to recognize skin cancer across various skin types

While advancements are being made, there is a call for innovative approaches to address the needs of populations at the greatest risk of being overlooked. The Huntsman Cancer Institute is actively working to broaden access to care through telehealth initiatives, outreach programs, and educational resources, particularly in rural and underserved regions. Additionally, the institute is enhancing screening and treatment availability with the establishment of a new Comprehensive Cancer Center in Vineyard, Utah County.

Dr. Asare emphasizes that cancer care must be tailored to individual patient needs, advocating for a system that ensures equitable access to early diagnoses and high-quality care for all.