Racial disparities in CTCL
Examining incidence rates of cutaneous T-cell lymphoma by race or ethnicity and socioeconomics (1,300 words, 6 minutes)
The results of a study on the occurrence of cutaneous T-cell lymphoma (CTCL) in New Jersey show racial discrepancies and a significant socioeconomic gradient. People living in census tracts with higher incomes have a higher risk of CTCL compared to those living in areas with lower incomes. The study also analyzed the findings by race/ethnicity and socioeconomic factors.
The findings were published in the International Journal of Environmental Research and Public Health.
“Differences in the incidence rates [of CTCL] by sex, age, and race have been previously reported,” the authors write. “Men have higher rates than women, and CTCL incidence is slightly higher in Black people compared to all other race groups.”
This study aimed to investigate the occurrence of CTCL in New Jersey by analyzing the location of diagnosis and identifying any possible clusters. It also aimed to determine any differences in CTCL risk based on the census tract's race, ethnicity, and socioeconomic status. This was a cross-sectional study.
Among the findings:
CTCL incidence varied across New Jersey, but there were no statistically significant geographic clusters
After adjustment for age, sex, and race/ethnicity, the relative risk of CTCL was significantly higher in the highest-income quartile than in the lowest
Interactions between race/ethnicity and socioeconomic status showed that relationships between income and relative risk were evident in all racial or ethnic groups
Compared to non-Hispanic White individuals in low-income tracts, CTCL risk was higher among non-Hispanic White individuals in high-income tracts and among non-Hispanic Black individuals in tracts of all income levels
“The exact causes of CTCL remain largely unknown. Our findings suggest a strong socioeconomic gradient and racial disparities with the increasing risk being associated with higher socioeconomic status and the highest CTCL rates in affluent Non-Hispanic Black people,” the researchers say in their conclusion. “However, we did not detect any statistically significant geographic clustering of CTCL incidence in New Jersey. Future studies should examine the geographic variations of CTCL in other states and include information about individual-level socioeconomic status and health insurance.”
Bottom line: Black individuals, as are individuals with higher socioeconomic status, appear to be at a higher risk of this rare skin cancer. However, it isn’t yet known why this discrepancy exists.
From the literature on skin cancer in skin of colour
Challenges documenting racial disparities in Merkel cell carcinoma
This paper discusses current barriers to accurately identifying racial or cultural differences in Merkel cell carcinoma (MCC). The authors of this paper note that MCC is rare in general and predominantly impacts White patients. However, the overall incidence and the proportion of minority patients with MCC are both rising.
The researchers write that racial disparities in stage at presentation and patient survival are well-documented in more common forms of skin cancer. However, it is not known what disparities in MCC might exist. The study of MCC disparities is hampered by limitations in data registries, including the U.S. SEER (Surveillance, Epidemiology, and End Results) and NCDB (National Cancer Database) registries. As well they note the advent of immunotherapy for MCC has resulted in an evolving natural history of the disease in the population. While published MCC immunotherapy clinical trials have consistently reported the racial diversity of their participants, they have not included patients' ethnicities, the authors write.
Qualitative assessment of uptake retention and evaluation of prevention materials for skin cancer among Hispanics
Researchers examined the retention and evaluation of genetic risk information materials in a skin cancer prevention intervention conducted on Hispanics living near Tampa, Fla. and Ponce, Puerto Rico.
Among all the participants in the intervention, 489 provided two open-ended responses to a follow-up survey.
From the responses, researchers identified five major thematic categories: 1) intervention comments; 2) tips and tricks; 3) cancer prevention; 4) general information; and 5) risk factors and genetics.
Most of the responses were comments on the intervention (e.g., information was clear, easy to understand) and tips and tricks for sun protection (e.g., using sunscreen, wearing protective clothing).
The participants noted the importance of conducting skin exams professionally or at home.
English-preferring Tampa residents stated their individual risk factors, especially race and ethnicity, more frequently than Ponce residents and Spanish-preferring Tampa residents. Ponce residents were more likely to comment on wanting to share intervention materials with family and friends.
Skin cancer and hydrochlorothiazide: Novel population-based analyses considering personal risk factors including race/ethnicity
The authors of this paper note that the antihypertensive medication hydrochlorothiazide has photosensitive properties, potentially increasing skin cancer risk. They investigated this possibility among hydrochlorothiazide users in three cohorts, building the cohorts from data in the IBM MarketScan Research Databases. These were commercial and encounters, a subcohort of health risk assessment respondents, and Medicaid. Researchers compared the risk for hydrochlorothiazide versus ACE inhibitors.
They found the baseline characteristics were similar between participants, aside from there being more Black individuals among hydrochlorothiazide users (43.3% [95% CI, 43.0%-43.6%]) than ACE inhibitor users (28.1% [95% CI, 27.9%-28.3%]).
The hazard ratio (95% CI) for nonmelanoma skin cancer related to hydrochlorothiazide (versus ACE inhibitor) was 0.96 (0.91-1.00) in the commercial cohort, 1.01 (0.77-1.32) for the health risk assessment subcohort, and 1.33 (0.77-2.29) for Medicaid. For melanoma, the respective hazard ratios were 1.07 (0.95-1.20), 0.85 (0.43-1.67), and 0.93 (0.51-1.67).
They concluded their evaluation, including adjusting for race and ethnicity, did not establish a clear difference between hydrochlorothiazide and ACE inhibitor regarding skin cancer risk.
Merkel cell carcinoma: A review of clinical management with focus on Asian patients
This review was conducted to present updates on the knowledge and current trends of clinical management of Merkel cell carcinoma (MCC), focusing on Asian reports. The authors write they focused on this population because most skin cancers differ substantially between Caucasians and Asians, and researchers have reported differences in MCC in racial and ethnic groups.
The authors write that the development of a Japanese nationwide survey or cancer registry, the identification of Merkel cell polyomavirus, and the use of immune checkpoint inhibitors allowed a better understanding of its characteristics and biology and revolutionized the clinical management of patients with MCC.
They note MCC incidence has gradually increased worldwide but varies by geographic location, race and ethnicity.
Some knowledge gaps the authors identify include:
A lack of randomized prospective studies to evaluate the significance of sentinel lymph node biopsy, complete lymph node dissection and adjuvant radiation therapy in MCC
While patients with distant MCC are administered immune checkpoint inhibitors as the first-line therapy, there is no established second-line therapy for refractory disease
The favourable results of clinical studies performed in Western countries need to be validated in patients in Asia
VIDEO: Melanin & melanoma with Dr. Hope Mitchell, Perrysburg, Ohio. Part one of four
Dr. Mitchell discusses the impact of melanoma on the Black community in the U.S.
At the intersection of skin and society
The Pacific Northwest Canoe Journey has resumed after a three-year hiatus due to the pandemic. Indigenous canoe families from all along the Pacific coast are gathering in the host community—in 2023, the host is the Muckleshoot. The tribe expects a crowd of 8,000 to 10,000 people to gather to celebrate the event.
As reported by ICT News, for more than 30 years, tribal canoe families have met each summer for the event. One hundred twenty canoe families from tribes across British Columbia, Oregon, and Washington began the journey last week, landing at Alki Beach in Seattle on July 30.
After landing, a week of potlatch protocol will occur at the Muckleshoot Community Center. Potlatch will begin July 31 and continue 24 hours a day until Aug. 6.
Next two weeks
August is Psoriasis Awareness Month / Action Month
Aug. 1 is National Minority Donor Awareness Day in the U.S.
Aug. 9 is International Day of the World’s Indigenous Peoples
Something to think about in the week ahead…
Conrad Hall, U.S. artist, 1926 to 2003
Next week
Aug. 7 is Civic Holiday here at our headquarters in Toronto. Skin Spectrum Weekly will return on Aug. 14 with research into the representation of educational videos about dermatology in Black skin on the popular video site TikTok.
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper print providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Dr. Geeta Yadav (Toronto) discusses the management of post-inflammatory dyspigmentation in patients with psoriasis and how effective management can improve patient quality of life.
Drs. Michael Corbo (Richmond Hill, Ont.), Parbeer Grewal (Edmonton), Ron Vender (Hamilton) and Jensen Yeung (Toronto) share their thoughts in a round-up update on current and upcoming treatments for psoriasis.
An essay from Dr. Chaocheng (Harry) Liu (Vancouver) submitted to the 2022 Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE) short essay contest. Dr. Liu gave his perspective as a resident on dermatology education on skin of colour in Canada.
Plus regular features, including the popular column “Vender on Psoriasis” by Hamilton, Ont. dermatologist Dr. Ron Vender
Read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary* subscription or to receive a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates new findings concerning dermatologic issues that affect women and the female dermatologists who care for them. Read the current issue here.
Season two of the Shear Listening Pleasure podcast with Dr. Neil Shear has launched. Listen to the eighth episode here, where Dr. Shear speaks with dermatologist Dr. Sonja Molin (Kingston, Ont.) about allergology, patch testing, and the growth of Queen’s University’s dermatology division.
And if you’re looking for a web destination for all things derm, please visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.