Rethinking prevention: Study shows cultural outreach cuts skin cancer disparities
Culturally tailored, in-person education raised skin cancer awareness and confidence in self-exams among underserved Spanish- and Punjabi-speaking communities (Issue #524, 1,700 words, 8 minutes)
Researchers have found that an in-person, linguistically tailored, community-based educational intervention significantly improved skin cancer awareness and self-examination confidence among underserved Spanish- and Punjabi-speaking populations in California.
The findings were published in the International Journal of Women’s Dermatology (2025 Dec 11; 11(4):e239).
“Skin cancer represents a persistent public health challenge, particularly in underserved communities where access to dermatology care and sun protection education is often limited,” the authors write. “Disparities are especially pronounced among patients of colour, who frequently present with worse skin cancer outcomes, including more advanced stages of melanoma at diagnosis and lower survival rates.”
The investigators note that public health campaigns and prevention strategies have historically centred on lighter-skinned populations. This bias has contributed to lower awareness of skin cancer risk among communities of colour.
They write that culturally- and linguistically-tailored interventions are essential for improving sun protection behaviours and skin self-examinations, particularly in Hispanic communities, where there is a recognized need for translated and culturally appropriate awareness campaigns.
To address this need, investigators implemented a three-part in-person intervention between April and August 2024 at University of California, Davis-affiliated student-run clinics.
As part of this intervention, participants completed pre- and post-intervention surveys assessing demographics, skin cancer knowledge, beliefs, and self-examination confidence. The intervention used American Academy of Dermatology materials, delivered in English, Spanish, and Punjabi, supported by trained bilingual medical and undergraduate student volunteers.
Thirty-two adults (56% Latine, 44% Asian; 81% women, 84% aged ≥40 years) participated.
Researchers observed significant improvements in skin cancer knowledge, including understanding of the ABCDE rule (6-90%, p<0.001), and self-examination confidence (19-63%, p<0.001). However, changes in beliefs, particularly regarding biopsies and skin cancer misconceptions, were limited. The authors identified several key structural barriers, including high costs, lack of insurance coverage, and limited referral access. These barriers disproportionately affected Latine participants.
The authors note their findings are limited in generalizability due to variability in educational delivery and a small, older sample population.
“Shifting deeper health beliefs may require more sustained and targeted interventions,” they conclude. “Future efforts should expand community-driven, language-concordant interventions and explore long-term impacts on behaviour and beliefs.”
Bottom line: There is potential for targeted educational interventions to shift patient awareness and attitudes related to skin cancer in underserved racialized populations. However, these interventions will need to be sustained, community-driven, and delivered in language accessible to those populations.
From the literature on skin cancer in skin of colour
Disparities in acral lentiginous melanoma: Factors beyond delayed diagnosis
Researchers conducted this study to better understand the epidemiology of acral lentiginous melanoma (ALM) in different racial groups and to establish whether outcome disparities are truly driven by delayed diagnosis.
The authors extracted cutaneous melanoma cases from the Surveillance, Epidemiology, and End Results Program database. They then compared disease severity at diagnosis and risk of melanoma-specific death, independent of clinicopathological and socioeconomic covariates, among racial groups in the four primary melanoma histological subtypes.
Findings showed no significant difference in disease severity at diagnosis between Black and White patients with ALM. Remarkably, ALM was the only major melanoma subtype in which Black patients faced a significantly higher risk of mortality (hazard ratio=2.04, 95% confidence interval: 1.31-3.11) when compared to White patients.
Two limitations to more comprehensively assessing disparities were limited data on ALM in non-Black and non-White patients, and a lack of non-U.S. data or relevant large genetic studies.
The authors say their findings counter previous assumptions that racial disparities in ALM are primarily attributed to delays in diagnosis and socioeconomic challenges. They suggest that more studies are needed to understand the disparity in ALM outcomes among Black patients.
Nicotinamide for skin cancer chemoprevention
Researchers evaluated the clinical efficacy of nicotinamide supplementation for skin cancer prevention in the general population and among solid organ transplant recipients.
To do this, they conducted a retrospective cohort study using electronic health record data from the U.S. Veterans Affairs Corporate Data Warehouse (October 1, 1999 to December 31, 2024) on 33,822 patients.
Patients who were exposed to nicotinamide were propensity score matched based on the number and year of skin cancers after which treatment with nicotinamide was initiated, age, sex, self-reported race, exposure to acitretin, exposure to field therapy, history of chronic lymphocytic leukemia, and history of solid organ transplant. The index date was the first prescription of nicotinamide filled within the VA system. Researchers used stratified Cox models to investigate the association of nicotinamide with skin cancer development.
Participants were exposed to nicotinamide 500 mg twice daily for longer than 30 days as documented in the electronic health record.
Within the data set, there were 12,287 patients (mean [SD] age, 77.2 [8.9] years exposed to oral nicotinamide, 500 mg, twice daily for longer than 30 days. That sample included 241 women [2.0%]; 31 [0.3%] American Indian or Alaska Natives, 3 [<0.1%] Asians, 13 [0.1%] Black or African Americans, 59 [0.5%] Native Hawaiian or other Pacific Islanders, and 11,662 [94.9%] White individuals.
Those patients were matched to 21,479 unexposed patients (mean [SD] age, 76.9 [8.7] years; 374 women [2.0%]; 49 [0.2%] American Indian or Alaska Native, 3 [<0.1%] Asian, 16 [0.1%] Black or African American, 88 [0.4%] Native Hawaiian or other Pacific Islander, and 20,517 [95.3%] White individuals).
Within the matched dataset, there were 10,994 instances of basal cell carcinoma after nicotinamide exposure and 12,551 cutaneous squamous cell carcinomas (cSCC). A total of 1,334 (3.9%) in the matched cohort were solid organ transplant recipients.
Overall, there was a significant 14% reduction in skin cancer risk. When nicotinamide was initiated after a first skin cancer, the risk reduction rose to 54%, although this benefit declined with initiation following subsequent skin cancers. The investigators observed this risk reduction across skin cancers overall, basal cell carcinoma, and cSCC, with the greatest reduction observed for cSCC. Among solid organ transplant recipients, no overall significant risk reduction was observed, although early nicotinamide use was associated with reduced cSCC incidence.
Increasing Mohs micrographic surgery utilization in darker skin phenotypes from 2011 to 2022
This study evaluates trends in the procedural skin cancer treatment.
The authors used Optum’s deidentified Clinformatics Data Mart Database (2011 to 2022) to identify U.S. patients with light skin (race value: White; Skin Colour Ethnicity [SCE] I‒III) and those with darker skin (race values: African, Asian, Hispanic; SCE IVa-VI). Investigators identified skin cancer treatments using Current Procedural Terminology codes for Mohs Micrographic Surgery (MMS), wide local excision (WLE), and destructive skin cancer treatments with same-day International Classification of Diseases 9/10 codes for basal cell carcinoma, squamous cell carcinoma, melanoma, and Merkel cell carcinoma. They used Mann-Kendall tests and Joinpoint analysis to assess trends over time and evaluate average annual percent changes (AAPCs).
In total, the authors included 1,625,367 adult patients with 4,184,496 skin cancer treatments. They found annual MMS frequency increased between 2011 and 2022 for both groups {SCE IVa‒VI 53.9% increase, AAPC 3.89% (95% confidence interval [CI] 2.84-4.96, p < .001); SCE I‒III 46.7% increase, AAPC 3.86% (95% CI 3.61-4.12, p<0.001)}. The rates for WLE and destructive methods decreased for both populations (p<0.001).
The authors conclude that Mohs micrographic surgery utilization is increasing over time for both lighter- and darker-skinned patients.
At the intersection of skin and society
A new report by Statistics Canada says Indigenous adults were incarcerated at a rate 10 times higher than non-Indigenous adults in six provinces, reports Brieanna Charlebois for The Canadian Press. Justice advocates have called the disparity “staggering” and a roadblock to reconciliation.
According to the news outlet, the agency’s new measure, called the overrepresentation index, was used to make the finding for First Nations, Inuit and Métis people in British Columbia, P.E.I., Nova Scotia, Ontario, Saskatchewan, and Alberta in 2023/2024.
“The numbers in this report are staggering, but not surprising,” Kory Wilson, chair of the B.C. First Nations Justice Council, said in a statement on Jan. 14, 2026. “Indigenous people are not inherently more criminal—we are more criminalized.”
The Statistics Canada report, released Wednesday, Jan. 14, 2026, said Indigenous people made up 33.2% of the custodial population in those provinces, despite comprising only 4.3% of the overall adult population in those regions.
Indigenous adults were incarcerated at a rate of 89 per 10,000 population on an average day, compared with eight per 10,000 among non-Indigenous adults.
The report also notes 2.6% of the Indigenous adult population was incarcerated at some point during the 2023/2024 year, and that rate more than doubled to 7.3% among Indigenous men aged 35 to 44.
Overrepresentation was greater for women than for men. Researchers for the report also determined that, over the five-year period between 2019 and 2024, the overrepresentation of Indigenous adults in custody increased each year.
Cree lawyer Eleanore Sunchild, who is based in Saskatoon, said the relationship between Indigenous Peoples and the justice system had been strained since colonization, but also pointed to other injustices that may be a factor in rates of incarceration, such as trauma from residential schools or the ’60s scoop.
“There’s been such a push toward incarceration of Indigenous people, and in doing that, I don’t think that the governments realized that it was colonization that created this problem,” she said in an interview with APTN News on Jan. 14, 2026.
She said authorities need to focus on helping people heal from generational trauma.
Statistics Canada’s report said the overrepresentation of Indigenous people is “complex and interconnected, though indisputably linked to colonialism, displacement, socioeconomic marginalization, intergenerational trauma, and systemic discrimination.”
“The overrepresentation of Indigenous people in Canada’s correctional systems is a long-standing and deeply rooted issue,” the agency said.
The Statistics Canada report also found the Black population was incarcerated at a rate three times the White population in Nova Scotia, Ontario, Alberta, and B.C. It said Black people accounted for about 13% of the custodial population on an average day in those provinces, despite making up only 3.3% of the general adult population.
This week
Jan. 28 is International Day of Peaceful Coexistence
Jan. 30 is World Neglected Tropical Diseases Day
Jan. 31 is National Bug Busting Day (for combating head lice) in the U.K.
Something to think about in the week ahead . . .
—Daniel Day-Lewis, (1957-present), British actor
Next week
Researchers report on the efficacy of a serum and sunscreen regimen containing 2-mercaptonicotinoyl glycine in managing facial dyschromia in female patients with skin of colour.
If you enjoy Skin Spectrum Weekly, why not check out the Chronicle’s other publications, podcasts, and portals?
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Drs. Melinda Gooderham (Peterborough, Ont.), Mark Kirchhof (Ottawa), Jensen Yeung (Toronto), and Jessica Asgarpour (Toronto) review new medications that entered Canadian dermatologists’ toolboxes in 2025.
Dr. Jeffrey Marcus Cohen (New Haven, Conn.) provides insight into anticipating and managing paradoxical reactions when treating psoriasis and AD patients with advanced medications.
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Love nicotinamide! In my Mohs practice, I've started counseling high-risk patients on this even before they hit the "multiple NMSC" threshold. So easy to get too!
Thanks for writing this, it clarifies a lot. My Pilates practice makes me so body-aware, but this shows how much more specific info communties need.