A Modified Fitzpatrick Scale Is Promising as a Tool for Grading Skin Cancer Risk in People of Color
March 7, 2017—Orlando, Florida—In non-Caucasian populations, education is needed regarding sunscreen use and the importance of seeking medical attention for suspicious nevi. In addition, physicians need to spend more time discussing skin cancer risk. A modified Fitzpatrick scale shows promise for future use in assessing skin cancer risk in these groups.
These conclusions, based on results of an internet-based survey, was presented at the 2017 American Academy of Dermatology Annual Meeting, from March 3 – 7.
James A. Solomon, MD, PhD, of the University of Central Florida, Orlando, said, “This survey is part of the beta testing of a new platform to utilize the internet to interact globally with patients to perform continuous quality improvement assessments.”
He continued, “The platform will allow participants to log on and off via one server. A number will be assigned to the patient interactive form, which will be seen by researchers. Beta testing has shown an absence of patient survey burnout if correct questions are asked and participants are recruited via the internet globally in more than one language.”
He elaborated, “Beta testing has used SurveyMonkey. This platform allows only one chance to complete surveys with dozens to nearly 150 questions. We are afforded hundreds of participants. They can log on or log off at will, and address hundreds of questions concerning lifestyle, work, food, skin care, health habits, treatment compliance, and more. They will also log on every month to note and time stamp any changes in their disease states as well as the rest of their lifestyle, diet, exposures, work, and additional factors.”
He added, “We will use complex adaptive systems statistics to analyze these data in a nonlinear non – time-dependent manner to establish arrays of patients with similar outcomes. The platform will include not only the modified Fitzpatrick scale but also expand on racial/ethnic background to allow participants to identify all countries/regions where they have heritage.”
Ajay Kailas, BS, also of the University of Central Florida, explained that malignant melanoma, basal cell carcinoma, and squamous cell carcinoma account for approximately 40% of all neoplasms among the Caucasian population. Skin cancer is, in fact, the most common malignancy in the US. Despite the high rate of skin cancer, however, minimal data is available regarding skin cancer in people of color.
The incidence of skin cancer in the US is approximately 5% for Hispanics, 4% for Asians, and 2% for African Americans, affecting 4.5 million people of color in the US every year. Furthermore, the 5-year survival rates for melanoma are 58.2% for African-Americans, 69.7% for Hispanics, and 70.9% for Asians vs 79.8% for Caucasians.
Though these groups experience lower incidences of skin cancer (melanoma, basal cell carcinoma, and squamous cell carcinoma), they exhibit higher death rates.
The literature suggests that lack of awareness of melanoma among ethnic minorities is one of the main reasons for their poor skin cancer prognosis. Mr. Kailas and colleagues set out to assess skin cancer knowledge, awareness, and sun-protective behavior among people of color via an online survey promoted via social media.
From August to December 2016, a link to an internet-based survey and short excerpt detailing the purpose of the survey was posted several times a week in social media groups such as Twitter, LinkedIn, and Facebook, with the intent of recruiting subjects from the general public. The social media groups included ethnic interest groups and skin cancer awareness groups as well as general groups. The survey consisted of 80 questions.
Pearson’s chi square test was used to analyze the data. All tests were two-sided. Data was analyzed using SPSS 22.0 (IBM).
The global survey received 211 responses. The population was mostly female (76%) and represented younger age groups. The results demonstrated gaps in sunscreen use, behavioral differences, and patient satisfaction between Caucasian and ethnic groups. Sunscreen use was more prevalent among Caucasians than people of color, as 80% of Caucasians reported sunscreen use (P < .001).
Second, people of color demonstrated significant behavioral differences in seeking medical attention vs Caucasians. For example, if a suspicious mole developed, 70% of Caucasians stated they were “very likely” to see a physician vs only 42.1% of other, 49.5% of African-Americans, 26.3% of Latinos, 29.4% of Asians, and 10% of Asian Indians (P <.001).
Patient satisfaction differed in terms of the amount of time the physician spent discussing skin cancer risk. A total of 67.1% of Caucasians reported being satisfied vs 47.4% of other, 43.2% of African-Americans, 31.6% of Latinos, 30.3% of Asians, and 30% of Asian Indians (P <.001).
The purpose of the modified Fitzpatrick scale is to separate the ability to burn vs tan, provide more variability within races, and include more categories for darker skin. Zero to seven points were given for each of four categories (a maximum total of 28): ability to burn, ability to tan, skin darkness, and maximal darkness of tanned skin.
Scores were similar among other (sample mean 13.79), Asian (sample mean 13.56), and Latino (sample mean 13.63) skin as a group. Asian Indian (sample mean 20) and African-American (sample mean 20.26) skin as a group, but differed for Caucasian (sample mean 8) skin in addition to the modified Fitzpatrick scale.
Mr. Kailas concluded that education is needed regarding sunscreen use and the importance of seeking medical attention for suspicious nevi. Physicians need to spend more time discussing skin cancer risk. The modified Fitzpatrick scale showed promise for future use.
The gaps in awareness can be addressed via:
- A national sunscreen campaign focusing on people of color and their need to wear sunscreen, including distributing free sunscreen to low-income areas as well as educational pamphlets
- Educating people of color to see a physician if a suspicious mole or nevus develops. This can be accomplished by referring this population to resources that teach them how to examine their skin, such as online instruction in skin self-examination
- Encouragement of physicians and residents to spend time discussing skin cancer risk among all new patients, regardless race or ethnicity
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