Commemorating Indigenous Peoples’ Day: What American Indian/Alaska Native People Should Know About Melanoma

Indigenous Peoples' Day, which commemorates American Indian/Alaska Native history, traditions, and culture, was celebrated across the US on October 14, 2024. In honor of these celebrations, we highlight what American Indian/Alaska Native people should know about melanoma.

A recent paper¹ Melanoma Incidence Rates Among Non-Hispanic American Indian/Alaska Native Individuals, 1999-2019 reported melanoma rates in American Indian/Alaska Native people. To learn more, we talked to the lead author of the paper, Julie Townsend, MS, who is an epidemiologist with the Scientific Support and Clinical Translation Team in the Comprehensive Cancer Control Branch of the Division of Cancer Prevention and Control.

Melanoma in American Indian/Alaska Native People

American Indian/Alaska Native people have the second highest rate of skin cancer after white people². People of color, which include American Indian/Alaska Native people, are less likely to develop melanoma, but when they do, it is more likely to be in an advanced stage and thus more difficult to treat². Ms. Townsend noted that melanoma is twice as common in American Indian/Alaska Native men age 55 years and older, compared to women of the same age, and that new cases are also increasing in women¹. American Indian/Alaska Native people living in the Southern Plains and Pacific Coast areas of the US have the highest rates of melanoma¹. The body area with the most deadly melanomas in American Indian/Alaska Native people is the trunk compared to the head and neck in white people³. In people with darker skin tones, signs of skin cancer can be less visible or well known than in people with lighter skin tones.

Melanoma-Related Differences in Indigenous People and Possible Reasons for These Differences

Differences in melanoma incidence rates and outcomes exist for American Indian/Alaska Native people compared to white people. Survival of American Indian/Alaska Native people who develop melanoma has improved only slightly and has not kept pace with the improvement in survival in white people⁴. Multiple reasons, including certain sun safety behaviors, may explain the persistent differences in incidence rates and survival from melanoma.

Compared to other groups, American Indian/Alaska Native people are⁵:

• Less likely to use sunscreen than white people.
• Less likely to wear hats and seek shade when outside than other minorities.
• More likely to use indoor tanning beds than other minority groups.
• More likely than other non-white groups to get a sunburn when in the sun for an hour.

Differences also exist in education, interactions with doctors, and tumor characteristics:

• People of color may receive little or no education from their doctors about their risk of skin cancer².
• American Indian/Alaska Native people are less likely than white people to receive a full-body skin exam from a dermatologist⁵.
• Diagnosing melanoma may be challenging in darker skin, leading to later diagnosis, more advanced disease, and worse survival⁴.
• American Indian/Alaska Native people are more likely to have thick and or/ulcerated tumors compared to white people⁴.
• American Indian/Alaska Native people have a longer time from diagnosis to surgery to remove the melanoma⁴.
• American Indian/Alaska Native people have unequal access to standard treatments such as targeted therapies and immunotherapy⁴.

Social, geographic, and economic differences also exist:

• One fourth of marginalized rural communities are made up mainly of American Indian/Alaska Native people. Accessing medical care is often difficult in rural areas, and there are fewer dermatologists in these regions.¹
• Systemic racism leads to reduced access to health care, education, and employment.
• Many American Indian/Alaska Native people live in rural areas, which makes access to healthcare more difficult. Ms. Townsend stated that many rural clinics are under-resourced, making it challenging for people to receive timely and efficient skin care.
• Health insurance coverage is lower than other groups⁵.

Research efforts are suboptimal:

• American Indian/Alaska Native people are under-represented in clinical trials, meaning that trial results may or may not apply to people in these communities⁴.
• Underreporting of melanoma and misclassification of American Indian/Alaska Native people make research more difficult. Efforts to correct misclassification may help researchers better understand melanoma in the American Indian/Alaska Native population and why American Indian/Alaska Native people have higher rates of melanoma than other people of color¹.

Improving Outcomes for American Indian/Alaska Native People with Melanoma

Efforts are underway to improve outcomes for American Indian/Alaska Native People with melanoma:

• A Sun Safety Guide for Tribal Communities and Schools is available.
• In this webinar, American Indian tribe members talk about their experience with skin cancer, their efforts to educate their peers, and facts about skin cancer in this group (at 27:45).
• Melanoma needs to be recognized as a problem in the American Indian/Alaska Native population. Greater awareness of melanoma and education as well as ways to detect and treat it are needed both by American Indian/Alaska Native people and their doctors.
• Improved research efforts are needed to understand differences in melanoma treatment and detection in American Indian/Alaska Native people and to learn ways to eliminate these differences.
• Community Health Aide Programs and Project ECHO may play a role in improving access to healthcare including dermatology care. These programs virtually connect local healthcare aides caring for patients in rural areas with medical professionals in other locations and are expanding across the US. However, Ms. Townsend noted that lack of access to broadband connectivity can sometimes impede these efforts.

Ms. Townsend stated that “Greater awareness and attention to melanoma in American Indian/Alaska Native people is needed and people should be aware of changes in their skin and report any concerns to a healthcare professional.”