Challenges in Skin Cancer Screening and Access to Treatment Among Multiple U.S. Racial and Ethnic Population Groups:...

Skin cancer remains the most common malignancy in the United States, yet disparities in screening, diagnosis, treatment, and outcomes persist among racial, ethnic, and underserved populations. Minority groups are more likely to present with advanced-stage disease and experience worse survival outcomes compared with non-Hispanic White populations. This systematic review synthesized contemporary U.S.-based evidence examining barriers to skin cancer prevention, detection, and treatment among underserved populations.

Guided by the Arksey and O'Malley framework and reported in accordance with PRISMA guidelines, we searched PubMed, Embase, and Cochrane databases for studies published between 2009 and 2024. Inclusion criteria encompassed U.S.-based studies evaluating disparities in skin cancer screening, diagnosis, treatment, or outcomes among racial and ethnic minority populations. Forty-seven studies met inclusion criteria. Data were extracted and synthesized using the Social-Ecological Model (SEM) and mapped to Healthy People 2030 domains.

Consistent disparities were identified across the care continuum. Minority and socioeconomically underserved populations were more likely to experience delayed diagnosis, advanced-stage presentation, treatment delays, and poorer survival outcomes. Insurance status, socioeconomic position, education, geographic access, and provider-level factors, including limited training in skin of color, were prominent contributors. A total of 516 barriers were identified across SEM levels, with individual, organizational, and societal barriers most frequently reported. Misdiagnosis and atypical clinical presentations, including acral lentiginous melanoma, further compounded barriers in accessing care.

Skin cancer rates in the U.S. are multifactorial and structurally embedded. Multilevel interventions addressing insurance continuity, dermatologic workforce distribution, culturally tailored education, and enhanced provider training in diverse skin presentations are necessary to advance optimal skin cancer outcomes.

This systematic review was registered on PROSPERO (ID # 1023303).