To the Editor: Although less common in richly-pigmented populations, melanomas, particularly acral lentiginous melanomas, occur. In Jamaica, 51% are acral lentiginous melanomas.1 Skin of color patients are reportedly less melanoma aware.2,3 Late presentation contributes to poor outcomes. This cross-sectional study assesses melanoma awareness (MA) in a Jamaican/Afro-Caribbean group.
In US-based data, ∼58% of persons had some MA.3,4 We administered 180 questionnaires (Fig 1), 90 to dermatology and 90 to nondermatology clinic (medicine/surgery) attendees at the University of the West Indies. Questionnaires were administered to attendees agreeing to participate until sample-size achieved. Adults with no melanoma history were enrolled. Our questionnaire (partially modeled off a preexisting instrument3) assessed the following: (1) MA, (2) if aware, detailed knowledge, (3) information-source ranking (where one typically/historically gets information), and (4) demographic/socioeconomic data. Simply ‘hearing of melanoma’ may not influence early presentation. We hypothesize that possessing minimum specific meaningful knowledge (MK) might. Particularly, knowing its malignant nature/color/presentation/acral-predominance/detection/mortality risk potentially constitutes MK. We scored responses assigning each parameter 0/0.5/1 based on knowledge-level (Supplementary Table I, available via Mendeley at https://doi.org/10.17632/spgf32p2gk.1). MK was assigned at ≥4.5 (non-0 score per parameter).
Fig 1.
Questionnaire for evaluating melanoma awareness in a Jamaican population. JMD, Jamaican dollars.
Regarding socioeconomic data, education was stratified into tertiary/non-tertiary and income into relatively low/high (lower and upper 2 tiers—Fig 1). Information-sources were divided into social media/internet-based and traditional media. Descriptive statistics were generated. Association was evaluated with χ2/t tests (IBM SPSS V26).
One hundred eighty responded. Table I displays select results. Overall, 55.6% (n = 100) were melanoma unaware (M−) and 44.4% (n = 80) melanoma aware (M+); 79.5% did not know local melanoma information sources. M+ persons were significantly younger (P < .001). Awareness associated with tertiary education and relatively higher income (P < .001). No association existed between MA and sex/urbanization/dermatology clinic attendance/information-source usage.
Table I.
Melanoma awareness in a Jamaican population: Select results
| General, demographic/SE data | Overall respondents (n = 180) |
M− group (n = 100) |
M+ group (n = 80) |
Association with MA (P-value) |
Specific melanoma knowledge in M+ persons (n = 80) [%] |
|---|---|---|---|---|---|
| Sex (%) n = 180 |
F: 71.1 | F: 69 | F: 72.5 | Not significant (.713) |
Melanoma is a malignancy [83.8] |
| M: 28.9 | M: 31 | M: 27.5 | |||
| F:M ratio = 2.5:1 | F:M ratio = 2.2:1 | F:M ratio = 2.6:1 | |||
| Age (y) n = 175 |
Range: 18-84 | Range: 21-74 | Range: 18-84 |
M+ respondents significantly younger than M− mean difference = 8.3 y (<.001) |
Melanoma is most commonly brown/black [62.5] |
| Mean: 46.1 ± 15.06 SD | Mean: 49.7 ± 13.08 SD | Mean: 41.3 ± 16.25 SD | |||
| Race (%) n = 180 |
Black: 88.9 | Black: 92 | Black: 85 | Not significant (.317) |
Signs of melanoma 1 sign [21.3] Multiple signs [45.0] |
| Mixed: 10 | Mixed: 7 | Mixed: 13.8 | |||
| White: 1.1 | White: 1 | White: 1.3 | |||
| POR urbanization (%) n = 178 |
High: 84.3 | High: 81.8 | High: 87.3 | Not significant (.315) |
Risk factors for melanoma 1 risk factor [22.5] Multiple risk factors [56.3] |
| Low: 15.7 | Low: 18.2 | Low: 12.7 | |||
| Educational attainment (%) n = 178 |
No formal: 0.6 | No formal: 0 | No formal: 1.3 |
Significantly associated. Higher proportions of tertiary educated were found in M+ group (63.8%) compared with M− group (32%) (<.001) |
Protective value of sunscreen [77.5] |
| Primary: 8.4 | Primary: 11.2 | Primary: 5.0 | |||
| Secondary: 44.4 | Secondary: 56.1 | Secondary: 30 | |||
| Tertiary: 46.6 | Tertiary: 32.7 | Tertiary: 63.7 | |||
| Relative income bracket (%) n = 172 |
Low (tier 1-2): 61.6 | Low: 73.7 | Low: 46.8 |
Significantly associated. M+ group had higher proportion of relatively high-income respondents (51.2%) than M− group (25%) and more relatively high-income respondents were aware of melanoma (<.001) |
How melanoma is detected FBSE [40] Acral + FBSE [30] |
| High (tier 3-4): 38.4 | High: 26.3 | High: 53.2 | |||
| Clinic type (%) n = 180 |
DC: 50 | DC: 45 | DC: 56.3 | Not significant (.134) |
Acral location in Afro-Caribbean persons [33.8] |
| NDC: 50 | NDC: 55 | NDC: 43.8 | |||
| Primary sources of general information (%) n = 179 |
SMIB: 67.6 | SMIB: 61 TM: 37 |
SMIB: 76.3 TM: 23.7 |
Not significant (.07) |
Aware of mortality risk of untreated melanoma [56.3] |
| TM: 31.3 | |||||
| Equal SMIB/TM: 1.1 |
Bolded text in column 5 represents statistically significant associations. The column 6 additionally reports detailed melanoma knowledge in melanoma aware persons.
DC, Dermatology clinic; F, female; FBSE, full body skin examination; M, male; M+, melanoma-aware group; M−, melanoma-unaware group; MA, melanoma awareness; NDC, nondermatology clinic; POR, parish of residence; SE, socioeconomic; SMIB, social media/internet-based resources; TM, traditional media.
Although most M+ respondents (83.5%) identified melanoma as skin cancer, 37.5% did not know/incorrectly selected its likely color, 65% were ignorant of acral predominance in Afro-Caribbean persons and only 56.3% thought untreated melanoma likely to kill (Table I); 35% achieved MK (score ≧4.5). Analyzing MK as the end point, association with income/education was lost (P = .67/0.054). MK-achievers were younger (34.2 ± 16.23 SD years) than their counterparts (45.1 ± 15.09 SD years, [P = .003]); 50% reported social media/internet-based, 45% doctors, 30% family/friends, and 23.8% traditional media as contributing to MA. Given his potential celebrity leverage, we evaluated M+ awareness of Bob Marley’s melanoma diagnosis. Only 25% (n = 20) endorsed knowing a celebrity with melanoma; 80% identifying Marley.
Most of our sample was melanoma unaware. Our MA (44.4%) is lower than recent data (United States) where 57.6% of richly-pigmented participants identified melanoma as skin cancer.3 Younger age, tertiary education, and relatively high-income significantly associated with MA.
Population-relevant acral lentiginous melanoma–focused information was less known than UV-related melanoma information (Table I) suggesting knowledge acquisition from international, not local educators. Although hypothetical, we advance the logic that MK potentially increases the chance of early diagnosis. Only 35% of M+ persons achieved MK. The data suggest a relative lack of correct/detailed knowledge in aware persons.
Targeted education may increase MA. Utilization of typical information gathering sources, celebrity leveraging (perhaps Marley), and capitalizing on dermatology visits for population-relevant education are suggested. Limitations include urban-predominant respondents, a single-center population and use of unvalidated instruments.
Conflicts of interest
None disclosed.
Footnotes
Drs Thomas and Ho contributed equally to this article.
Drs Thomas and Ho are cofirst authors.
Funding sources: None.
Patient consent: The authors obtained written consent from patients for these results to be published in print and online and with the understanding that this information may be publicly available. Patient consent forms were not provided to the journal but are retained by the authors.
IRB approval status: Approved. CREC-MN.0343,2021/2022.
References
- 1.Liburd C.G., Gibson T.N., Hanchard B., Waugh N., McNaughton D. Cutaneous malignant melanoma in Jamaica, 1958 to 2007. West Indian Med J. 2014;63(7):717–720. doi: 10.7727/wimj.2013.265. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Robinson J.K., Joshi K.M., Ortiz S., Kundu R.V. Melanoma knowledge, perception, and awareness in ethnic minorities in Chicago: recommendations regarding education. Psycho Oncol. 2011;20(3):313–320. doi: 10.1002/pon.1736. [DOI] [PubMed] [Google Scholar]
- 3.Sanchez D.P., Maymone M.B.C., McLean E.O., et al. Racial and ethnic disparities in melanoma awareness: a cross-sectional survey. J Am Acad Dermatol. 2020;83(4):1098–1103. doi: 10.1016/j.jaad.2020.04.137. [DOI] [PubMed] [Google Scholar]
- 4.Miller D.R., Geller A.C., Wyatt S.W., et al. Melanoma awareness and self-examination practices: results of a United States survey. J Am Acad Dermatol. 1996;34(6):962–970. doi: 10.1016/s0190-9622(96)90273-x. [DOI] [PubMed] [Google Scholar]