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Modified Fitzpatrick scale promising as tool for grading skin cancer
risk in people of colour
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, find results of an internet-
based survey.
J
ames 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 utilise the
internet to interact globally with patients
to perform continuous quality improvement
assessments.”
“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 Sur-
veyMonkey. 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 compli-
ance, 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 analyse these data in
a nonlinear non- time-dependent manner
to establish arrays of patients with sim-
ilar 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 regard-
ing skin cancer in people of colour.
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 colour in
the US every year. Furthermore, the 5-year
survival rates for melanoma are 58.2%
for African-Americans, 69.7% for Hispan-
ics, 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 carci-
noma), they exhibit higher death rates.
The literature suggests that lack of aware-
ness of melanoma among ethnic minorities
is one of the main reasons for their poor
skin cancer prognosis. Mr Kailas and col-
leagues set out to assess skin cancer
knowledge, awareness, and sun-protective
behaviour among people of colour 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 recruit-
ing subjects from the general public. The
social media groups included ethnic inter-
est groups and skin cancer awareness
groups as well as general groups. The sur-
vey consisted of 80 questions.
Pearson’s chi square test was used to ana-
lyse the data. All tests were two-sided. Data
was analysed 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, behavioural differences, and patient
satisfaction between Caucasian and ethnic
groups. Sunscreen use was more prevalent
among Caucasians than people of colour,
© 2017 American Academy of Dermatology Association.
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