Despite declining melanoma mortality among non-Hispanic White individuals, survival disparities persist for Latino populations. A recently published qualitative study examined interviews with Latino patients and found that systemic barriers — especially insurance approvals, referral bottlenecks, low disease awareness, and lack of linguistic interpretation — can slow diagnosis and treatment of melanoma in this community.

“The most important takeaway from my perspective is the recognition of numerous barriers within the US healthcare system that contribute to delays in timely diagnosis and treatment of melanoma for Latino populations, particularly among those covered by public health insurance,” lead author Kimberly A. Miller, PhD, MPH, associate professor of the Department of Population and Public Health Sciences at Keck School of Medicine of the University of Southern California, Los Angeles, told Medscape Dermatology.

“Consequently, there is a critical need to expedite care on multiple fronts — by raising awareness of melanoma risk among Latino individuals and their clinicians, establishing stronger and more direct referral pathways, and empowering patients to communicate confidently during medical encounters,” she commented.

The study was published on October 1 in JAMA Dermatology.

Latino individuals have a lower overall incidence of melanoma than non-Hispanic White patients but are more often diagnosed at thicker stages, which contributes to worse outcomes, the study authors noted. For the study, they interviewed 20 Latino patients with melanoma in Los Angeles County, California, between May and November 2023. Using reflexive thematic analysis, they identified two facilitators — patient self-advocacy and linguistically appropriate care — as well as four barriers: insurance-related delays, referral delays, low awareness of melanoma, and lack of linguistically appropriate care.

Study Details

Eligible participants were Latino adults with cutaneous melanoma identified through the Los Angeles County Cancer Surveillance Program, Los Angeles. Interviews explored patient pathways to diagnosis, barriers and facilitators to obtaining care, referral experiences, and knowledge of melanoma. Half of the interviews were conducted in Spanish. Most participants were diagnosed at an early stage (in situ or localized).

Among the key findings was that many patients relied on family members to translate medical information. Miller told Medscape Medical News she was most surprised by how common this was, even in Southern California. “I was most surprised by how frequently patients reported relying on a family member to translate into Spanish for them, especially given the study was conducted in Southern California, a majority Latino region,” she said. 

“The lack of professional translation services creates significant barriers to effective care and can undermine patient-provider communication, often resulting in poorer care quality, delayed diagnosis, and worse health outcomes.”

In addition, patients with public or managed care plans described prolonged approval timelines and long waits to see dermatologists. Some reported that switching to coverage with a preferred provider organization expedited referrals and treatment.

The study also found that several participants had little prior knowledge of melanoma and did not perceive themselves at risk because of their skin color. The authors noted that targeted risk communication and clinician education about melanoma in diverse skin types are needed.

Patients who “self-advocated” for their healthcare were identified as facilitators of timely diagnosis and treatment. Individuals who insisted on evaluation, biopsy, or referral, the authors reported, moved more quickly through the healthcare system.

Clinical Implications

According to the study authors, interventions are needed at the patient, provider, and system levels. Their suggested strategies include:

• Expanding culturally relevant patient education that emphasizes melanoma can affect all skin types.
• Providing professional interpreters and Spanish-language educational materials at all care points.
• Training clinicians in recognizing melanoma in diverse skin tones and delivering culturally competent counseling.
• Streamlining referral processes from primary care to dermatology.
• Proactively addressing insurance-related delays through navigation support.

“Delays in melanoma diagnosis and treatment have multifactorial causes, and there is no simple solution,” Miller said. “To improve outcomes, and specifically to increase survival rates for Latino patients, comprehensive, multilevel strategies are needed. These include culturally relevant patient education, provider training in equitable melanoma care, and healthcare system improvements that strengthen navigation support and streamline timely referrals to specialty care.”

Challenges, Looking Ahead

The authors acknowledged that their small sample from Los Angeles County may not reflect the diversity of the broader US Latino population. Recruitment challenges and potential selection bias were also noted. Nevertheless, they emphasized that the narratives provide critical patient-centered insights into modifiable barriers, including language access, insurance, and referral speed.

“To ensure timely diagnosis and treatment of melanoma, it is imperative that we provide culturally congruent and respectful care for Latino patients,” Miller said.

The study was supported by the National Cancer Institute. Miller reported having no disclosures. One author reported receiving personal fees from Otsuka Pharmaceutical outside the submitted work; no other author disclosures were reported.

Jennifer Lightowler is a Connecticut-based dermatology physician assistant and freelance medical writer.