Skin cancer risk assessment in dark skinned immigrants: the role of social determinants and ethnicity.

OBJECTIVES: Dark-skinned people have a lower incidence rate of skin cancer, in particular melanoma, which is detected at more advanced stages leading to poorer prognoses and long-term outcomes compared to whites. The gap in survival is due to some difficulty in melanoma detection, lack of attention from doctors and awareness by patients. This study aims to assess skin cancer risk awareness in dark-skinned immigrants and to determine the influence of socioeconomic factors and ethnic origin on behaviors. DESIGN: This is a cross-sectional health facility based study carried out in a 12-month period. A semi-structured questionnaire to assess skin cancer risk awareness and a dermatological examination was offered to dark-skinned immigrants consecutively attending the dermatology department of the National Institute for Health, Migration and Poverty in Rome. RESULTS: 147 dark-skinned immigrants were enrolled, of which 54.4% were males, coming from Africa (53.1%). They were mainly young, aged 18-34 (56.5%). The level of education and length of stay in Italy was significantly related to the awareness about skin cancer: people with a high educational level (OR: 8.1 95% CI: 3.2-23.4) or immigrated more than 4 years before the interview (OR: 2.1 95% CI: 1.0-4.4) have a greater knowledge about skin cancer. CONCLUSIONS: Education level is the strongest predictive factor of skin cancer awareness, whereas cultural behaviours and personal experience of sunburns are the main factors determining sunlight avoidance. Health promotion programs targeting immigrants must consider cultural differences related to ethnicity and country of origin, and adopt a transcultural approach.

Cupping-related skin lesions.

In the outpatient department of the National Institute for Health, Migration and Poverty (NIHMP) in Rome, Italy, and at the Italian Dermatological Hospital in Mekele, Ethiopia, from January 1, 2007, to December 31, 2009, 47 patients, adults, and children showing typical circular skin lesions referable to cupping were observed. The patients (32 men and 15 women) underwent complete dermatological examination, and their case histories were collected with the aid of a cultural mediator from the same linguistic or cultural area of the patient. The clinical picture included blue-red, circular erythematous spots, sometimes covered with crusts, consistent with recent cupping (figure 1 and figure 2). In some cases, particularly in older lesions, atrophic-cicatricial lesions and irregular, normal-color, slate gray, or hypochromic skin surface were observed (figure 3). Lesions were observed on the back, on the presternal region (figure 4), and, in case of pathologies causing abdominal swelling (i.e., kwashiorkor, intestinal parasitosis), on the abdomen (figure 5). The clinical pictures initially diagnosed as dermatophytoses or lesions caused by traumas or violence were later proved to be cupping-related outcomes or complications.

Erythema nodosum induced by kerion celsi of the scalp in a woman.

A 35-year-old woman, with a 3-week history of an enlarging erythematous, scaly plaque of the scalp vertex associated with the onset of some painful, subcutaneous nodules on her pretibial regions. Trichophyton mentagrophytes was isolated from the scalp lesion and the histological examination of one of the nodular lesions of the legs showed a septal panniculitis. The diagnosis of erythema nodosum (EN) induced by kerion celsi was made and the patient started therapy with oral terbinafine 250 mg per day for 4 weeks associated with naproxene per os 1 g per day for 2 weeks. Erythema nodosum is considered a reaction pattern to a wide variety of microbial and non-microbial stimuli: dermatophytic infections are rarely associated with EN.

Clinical features and treatment of dermatosis papulosa nigra in migrants to Italy.

Dermatosis papulosa nigra (DPN) is a benign epithelial tumor that is common in dark-skinned people. Although the diagnosis is easily made on medical examination, DPN is characterized by a chronic and worsening course. Therefore, even if DPN is a benign disease, the lesions are unaesthetic and the therapeutic options are quite inefficient. A prospective study was carried out during a period of 24 months (January 2006 to December 2007) at the Department for Preventive Medicine for Migration, Tourism and Tropical Dermatology of San Gallicano Dermatological Institute in Rome. Among 58 patients, 41 (71%) were women and 17 (29%) were men. The mean age was 33.5 years (range, 8-45 years). One pediatric patient was observed. This study is the first in Italy that, in recent years, has observed an important growth of the migration. The classic female predominance, family predisposition, and photodistribution of the lesion were found. DPN is frequently associated with patient discomfort, therefore the education of patients to reduce self-treatment is important.