ORIGINAL RESEARCH TABLE 1. Participant demographics, behaviors, and prescreening awareness DEMOGRAPHICS Total Average age* Sex, n (%) Male Female Location, n (%) Urban † Rural Race/ethnicity || , n (%) White Latinx Black Asian or Pacific Islander Native American Mixed Sunscreen use, n (%) Consistent Frequent Occasional Rare Never Never (White) Never (Black) Never (Latinx) Never (Asian or Pacific Islander) Never (Native American) Never (Mixed) Chi-square test (race vs. never use) Family history of skin cancer, n (%) White with positive family history Black with positive family history Latinx with positive family history Asian or Pacific Islander with positive family history Native American with positive family history Mixed with positive family history Chi-square test (race vs. family history) 110/246 (44.7%) 3/58 (5.2%) 10/74 (13.5%) 1/35 (2.9%) 2/11 (18.2%) 5/15 (33.3%) p <0.0001 ¶ 181 (44.0%) 40 (9.7%) 122 (29.7%) 35 (8.5%) 63 (15.3%) 23/246 (9.4%) 22/58 (37.9%) 8/74 (10.8%) 4/35 (11.4%) 4/11 (36.4%) 2/15 (13.3%) p <0.001 ‡ 246 (59.9%) 74 (18.0%) 58 (14.1%) 35 (8.5%) 11 (2.7%) 15 (3.6%) 395 (96.1%) 16 (3.9%) 175 (42.6%) 236 (57.4%) TOTAL 411 49 years *The study included adults aged 18 and older. || Race/ethnicity percentages may add up to >100% because participants could select multiple categories. † Urban and rural classification was based on participant ZIP codes using the Economic Research Service's rural-urban commuting area codes. ‡ p <0.001 indicates a significant difference in sunscreen use between White and Black racial groups (chi-square test). ¶ p <0.0001 indicates a significant difference in family history of skin cancer between White and Black racial groups (chi-square test). Among the 411 participants screened, 57.4% were female, 42.6% were male, and the mean age was 49 years. Racial and ethnic demographics included 59.9% White, 18.0% Latinx, 14.1% Black, 8.5% Asian or Pacific Islander, 2.7% Native American, and 3.6% Mixed. The majority (96%) resided in urban ZIP codes, with 4% from rural ZIP codes (Table 1). Of 411 participants, 40 (9.7%) had notable lesions (number needed to screen [NNS]=10.3): 9 suspected nonmelanoma skin cancers (NNS=45.7) of which 7 were biopsy-confirmed basal cell carcinomas (NNS=58.7); 4 suspicious pigmented lesions (NNS=103); and 23 actinic keratoses (NNS=17.9) (Table 2). While histologic confirmation was not available for all lesions, many patients were connected to appropriate follow-up care. On a 0 to 10 Likert scale, prescreening awareness of risk-minimizing practices was lower in Black (mean: 5.67) and Latinx (mean: 5.93) participants compared to White participants (mean: 7.43; p <0.001). Similarly, baseline knowledge of concerning lesion characteristics was also lower among Black (mean: 4.42) and Latinx (mean: 4.15) compared to White individuals (mean: 5.82; p =0.0006). Age showed a weak but statistically significant correlation with awareness of concerning-lesion characteristics (r=0.216; p <0.001). Mean awareness scores increased significantly postscreening for both risk-minimizing practices (+1.37 points) and concerning-lesion recognition (+2.66 points; p <0.0001). Among 205 participants without a prior dermatologist, the most reported barrier was lack of perceived need (72.2%), followed by lack of time (9.76%), and cost (4.88%), with no variation by race ( p =0.7087) or rural/urban residence ( p =0.5067). Sunscreen use varied by race. A total of 37.9% of Black participants reported never using sunscreen versus only 9.35% of White participants ( p <0.001). Family history of skin cancer was significantly more common among White (44.7%) than Black participants (5.2%; p <0.0001). Notably, participants with lower risk-minimizing practice awareness were more likely to report never or rarely using sunscreen ( p <0.001). Cost analysis assumed a $150 average skin cancer screening visit cost 2 plus $6.70 in travel expenses based on the Internal Revenue Service (IRS) mileage reimbursement rate of $0.67 RESULTS 56 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY October 2025 • Volume 18 • Number 10
Journal of Clinical and Aesthetic Dermatology October 2025: Page 56
