Skin Cancer in the Incarcerated Population—A Single-Center Study

Abstract

BACKGROUND The incarcerated population may have variable access to specialty care that may affect the detection and diagnosis of skin cancer. OBJECTIVE The purpose of the study was to characterize skin cancers in the incarcerated population and determine time to treatment initiation (TTI) after biopsy. METHODS A retrospective cohort study was performed using data from a single-center referral hospital of incarcerated patients with biopsy-proven basal cell carcinoma (BCC), squamous cell carcinoma (SCC), or melanoma between January 2009 and December 2019. The main outcome measured was TTI after biopsy. RESULTS One hundred thirteen patients, majority men (96.5%) and of Caucasian race (89.4%), were diagnosed and/or treated for 191 skin cancers. Of these 191 skin cancers, 118 were BCC (61.8%), 58 were SCC (30.4%), and 15 were melanomas (7.9%). The average TTI after biopsy for melanoma was 57 days (range: 21-136, median: 51, 95% confidence interval: 39.89-74.10) with an average Breslow depth of 1.57 mm. CONCLUSION The average TTI of melanoma in the incarcerated population in this study was greater than 30 days, which may have increased mortality risk.

Commentary Skin Cancer in the Incarcerated Population—A Single Center Study

“…6 Of those incarcerated in Louisiana, 67.5% were African Americans. 1 Although only 1 of the 15 melanomas diagnosed in this study was in a Black man, it raises the question of whether other melanomas were potentially missed in this population from 2009 to 2019. The authors point out that the TTI for this single Black prisoner who had melanoma was 98 days compared with 54 days for the Caucasian prisoners.…”

“…A nna Swigert and her coauthors have written a timely article on the diagnosis and management of skin cancer of Louisiana's incarcerated population who were seen at the University Medical Center New Orleans over a 10-year period. 1 More than 96 percent were men, and greater than 89 percent were Caucasian. In this retrospective study, among other findings, the authors note that of the 191 skin cancers diagnosed and treated, a higher percentage consisted of squamous cell carcinoma than in the nonincarcerated population.…”

Systematic Review of Surgical Care in the Incarcerated Population: Identifying Knowledge Gaps for Future Research

“… 1 In Louisiana, incarcerated patients experienced an average delay of 57 days in the initiation of treatment after the biopsy-proven melanoma. 35 While there are efforts to evaluate cancer care on the state level, 36 the generalizability of these findings is unknown. Moreover, in Connecticut, the incidence of cancer during incarceration exceeds that of the general population shortly after release from correctional facilities (standardized incidence ratio 1.34; 95% CI = 1.23–1.47).…”