title: Skin cancer risk assessment in dark skinned immigrants: the role of social determinants and ethnicity.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: a Department of Dermatology , National Institute for Health, Migration and Poverty (INMP) , Rome , Italy.
authors.forename: Valeska
authors.initials: V
authors.lastname: Padovese
authors.affiliation: a Department of Dermatology , National Institute for Health, Migration and Poverty (INMP) , Rome , Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Franco
authors.affiliation: a Department of Dermatology , National Institute for Health, Migration and Poverty (INMP) , Rome , Italy.
authors.forename: Mariacarla
authors.initials: M
authors.lastname: Valenzano
authors.affiliation: a Department of Dermatology , National Institute for Health, Migration and Poverty (INMP) , Rome , Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pecoraro
authors.affiliation: a Department of Dermatology , National Institute for Health, Migration and Poverty (INMP) , Rome , Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Cammilli
authors.affiliation: a Department of Dermatology , National Institute for Health, Migration and Poverty (INMP) , Rome , Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Petrelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000208:ethnology; D001208:Asia / Q000208:ethnology; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005006:Ethnicity; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011203:Poverty; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000453:epidemiology / Q000208:ethnology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Dark-skinned people; ethnicity; immigrants; melanoma; skin cancer risk