Reviewed by: Adewole “Ade” Adamson, MD, MPP
Written by: Ashley Lawrence
Health disparities are inequalities in the quality of health, health care, and health outcomes experienced by groups of people based on their race, ethnicity, socioeconomic status, disability status, gender, age, geographic location, and/or sexual identity or orientation. For people of color in particular, a disproportionate burden of preventable disease, death, and disability exists. By working to identify and address the factors that lead to health disparities, barriers to health equity can be broken down to improve access to health care and overall health outcomes for all.
At UT Health Austin, our mission is to serve the community of Central Texas by not only providing care, but also supporting our physician leaders in modeling new ways of delivering care that build a better, more equitable system. We strive to create a diverse and inclusive climate and culture that deepens our intellectual environment, impacts the academic experience, improves patient care and health outcomes, and advances equity.
Adewole “Ade” Adamson, MD, MPP, is a board-certified dermatologist in both UT Health Austin’s Dermatology Clinic and UT Health Austin’s Melanoma and Pigmented Lesion Clinic. He specializes in caring for patients at high risk for developing melanoma skin cancer, such as those with many moles (particularly atypical moles) or a personal and/or family history of melanoma. Dr. Adamson is also an assistant professor in the Dell Medical School Department of Internal Medicine (Division of Dermatology), where his research primarily focuses on improving the quality of life of melanoma patients and addressing healthcare disparities in the Austin community and beyond.
Melanoma and Pigmented Lesions
Melanoma is type of skin cancer that usually appears dark in pigment and can develop anywhere on your body, from the palms of your hands and the soles of your feet to the back of your legs and even your scalp. If left untreated or diagnosed at a later stage, melanomas can become fatal.
“Melanoma is largely thought of as a disease that primarily affects people that self-identify as White. While this is true, melanoma can actually affect people of other racial and ethnic groups, including Blacks, Hispanics, Asians, etc. One of the misconceptions among people of color is that they cannot develop melanoma, which is not true and can lead to delays in diagnosis. There exists an inverse relationship between your risk of developing melanoma and the pigment of your skin. The darker your skin, the less likely you are to develop melanoma. Although that risk, I want to emphasize, is still not zero.”
Patients at high risk for developing melanoma typically answer “yes” to one or more of the following questions:
- Do you have very light skin type that reacts sensitively to sunlight?
- Did you have severe, blistering sunburns during childhood or adolescence?
- Are you exposed to strong sunlight at regular intervals?
- Do you have multiple moles (more than 50)?
- Do you have many moles that are irregular in shape or color?
- Do you have large moles (more than 2 inches in diameter)?
- Have you noticed any new moles on your body?
- Is there a history of skin cancer in your family?
- Did you already have a melanoma?
- Have you noticed any changes in your moles?
“Pigmented lesions are moles that look slightly irregular or slightly atypical, but they in themselves are not necessarily cancerous. In patients that have a lot of these types of moles, over 50 or maybe even in the hundreds, those patients are at increased risk for potentially developing melanoma. Therefore, we often recommend that those kinds of patients see a dermatologist regularly for screening.”
Using the “ABCDE” rule can help you identify suspicious moles during self-evaluation.
ABCDEs of melanoma:
- A for Asymmetry
- B for Borders that are irregular, jagged, or blurred
- C for Color variation
- D for Diameter larger than the head of a pencil eraser
- E for Evolving size, shape, color, bleeding, or other concerning symptoms
Addressing Disparities in Health Care
For patients who do not self-identify as White, melanoma is often diagnosed at a later stage, which tends to result in worse outcomes for those patients. Sometimes this is due to poor recognition of the signs and symptoms of melanoma, either by clinicians or the patients themselves, particularly when melanoma develops on the palms of the hands and/or the soles of feet as these are areas that people don’t regularly look at. Other times, it has to do with lack of access due to being uninsured or even underinsured, which can cause delays in receiving potential life-saving treatment.
“The treatment of melanoma can sometimes be really complex. It can include dermatologists, surgical oncologists, medical oncologists, pathologists, and radiation oncologists. Therefore, the treatment plans for patients can be really difficult, especially for patients that have limited access. Here at UT Health Austin and the Dell Medical School, we’ve created what’s called a Cutaneous Oncology Multidisciplinary Conference through the Livestrong Cancer Institutes to help patients coordinate their care. We get all of these physician specialists together weekly to discuss individual patients and what the best treatment plans for these patients are to ensure we are delivering the best care possible. This also ensures all the players involved in the patient’s care are on the same page throughout the patient’s entire cancer journey, from diagnosis and treatment to survivorship, as well as prevents patients from falling through the cracks or getting lost in the healthcare system.”
UT Health Austin clinicians collaborate with their colleagues at the Dell Medical School and The University of Texas at Austin to utilize the latest research, diagnostic, and treatment techniques, which allows for improved patient treatment and outcomes. This multidisciplinary, coordinated care model makes it easier for patients to get the care they need, when they need it.
Looking to the Future
“One of the challenges with taking care of patients that have a lot of moles is that it’s hard for someone, by memory, to remember what moles look like in between visits. At UT Health Austin, we have something called a FotoFinder, which is a machine that takes standardized, digital photos of all the moles on the body, so we can keep track of them over time. Access to this cutting-edge technology was made possible in part through a generous donation from Meredith’s Mission for Melanoma and is a great resource for those patients that have a lot of moles and/or a history of melanoma. An advantage of using the FotoFinder is having a baseline set of images that we can compare subsequent skin examinations to. This helps eliminates some of the uncertainty around whether a mole is new or changing, which can trigger an unnecessary biopsy. It can also help identify subtle changes in moles over time.”
FotoFinder is a skin imaging technology that performs pain-free automated total body mapping to create an accurate skin map of the patient to analyze and more efficiently track any changes to moles as well as other skin issues. This state-of-the-art device uses a combination of high-resolution photography, video dermoscopy, and artificial intelligence to create a highly magnified image of your moles and mole structure and is one of the most advanced diagnostic tools used in detecting abnormalities early. Currently, UT Health Austin is one of only two providers in the state of Texas with access to this technology.
“When I capture closeup images, called dermoscopic images, of moles that are a little odd looking, if necessary, I have the ability to query an artificial intelligence-powered program to give me a risk score as to whether something is worth biopsying, almost like a decision support tool. It’s not something I routinely rely upon, but with the help of my colleagues in biomedical engineering on The University of Texas at Austin campus, I am trying to figure out whether there’s a way for us to use and incorporate artificial intelligence-powered technology in the treatment of patients to further address existing health disparities.”
Dr. Adamson’s research has been generously supported through funding from the American Cancer Society, the Dermatology Foundation, the Robert Wood Johnson Foundation, and the National Institutes of Health. Additionally, his clinic and research work has also received support from Meredith’s Mission for Melanoma and the Brown Skin Too Foundation.