BMJ Case Reports 2015; doi:10.1136/bcr-2014-207139

Ramifications of poor medical education and screening in minority populations: an extensive acral melanoma

Editor's Choice
  1. Navin Arora3
  1. 1Department of Aviation Medicine, Naval Health Clinic Hawaii, JBPHH, Honolulu, Hawaii, USA
  2. 2Department of Pathology, Tripler Army Medical Center, Honolulu, Hawaii, USA
  3. 3Department of Dermatology, Tripler Army Medical Center, Honolulu, Hawaii, USA
  1. Correspondence to Dr Cody Ronald Jackson, sponsorw{at}
  • Accepted 10 January 2015
  • Published 30 January 2015


After 2 years of holistic self-treatment on his home island, an elderly Samoan man presented with a painful, hyperpigmented mass on his left heel. Physical examination revealed a black, friable tumour with necrotic tissue and superficial ulcerations with no other associated symptoms. Further investigation revealed that the mass was invasive. The tumour was treated with resection and a final diagnosis of acral lentiginous melanoma, stage T4b was made. Poor access to care and screening services are large barriers to care for minorities and patients with low socioeconomic status. Once access is obtained, however, patient compliance is not guaranteed. Healthcare practices often clash with societal beliefs, and so patient education regarding their disease and its possible progression, along with treatment options, is important. Furthermore, a lack of ethnically diverse physicians contributes to low cultural competency during interaction with patients from minorities, resulting in poor communication and low patient satisfaction.

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