The overall incidence of cancer in Latin America is estimated to be 163 cases per 100,000 people, which is a much lower rate than in the USA or Europe [26]. However, the proportion of people who die from cancer in Latin America is almost twice than in the USA, with around 13 deaths for every 22 cases of cancer in Latin America, compared to around 13 deaths for every 37 cases of cancer the USA, and approximately 13 deaths for every 30 cases of cancer in Europe [27]. Researchers estimate that by 2030, almost two million cases of cancer will be diagnosed in Latin America and the Caribbean, with more than one million deaths from cancer predicted to occur annually.

Latin America and the Hispanic population is facing an alarming increase in cancer rates, and unless urgent action is taken to prevent cancers, improve health care systems and facilities, access to vital medical care, and treatment of poor people, the USA will be overwhelmed by this inevitable epidemic. Many have stated that patients are diagnosed when the disease is at a late stage, making it obviously much harder to treat and more likely to have poor outcomes. Also the socioeconomic status in some of the Latin American countries and populations can be poor, rural, or indigenous communities, which provides little access to cancer treatments; a problem exacerbated by low, and highly inequitable, health investment in most Latin American countries.

Hispanics have the lowest rates of dermatology visits, many don’t ever visit the dermatologist when they are young [28]. Because skin cancer prevention and screening practices historically have been lower among Hispanics, Blacks, and Asians, and given the changing demographics in the United States, interventions that are tailored to each of these groups will be needed [29]. Campaigns to educate the public should be targeted to educate people of all skin types, including the possibility of developing skin cancers in areas not exposed to the sun [30], since sunlight is not the most important cause of developing most of skin cancer in people of color [31].

Other important risk factors are imperative to recognize, because the focus is placed on the white- and light-skinned individuals based on the susceptibility to the UV radiation. Many risk factors include personal or family history of melanoma, evolving or changing nevi, new nevi after a certain age (most likely after 35 years of age), history of blistering sun burns at young age, immunosuppression, and fitzpatrick types I and II. Because some of these risk factors do not apply to the minority population, more understanding is needed in this subject and further research is an urgent matter.

Recent studies have demonstrated that the photoprotection from melanin in individuals with skin of color is only partial [32]. They have shown an association between melanoma and UV radiation in non-whites [15]. However, some studies have shown the data is inconclusive [33]. One important factor to consider is that other sun-protected sites such as palmar, plantar, and mucosal surfaces have been linked to melanoma, demonstrating there are others causative factors. And this, as mentioned previously, should be a key point when focusing on prevention campaigns.

The top four states for detailed Hispanic origin groups with a national population size of one million or more in 2010 US Census Bureau [1] are California, Texas, New York, and Florida. More than 60 % of the Mexican origin population in the United States resided in California and Texas. About 41 % of the Puerto Rican population lived in two states, New York and Florida. More than 60 % of all Cubans lived in Florida, while Dominicans were highly concentrated in New York. About 32 % of people from Guatemalan and 50 % of Salvadoran population were concentrated in California. Demonstrating campaigns should be targeted to certain areas in order to capture a larger Hispanic audience.

The correlation between number of nevi and age is stronger in Hispanics and non-Hispanic whites than in any other ethnic/racial group [34]. Hispanics present the highest rates of thick melanoma at time of diagnosis, being twice as likely to present with regional or distant metastasis [35]. Also another important and different factor is that more than 50 % of BCCs in patients with skin of color are pigmented compared to 6 % in white individuals [36].

Hispanic individuals tend to present with more advanced, thicker tumors, and thus tend to have a poorer prognosis with higher mortality compared to white patients. Bradford et al. [11] reported that the acral lentiginous melanoma 5- and 10-year melanoma-specific survival rates were 80.3 % and 67.5 %, respectively, which were less than the overall rates for cutaneous malignant melanomas (91.3 % and 87.5 %, respectively). The acral lentiginous melanoma 5- and 10-year melanoma-specific survival rates were highest in non-Hispanic white individuals (82.6 % and 69.4 %, respectively), intermediate in black individuals (77.2 % and 71.5 %, respectively), and lowest in Hispanic white individuals (72.8 % and 57.3 %, respectively) and Asian/Pacific Islanders (70.2 % and 54.1 %, respectively). In a retrospective review of case reports from the Florida Cancer Data System, Hu et al. [37] showed that higher-stage melanomas were more common among Hispanic (26 %) and black patients (52 %) compared to white patients (16 %). This can be suggestive of the socioeconomic lack of access to health care, while other causative factors cannot be ignored and may explain the discrepancy in survival rates among ethnic groups.

There are very little data and studies that approach the topic of melanoma among Hispanics mainly because there is scarcity of cases in the USA and there are limitations on the ethnicity information in cancer registries. With recent reports [38] stating only 23.9 % of Hispanics’ visit the dermatologists not only can we explain the delay in diagnosis but also the small number of cases to date for research purposes. Most published studies on skin cancer incidence and mortality describe data for whites only.

Based on a recent study [39], factors associated with ever conducting a skin self-exam and a full body exam by a dermatologist included older age, English acculturation, higher risk factors for melanoma, more frequent sunscreen use, sunbathing, job-related sun exposure, higher perceived skin cancer risk, and doctor recommendations among others. In this particular study, the rates reported of ever conducting a skin self-exam or having a full body exam were 17.6 % and 9.2 %, respectively. These values reveal the lack of skin cancer education among Hispanics and the need for more investigation in this area, also to be able to understand why Hispanic patients are not engaging as much in preventive activities.

Treatment of NMSC (nonmelanoma skin cancer) includes Mohs surgery, surgical excision, cryosurgery, electrodesiccation and curettage (ED&C), and creams (fluorouracil/imiquimod) as well as photodynamic therapy among others. Certain factors such as size of lesion, location, and type determine the treatment options for each patient. For the metastatic types, other treatments such as radiation and oral medications have been used. For melanoma skin cancer many more variables come into play to make a decision in terms of treatment. Most of the times, an oncologist is involved when metastasis or larger tumors are found. The treatment options of localized cutaneous melanoma include a wide local excision and sometimes even amputations, depending on the site involved. Chemotherapy, radiation, IL-2, and experimental cancer vaccines are among other treatment choices.

According to the National Cancer Institute, melanoma staging is based on the thickness of the tumor (Breslow thickness), tumor ulceration, spread to lymph nodes, or spread to other parts of the body [40]. There are five stages, Stage 0, I, II, III, IV. Stage 0 being melanoma in situ, while Stage III includes lymph node involvement, and Stage IV includes distant spread to other parts of the body, including lung, liver, brain, bone, soft tissue, or the gastrointestinal system [1].

Although the incidence of melanoma is lower in Hispanics than in non-Hispanic white patients, the stage at time of diagnosis is often more advanced in Hispanic patients [41]. There is limited data regarding melanoma stage at time of diagnosis among Hispanic Americans. A study by Hu et al. [37] evaluated 41,072 cases of melanoma from 1990 to 2004 with known race/ethnicity and stage information that were reported to the Florida Cancer Data System (FCDS). It revealed that at presentation, both white Hispanics and black patients had significantly more advanced staged melanoma at diagnosis, 18 % and 26 % respectively, in comparison to 12 % of non-Hispanic white patients [15].

Another study analyzed 81 melanoma cases between 1970 and 1986 from the New Mexico Melanoma Registry and New Mexico Tumor Registry [42]. This study found that 36 % of Hispanics had more advanced stages of melanoma with 2 mm or thicker in depth, while only 16 % of non-Hispanic white patients had lesions at an advanced stage. Melanoma is highly curable if detected at early stages. According to the American Cancer Society, the 5- and 10-year survival rates are 91 % and 89 %, respectively. The 5-year survival rate drops to 62 % for regional disease and 15 % for distant stage disease [43].

Other factors affecting the disparity of melanoma stage at diagnosis may include socioeconomic status, education on skin cancer awareness, and cultural and social values. According to Ward et al. [43], residents of poorer counties have 13 % higher death rates from cancer in men and 3 % higher in women when compared to wealthier counties. Often Hispanic patients and even physicians in the medical community have a low index of suspicion of skin cancers in these ethnic populations. This frequently leads to a delay in diagnosis and subsequent advanced presentation and poorer prognosis. This further emphasizes the need for more skin cancer awareness programs and education on the importance of sun protection even in ethnicities with lower index of suspicion for skin cancer.

Primary skin cancer prevention efforts among US Hispanics and campaigns should be starting, this way preventing the delay on the NMSC and melanoma diagnosis. Promoting (1) the use of sunscreen or sunblock, (2) the use of sun-protective clothing and/or hats, and (3) shade-seeking behavior should be a norm at all dermatology office visits and also a review on the patients’ physical exams. It is important to understand that improvements are needed in primary skin cancer prevention practiced by Hispanics. Preventive measures should be taught and hopefully practiced more often by the Hispanic populations. Primary care providers need to promote the importance of full body exams and they should be part of the patients’ yearly well physical check up.

The 5-year survival rates for melanoma is 77.1 % for white Hispanic males, 86.8 % for white Hispanic females, 86.5 % for non-Hispanic males, and 92.2 % for non-Hispanic white females [42]. Although there is a difference in numbers of cancer deaths among the ethnic groups, there is a lack of studies on ethnic disparities with respect to melanoma within groups. Improved secondary prevention will help the prognosis among Hispanics since melanoma prognosis is directly proportional to stage at diagnosis.

The number of basal cell and squamous cell skin cancers (nonmelanoma skin cancers or NMSC) is difficult to estimate because these cases are not required to be reported to cancer registries [44]. Some suggest that 3.5 millions are diagnosed each year in the USA [45] and an estimated 3,170 deaths from NMSCs will occur in the USA in 2013 according to the skin cancer foundation [46].