The stakes of this research are far from academic. ALM is an aggressive melanoma subtype that does not follow the usual rules of skin cancer. While most melanomas are driven by ultraviolet exposure and occur more frequently in people with fair skin, ALM develops on the palms of the hands, the soles of the feet, and underneath the nails—places that rarely see the sun. Its incidence is rising among Hispanic/Latino populations, and African Americans face the highest mortality rate of any group. Because ALM lesions do not display the classic features captured by the widely taught ABCDE method—Asymmetry, Border irregularity, Color variation, Diameter greater than six millimeters, and Evolving over time—the standard prevention campaigns built around sun safety and mole checking simply do not apply.

The consequences of this knowledge gap are measurable and severe. People of color are twice as likely to be diagnosed with melanoma at stage IV and 1.4 times more likely to be diagnosed at stage III compared with their White non-Hispanic counterparts, according to prior studies cited by the research team. Delayed diagnosis translates directly into greater morbidity and mortality. Part of the problem is that both patients and physicians struggle to recognize ALM’s warning signs, and ethnic minority patients report that their primary care providers rarely discuss melanoma during wellness visits. Compounding all of this, there is a sheer absence of quality, representative patient education materials aimed at ethnic populations; most materials in the public domain feature non-Hispanic White models, showing ALM lesions on lighter skin.

That absence of representation is not a neutral oversight, the researchers argue. When every educational image shows a dark lesion on pale skin, it can indirectly communicate that people with darker skin tones are not vulnerable to the disease—a long-standing and harmful belief. The problem is especially acute because older adults and ethnic populations, who face higher ALM incidence, often have lower health literacy, and visuals are known to be one of the most effective ways to educate people with lower literacy and numeracy. Illustrations can carry information that dense text cannot, making them a critical tool in communities that are medically underserved.

To test whether targeted visuals could close this gap, the team built on an earlier study in which they had commissioned a professional designer, using a crowdsourced design marketplace, to create ALM education materials featuring darker-skinned models. That first study found that participants with darker skin tones showed greater knowledge gains when viewing materials with darker-skinned models, and that the effect flowed through message memorability—when people found the materials memorable, their knowledge increased. For the new study, the same designer refined and expanded the illustrations, creating three versions calibrated to the Fitzpatrick skin type scale, the standard dermatological classification that sorts skin into six types based on color and reaction to ultraviolet light. White materials depicted skin types I and II, light brown materials types III and IV, and dark brown materials types V and VI.

The experiment enrolled 313 participants, roughly half Hispanic/Latino and half African American, with an average age of 46.2 years. About half were male, half had a high school education or less, and slightly more than half reported household incomes below $49,000. Recruited through a Qualtrics panel, participants were randomly assigned to view one of the three education material versions and then completed an immediate post-test. Knowledge was assessed with a fourteen-item composite scale combining nine text-based questions with five visual identification tasks in which participants had to pick which of five images could depict ALM. Memorability was measured with a validated seven-point semantic differential scale asking whether the material would stick in the head, was memorable, would be thought about again, and was unforgettable.

The statistical analysis, using factorial ANOVAs and a moderated mediation model with 5,000 bootstrap samples, uncovered an interaction that neither simple demographic targeting nor a one-size-fits-all approach would have predicted. Hispanic/Latino participants perceived the dark brown materials as more memorable than the white ones, and the light brown materials as more memorable than the white ones as well; correspondingly, their knowledge scores were significantly higher after viewing either the light brown or dark brown versions compared with the white version. African American participants showed a different profile: they rated the dark brown and white materials as more memorable than the light brown version, and their knowledge scores were higher with dark brown and white materials than with light brown ones. In other words, the light brown materials—perhaps the intuitive middle-ground choice for reaching both communities—were actually the weakest option for African American participants.

The mediation analysis added a crucial theoretical layer. For Hispanic/Latino participants, exposure to the dark brown materials compared with white ones had a significant indirect effect on ALM knowledge through memorability, and the index of moderated mediation confirmed that race/ethnicity significantly moderated this indirect pathway. Memorability once again emerged as the key mechanism of effect, consistent with the theory of memorable messages, which holds that messages remembered over long periods can reshape attitudes, beliefs, and behaviors. The researchers frame their materials as disrupting messages—interventions that correct unproductive prior messaging, in this case the entrenched belief among people of color that skin cancer is not their problem. Rather than recalling information word for word, people retain the essence of memorable messages and reinterpret it across their lives, which makes memorability a powerful lever for health communication aimed at marginalized communities.

Some findings defied easy explanation, and the authors are candid about that. It was unexpected that African American participants did not respond better to light brown models than to white ones. One possibility is that African American audiences are accustomed to seeing white-skinned models in health and advertising materials and have learned to extrapolate that the information applies to them too. Another is that ALM lesions may be visually more distinct against lighter skin because of contrast. A third, more socially complex explanation involves colorism—the documented discourse around skin tone differences within African American communities—which may trigger stronger identification with dark brown models. Meanwhile, Hispanic/Latino participants were less influenced by white models despite some of them having fair skin types themselves, suggesting that identification operates through cultural and ethnic channels rather than skin tone alone. The authors note that, absent a manipulation check confirming participants perceived the models’ skin tones as intended, they cannot rule out that the conditions differed in perceived representation in unanticipated ways.

The practical implications are concrete. Patient education materials designed for Hispanic/Latino audiences should depict models with either light brown or dark brown skin, while materials for African American audiences should feature dark brown or white models. Beyond that, the study charts a methodological path forward: qualitative interviews to understand how people construct meaning from these visuals, paired with psychophysiological measures such as eye tracking, physiological arousal, and facial expression analysis to verify that participants actually attend to and process model skin tone. The authors also acknowledge limitations—no behavioral outcomes were measured, the mediation analysis relied on cross-sectional data, three skin tone categories cannot represent every shade, and the visual knowledge questions used wording that may have introduced ambiguity. Still, the core message stands: in the fight against a melanoma that hides on palms, soles, and nailbeds, who appears in the picture can determine whether the warning is remembered at all.

Subject of Research: Targeted visual health communication for acral lentiginous melanoma awareness among Hispanic/Latino and African American populations

Article Title: The effectiveness of targeted visuals: Improving awareness of acral lentiginous melanoma among Hispanic and African American participants

Article References: Pokharel, M., John, K. K., Liao, Y., Wu, Y. P., & Jensen, J. D. (2026). The effectiveness of targeted visuals: Improving awareness of acral lentiginous melanoma among Hispanic and African American participants. Journal of Behavioral Medicine. https://doi.org/10.1007/s10865-026-00716-9

Image Credits: AI Generated

DOI: 10.1007/s10865-026-00716-9

Keywords: acral lentiginous melanoma, patient education materials, skin tone, Hispanic/Latino health, African American health, memorable messages, demographic targeting, health communication, skin cancer disparities, visual knowledge, melanoma awareness, Fitzpatrick skin type scale

The investigation draws its power from an unusual and ambitious source: the All of Us Research Program, the National Institutes of Health’s effort to gather health data from one million or more people across the United States, with deliberate oversampling of groups that have historically been underrepresented in biomedical research. The researchers analyzed the program’s Controlled-Tier Dataset, release version 8.0, which combines participant-provided survey information with electronic health record data in a de-identified form accessible to approved researchers through the NIH Researcher Workbench. Because All of Us participants consented at enrollment to secondary research use of their survey and electronic health record data, the team could examine patterns of care access among skin cancer survivors who also identify as sexual or gender minorities, a population too small and too dispersed to study efficiently at any single medical center.

Why does this population warrant special scrutiny? The answer lies in a growing body of evidence suggesting that sexual and gender minority individuals may carry elevated dermatologic risk. A 2026 review by Irfan and Peebles in the JAAD Reviews series examined skin cancer prevalence and risk behaviors among sexual or gender minority individuals, adding to earlier concerns catalogued by Kratzer and colleagues in a sweeping 2024 Cancer paper on cancer in people who identify as lesbian, gay, bisexual, transgender, queer, or gender-nonconforming. Behavioral risk profiles matter here: patterns of indoor tanning use, ultraviolet exposure, and other skin-cancer-related behaviors have been reported to differ by sexual orientation and gender identity, and some subgroups appear to bear disproportionate exposure. If risk is elevated, then equitable access to dermatologic surveillance and treatment becomes a matter of basic cancer-control equity, not merely a question of comfort or courtesy in the clinic.

The barriers the study set out to measure are not hypothetical. Prior work has documented that transgender people in particular frequently avoid healthcare altogether because they anticipate discrimination, a finding established by Kcomt, Gorey, Barrett, and McCabe in a 2020 analysis published in SSM – Population Health. That study framed the problem as a call to create trans-affirmative care environments, noting that avoidance driven by expected mistreatment can delay screenings, interrupt chronic disease management, and allow treatable conditions to progress. For a skin cancer survivor, whose prognosis depends heavily on early detection of recurrences and new primary tumors, any systematic tendency to postpone or skip dermatologic follow-up carries measurable clinical consequences. Delayed surveillance can mean that a thin, highly curable melanoma is instead caught at a thicker, more dangerous stage.

Financial pressure compounds the problem. In 2023, Supapannachart, Chu, Chen, and Yeung, publishing in this same journal, analyzed population-based survey data from 2011 to 2018 and documented the burden of financial toxicity in skin cancer care in the United States. Financial toxicity, the term oncologists use for the economic strain a cancer diagnosis imposes on patients and households, encompasses out-of-pocket costs for surgery and pathology, copayments for frequent surveillance visits, and the income lost to time away from work. Skin cancer survivors typically require lifelong monitoring, so these costs recur year after year. When minority stress, anticipated discrimination, and structural barriers to insurance coverage intersect with this recurring financial burden, the cumulative effect on care-seeking behavior can be substantial, particularly for patients already navigating precarious employment or unstable housing at higher rates than the general population.

Geography adds yet another layer. McKay, Lampe, Barbee, Prasad, and Gonzales reported in 2024 in Public Policy & Aging Report on an evidence-based framework for supporting older LGBTQ+ adults in rural communities, drawing on the LGBTQ+ Social Networks, Aging, and Policy Study. Their findings highlight how rural sexual and gender minority elders often contend with sparse local healthcare infrastructure, long travel distances to specialized care, and smaller, more tightly knit social networks in which disclosure of one’s identity carries real social risk. Because skin cancer incidence rises steeply with age and cumulative sun exposure, older rural survivors who are also sexual or gender minorities sit at the intersection of several vulnerability factors at once. The All of Us program’s national reach, including participants from regions where dedicated LGBTQ+ health services are scarce, makes it a fitting instrument for detecting these compounded disparities.

Methodologically, the study is a secondary analysis of de-identified controlled-tier data, a design that allowed the investigators to assemble a cohort of skin cancer survivors identified within the All of Us program and to compare patterns of reported barriers to medical care across sexual orientation and gender identity groups. The research letter format means the team reported a focused analysis rather than an exhaustive treatise, but the underlying approach reflects a broader shift in how health disparities research is conducted. Instead of recruiting patients through clinics, where the sample is already filtered by who managed to obtain care, population-level datasets capture people across the full spectrum of healthcare engagement, including those who have fallen out of the system entirely. Survey-based measures of access barriers, paired with electronic health record indicators of care utilization, offer complementary windows on the same phenomenon.

The ethical architecture of the work is also worth noting. The All of Us program operates under a centralized Institutional Review Board approval at the National Institutes of Health, which covers use of controlled-tier data, and the authors’ institutions determined that this secondary analysis did not meet the definition of human subjects research under federal regulations, requiring no additional IRB review. All participants had provided written informed consent for secondary research use of their data at enrollment. The study received no specific funding, and the authors disclosed relevant consulting and advisory relationships typical of academic dermatologists, including Dr. Yeung’s grant support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and various industry sources, none of which funded this particular study.

What makes this research letter resonate beyond dermatology is the framework it implies for cancer survivorship research as a whole. Sexual and gender minority adults are increasingly visible in cancer statistics, thanks in part to the 2024 Cancer synthesis by Kratzer and colleagues, yet survivorship care, the phase of medicine where patients spend the majority of their years after diagnosis, remains understudied in these populations. The barriers documented in adjacent literatures, from anticipated discrimination to financial toxicity to rural isolation, do not disappear once a tumor is removed; if anything, the demands of long-term surveillance raise the stakes. A survivor who avoids the dermatologist because the intake form offers no room for their identity, or because the nearest affirming provider is three hours away, or because the copay competes with rent, is a survivor whose next skin cancer may be found late.

The study’s data are available to authorized researchers through the All of Us Researcher Workbench, and the authors acknowledge that the program’s participants made the work possible. As the All of Us dataset grows with each release, analyses like this one will gain statistical power to dissect barriers with finer granularity, distinguishing, for example, between cost-related delays, discrimination-related avoidance, and transportation or insurance obstacles. For clinicians, the immediate lesson is practical: dermatology practices that serve skin cancer survivors should expect sexual and gender minority patients in their panels and should build intake, billing, and follow-up systems that do not give those patients additional reasons to disengage. For policymakers, the study adds dermatologic survivorship to the list of domains where minority stress translates into measurable healthcare inequity, and where relatively modest interventions, from inclusive electronic health record fields to tele-dermatology outreach in rural areas, could meaningfully narrow the gap.

Subject of Research: Barriers to medical care among sexual and gender minority skin cancer survivors in the United States

Article Title: Barriers to medical care among sexual and gender minority skin cancer survivors

Article References: Smith, C. A., Ohamadike, C., Deitelzweig, C., Nock, M. R., Cohen, J. M., & Yeung, H. (2026). Barriers to medical care among sexual and gender minority skin cancer survivors. Archives of Dermatological Research, 318(1), Article 499. https://doi.org/10.1007/s00403-026-04970-4

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04970-4

Keywords: skin cancer, sexual and gender minority, healthcare barriers, dermatology, cancer survivorship, All of Us Research Program, health disparities, financial toxicity, transgender health, melanoma surveillance, minority stress, rural health