Skin cancer presents an increasingly dangerous health problem and poses potentially worse outcomes for minority patients. Delays in care can lead to tragic outcomes. At LA Health Services, the Dermatology program has taken a novel approach to ensure rapid access to care through eConsult and a new navigation program to ensure patients do not fall out of care.

Skin cancer rates have risen dramatically, up 77% from 1994 to 2014.  Here at LA Health Services we care for approximately 2,100 patients who have had skin cancer (ELM Registry, pulled 12/27/21). One of the most deadly skin cancers is melanoma. Although most patients with melanoma are non-Hispanic Whites, minorities consistently suffer worse melanoma-specific survival (J Am Acad Dermatol. 2021 June ; 84(6): 1585–1593). In fact, a study from 2021 analyzing 381,035 patients, revealed that racial disparity in survival from melanoma is worsening. All minority patients (Hispanic, non-Hispanic Black, non-Hispanic Asian or Pacific Islander (NHAPI), and non-Hispanic American Indian/Alaska Native patients) suffered increasing worse survival rates when compared to non-Hispanic White patients.

Worse health outcomes are associated with delayed access to specialty care, which potentially contributes to health disparities across socioeconomic groups (J Multidiscip Healthc. 2018; 11: 109–119). Dermatology is a specialty that tends to be in high demand, with skin cancer management and monitoring an important issue. Since 2018, skin cancer has been a strong priority for the LA Health Services Dermatology workgroup. A 2019 Quality Improvement Project led by Dr. Lori Hobbs with coaching from Ola Thomas, RN at Martin Luther King, Jr. Outpatient Center demonstrated the power of navigation. The strong work by Jacqueline Macaraeg, NP and La Shante Willis, LVN, improved outcomes with an increase to 96 percent for patient follow-up. Building on this concept, the Dermatology Nurse Navigation Program was approved for Fiscal year 2022 by LA Health Services and Los Angeles County Leadership as part of an LA Health Services Dermatology Expansion plan.

The full Dermatology Nurse Navigation program envisions using data and population information from ORCHID to create a registry that will then be managed by nurses across the system. This effort is currently under development, starting with identifying patients with skin cancer from electronic medical records. The effort is being led by Dr. David Engel and Mr. Praveen Gadde and validation by Lana Knyazeva, RN and Abe Abraham, LVN. Additional project management expertise is welcomed from Bahar Basseri.  While skin cancer navigation is only one aspect to improve overall care, it is an important strategy to improve health outcomes for our patients and close gaps in health disparities for LA County.

For more information on the skin cancer navigation project, and how nurse navigation is improving access for dermatology services, contact Dr. Delphine Lee, Director of DHS Dermatology Service Line at DLee6@DHS.lacounty.gov.