Keeping Up in School? | NIH News in Health

Identifying Learning Problems

Reading, writing, and math are the building blocks of learning. Mastering these subjects early on can affect many areas of life, including school, work, and even overall health. It’s normal to make mistakes and even struggle a little when learning new things. But repeated, long-lasting problems may be a sign of a learning disability.

Learning disabilities aren’t related to how smart a child is. They’re caused by differences in the brain that are present from birth, or shortly after. These differences affect how the brain handles information and can create difficulties with reading, writing, and math.

“Typically, in the first few years of elementary school, some children, in spite of adequate instruction, have a hard time and can’t master the skills of reading and writing as efficiently as their peers,” says Dr. Benedetto Vitiello, a child mental health expert at NIH. “So the issue is usually brought up as a learning problem.”

In general, the earlier a learning disability is recognized and addressed, the greater the likelihood for success in school and later in life. “Initial screening and then ongoing monitoring of children’s performance is important for being able to tell quickly when they start to struggle,” explains Dr. Brett Miller, a reading and writing disabilities expert at NIH. “If you’re not actively looking for it, you can miss opportunities to intervene early.”

Each learning disability has its own signs. A child with a reading disability may be a poor speller or have trouble reading quickly or recognizing common words. A child with a writing disability may write very slowly, have poor handwriting, or have trouble expressing ideas in writing and organizing text. A math disability can make it hard for a child to understand basic math concepts (like multiplication), make change in cash transactions, or do math-related word problems.

Learning difficulties can affect more than school performance. If not addressed, they can also affect health. A learning disability can make it hard to understand written health information, follow a doctor’s directions, or take the proper amount of medication at the right times. Learning disabilities can also lead to a poor understanding of the benefits of healthy behaviors, such as exercise, and of health risks, such as obesity. This lack of knowledge can result in unhealthy behaviors and increased risk of disease.

Not all struggling learners have a disability. Many factors affect a person’s ability to learn. Some students may learn more slowly or need more practice than their classmates. Poor vision or hearing can cause a child to miss what’s being taught. Poor nutrition or exposure to toxins early in life can also contribute to learning difficulties.

If a child is struggling in school, parents or teachers can request an evaluation for a learning disability. The U.S. Individuals with Disabilities Education Improvement Act requires that public schools provide free special education support to children, including children with specific learning disabilities, who need such services. To qualify for these services, a child must be evaluated by the school and meet specific federal and state requirements. An evaluation may include a medical exam, a discussion of family history, and intellectual and school performance testing.

Many people with learning disabilities can develop strategies to cope with their disorder. A teacher or other learning specialist can help kids learn skills that build on their strengths to counter-balance their weaknesses. Educators may provide special teaching methods, make changes to the classroom, or use technologies that can assist a child’s learning needs.

A child with a learning disability may also struggle with low self-esteem, lack of confidence, and frustration. In the case of a math learning disability, math anxiety may play a role in worsening math abilities. A counselor can help children use coping skills and build healthy attitudes about their ability to learn.

“If appropriate interventionsActions taken to prevent or treat a disorder or to improve health in other ways. are provided, many of these challenges can be minimized,” explains Dr. Kathy Mann Koepke, a math learning disability expert at NIH. “Parents and teachers should be aware that their own words and behavior around learning and doing math are implicitly learned by the young people around them and may lessen or worsen math anxiety.”

“We often talk about these conditions in isolation, but some people have more than one challenge,” Miller says. Sometimes children with learning disabilities have another learning disorder or other condition, such as attention deficit hyperactivity disorder (ADHD).

“ADHD can be confused with a learning problem,” Vitiello says. ADHD makes it difficult for a child to pay attention, stay focused, organize information, and finish tasks. This can interfere with schoolwork, home life, and friendships. But ADHD is not considered a learning disability. It requires its own treatments, which may include behavior therapy and medications.

“Parents play an important role in treatment, especially for children in elementary school,” Vitiello says. Medications and behavioral interventions are often delivered
at home. Teachers can usually advise parents on how to help kids at home, such as by scheduling appropriate amounts of time for learning-related activities. Parents can also help by minimizing distractions and encouraging kids to stay on task, such as when doing homework. Effective intervention requires consistency and a partnership between school and home.

Many complex factors can contribute to development of learning disabilities. Learning disorders tend to run in families. Home, family, and daily life also
have a strong effect on a child’s ability to learn starting from a very early age. Parents can help their children develop skills and build knowledge during the first few
years of life that will support later learning.

“Early exposure to a rich environment is important for brain development,” Mann Koepke says. Engage your child in different learning activities from the start. Before they’re even speaking, kids are learning. “Even if it’s just listening and watching as you talk about what you’re doing in your daily tasks,” she says.

Point out and talk with children about the names, colors, shapes, sizes, and numbers of objects in their environment. Try to use comparison words like “more than” or “less than.” This will help teach your child about the relationships between things, which is important for learning math concepts, says Mann Koepke. Even basic things, like getting enough sleep and eating a healthy diet, can help children’s brain development and their ability to learn.

NIH is continuing to invest in research centers that study learning challenges and their treatments, with a special focus on understudied and high-risk groups.

Although there are no “cures,” early interventions offer essential learning tools and strategies to help lessen the effects of learning disabilities. With support from caregivers, educators, and health providers, people with learning disabilities can be successful at school, work, and in their personal lives.

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Mayo Clinic SURF program: Tamiel Turley’s Story

Meet Tamiel Turley, a senior at Texas Woman’s University who spent 10 weeks away from her family this past summer as a participant in the prestigious Mayo Clinic Summer Undergraduate Research Fellowship (SURF).

Developed by Mayo Graduate School, Mayo’s school for Ph.D. training, SURF is the first-of-its-kind initiative in the nation to bring together diverse college students from across the country for summer research apprenticeship training with Mayo Clinic scientists.

Learn more about Tamiel’s experience with the program, which exists on all Mayo campuses and receives nearly 1,200 applicants per year.

Learn more about SURF by visiting www.mayo.edu.

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What’s Living on Your Skin?

Take a closer look at the human body and the billions of bacteria that live on our skin.

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Safeguarding Our Health | NIH News in Health

Vaccines Protect Us All

We share more than food and culture within our homes and communities. We can also spread disease. Luckily, we live in a time when vaccines can protect us from many of the most serious illnesses. Staying current on your shots helps you—and your neighbors—avoid getting and spreading disease.

Vaccines have led to large reductions in illness and death for both kids and adults, says Dr. David M. Koelle, a vaccine expert at the University of Washington in Seattle. One study estimated that, among U.S. children born from 1994 to 2013, vaccines will prevent about 322 million illnesses, 21 million hospitalizations, and 732,000 deaths.

Vaccines harness your immune systemA collection of specialized cells and organs that protect the body against infectious diseases.’s natural ability to detect and destroy disease-causing germs and then “remember” the best way to fight these germs in the future. Vaccination, or immunization, has completely eliminated naturally occurring smallpox worldwide—to the point that we no longer need to get shots against this fast-spreading, deadly disease. Polio has been eliminated in the U.S. and most other nations as well, thanks to immunizations. Poliovirus can affect the brain and spinal cord, leaving people unable to move their arms or legs, or sometimes unable to breathe.

“These childhood diseases used to be dreaded problems that would kill or paralyze children,” says Koelle. “In the 1950s, it was a common occurrence for kids to be fine in the spring, get polio over the summer, and then have to go back to school in the fall no longer able to walk.”

Experts recommend that healthy children and teens get shots against 16 diseases (see Wise Choices box). With these shots, many disabling or life-threatening illnesses have significantly declined in the U.S., including measles, rubella, and whooping cough. But, unlike smallpox, these disease-causing germs, or pathogens, are still causing infections around the world.

“These days, the risks of not being vaccinated in a developed country, like the United States, may seem superficially safe because of low rates of infection due to vaccination and other advances in public health,” Koelle says. “But we live in an era of international travel where we can be exposed to mobile pathogens.” So even if you don’t travel, a neighbor or classmate could go overseas and bring the disease back to your area.

“When the rates of vaccination drop, there can be a resurgence of the disease,” explains Dr. Saad Omer, a global health researcher at Emory University in Atlanta. For instance, measles was completely eliminated in the U.S. in 2000. But since then, thousands of cases have occurred, mostly related to travel.

Omer and colleagues examined U.S. reports on measles outbreaks since 2000. “We found that measles cases have occurred mostly in those who are not vaccinated and in communities that have lower rates of vaccination. And that’s true for many vaccine-preventable diseases,” he says. Most of the unvaccinated cases were those who chose not to be vaccinated or not have their children vaccinated for non-medical reasons.

When enough people are vaccinated, the entire community gains protection from the disease. This is called community immunity. It helps to stop the spread of disease and protects the most vulnerable: newborns, the elderly, and people fighting serious illnesses like cancer. During these times, your immune system is often too weak to fend off disease and may not be strong enough for vaccinations. Avoiding exposure becomes key.

“There’s a huge benefit to all of us getting the recommended vaccines,” explains Dr. Martha Alexander-Miller, an immune system expert at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. “Number one, vaccines protect you. But they also limit the presence of disease-causing entities that are circulating in the community. So, you’re helping to protect individuals who may not be capable of protecting themselves, for example because they are too young to get vaccinated.”

When expectant moms are vaccinated, immune protection can pass through the placenta to the fetus. “Early on, the baby’s immune system is immature. So there’s a period of vulnerability where disease and death can occur,” Omer explains. “But the mother’s own antibodies—proteins formed by her immune system—can protect the baby.”

Doctors recommend that moms-to-be get both flu and Tdap (tetanus, diphtheria, and whooping cough) shots. A mother’s antibodies can help protect the newborn until they can receive their own vaccinations.

Some vaccines must be given before pregnancy. Rubella, for instance, can cause life-altering birth defects or miscarriage if contracted during pregnancy. There’s no treatment, but the measles, mumps, and rubella (MMR) vaccine offers prevention. Vaccines for many other common diseases that put newborns at risk are being studied.

“We’ve made amazing progress in the development of effective vaccines,” says Alexander-Miller. “Our ability to have such breakthroughs is the end result of very basic research that went on for years and years.” NIH-funded scientists continue to search for new ways to stimulate protection against various diseases.

Koelle studies how our bodies fight herpes viruses. There are eight related herpes viruses, but the body responds differently to each one. So far, we only have vaccines for one: varicella-zoster virus, which causes chickenpox and shingles.

Koelle’s team is comparing how our immune system responds to chickenpox and the herpes simplex viruses, which cause mouth and genital sores. “We’re hoping to harness the success that has been possible with the chickenpox vaccine and see if we can create a vaccine that would work for both chickenpox and shingles and also herpes simplex,” he says.

Researchers are also working to improve existing vaccines. Some vaccines require a series of shots to trigger a strong immune response. The protection of other vaccines can fade over time, so booster shots may be needed. Some, like the flu vaccine, require a shot each year because the virus changes so that the vaccine no longer protects against new strains. So keeping up with the latest flu vaccines is important.

Ask your doctor’s office whether your vaccinations are current. You may also find records of vaccinations at your state health department or schools. If you can’t find your records, ask your doctor if it’s okay to get a vaccine you might have received before.

Most side effects of vaccines are mild, such as a sore arm, headache, or low-grade fever.

“It can be easy to take vaccines for granted, because you’ll never know all the times you would’ve gotten really sick had you not been vaccinated,” says Alexander-Miller.

Help your community keep diseases at bay: Stay up-to-date with vaccines.

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Somatic Symptom Disorders Part I: New Terminology for New Concepts

Dr. Jeffrey Staab, Mayo Clinic Psychiatrist, discusses the concepts that led to the development of the new terminology for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In DSM-4 somatic symptom disorders were defined negatively, by what they were not. Conversely, the DSM-5 emphasizes a couple core somatic symptom disorders and identifies the key features that can help determine the presence of these disorders. The DSM-5 looks to identify patterns of symptoms that can be identified positively, not the absence of a medical explanation or presumption of a psychological conflict. The change in nomenclature is the next step in the ever-evolving definition of these disorders.

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What Is Type 2 Diabetes?

Diabetes is when your body doesn’t process sugar the right way. But what does that mean exactly? When you have type 2 diabetes, your blood sugar level is too high. Here’s how it works.

Quiz: Myths and Facts About Type 2 Diabetes http://wb.md/2iCvBKv

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Fibromuscular Dysplasia: A Mystery of Vascular Medicine

Mayo Clinic vascular specialists, Robert McBane, M.D., Thom Rooke, M.D., Sanjay Misra, M.D., and Iftikhar Kullo, M.D., cover the rare disorder fibromuscular dysplasia in this video originally posted on Medscape Cardiology.

For more information visit: http://www.mayoclinic.org/diseases-conditions/fibromuscular-dysplasia/basics/definition/con-20034731/?mc_id=youtube

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What Are the Symptoms of a Blood Clot in Your Lung?

A blockage in your lung is serious, so it’s important to spot the signs and get medical help. Learn about what exactly a pulmonary embolism is and what to look for.

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Skin conditions by the numbers

 

Acne

  • Acne is the most common skin condition in the United States, affecting up to 50 million Americans annually.1
  • Acne usually begins in puberty and affects many adolescents and young adults.
    • Approximately 85 percent of people between the ages of 12 and 24 experience at least minor acne.2
  • Acne can occur at any stage of life and may continue into one’s 30s and 40s.3-5
    • Acne occurring in adults is increasing, affecting up to 15 percent of women.3-5
  • In 2013, the costs associated with the treatment and lost productivity among those who sought medical care for acne exceeded $1.2 billion.6
    • More than 5.1 million people sought medical treatment for acne in 2013, primarily children and young adults.6
    • The lost productivity among patients and caregivers due to acne was nearly $400 million.6

Atopic dermatitis

  • Atopic dermatitis affects nearly 28 million Americans of all ages.7
    • It affects up to 25 percent of children and 2 to 3 percent of adults.8
  • An estimated 60 percent of people with this condition develop it in their first year of life, and 90 percent develop it before age 5. However, atopic dermatitis can begin during puberty or later. 8-9
  • In 2013, the costs associated with the treatment and lost productivity among those who sought medical care for atopic dermatitis was $442 million.6
    • The total medical cost of treating atopic dermatitis was $314 million, for an average of $101.42 per treated patient.6
    • The lost productivity among patients and caregivers due to atopic dermatitis was $128 million.6

Hair loss

Psoriasis

  • Approximately 7.5 million people in the United States have psoriasis.13
  • Psoriasis occurs in all age groups but is primarily seen in adults, with the highest proportion between ages 45 and 64.6
  • Up to 40 percent of people with psoriasis experience joint inflammation that produces symptoms of arthritis. This condition is called psoriatic arthritis.14-16
  • Approximately 80 percent of those affected with psoriasis have mild to moderate disease, while 20 percent have moderate to severe psoriasis affecting more than 5 percent of the body surface area.13
  • The most common form of psoriasis, affecting about 80 to 90 percent of psoriasis patients, is plaque psoriasis. It is characterized by patches of raised, reddish skin covered with silvery-white scale.13
  • In 2013, the total direct cost of treatment associated with psoriasis was estimated to be between $51.7 billion and $63.2 billion.6

Rosacea

  • Rosacea is a common skin disease that affects 16 million Americans.17-19
  • While people of all ages and races can develop rosacea, it is most common in the following groups:
    • People between age 30 and 60.20
    • Individuals with fair skin, blond hair and blue eyes.20-21
    • Women, especially during menopause.20
    • Those with a family history of rosacea.21
  • In 2013, the costs associated with the treatment and lost productivity among those who sought medical care for rosacea was $243 million.6
    • More than 1.6 million people sought treatment for rosacea in 2013.6
    • The total medical cost of treating rosacea was $165 million, for an average of $102.26 per treated patient.6
    • The lost productivity among patients and caregivers due to rosacea was $78 million.6

Skin cancer

  • Skin cancer is the most common cancer in the United States.22-23
  • It is estimated that more than 9,500 people in the U.S. are diagnosed with skin cancer every day.24-26
  • The majority of diagnosed skin cancers are NMSCs. Research estimates that NSMC affects more than 3 million Americans a year.6, 24
  • The overall incidence of BCC increased by 145 percent between 1976-1984 and 2000-2010, and the overall incidence of SCC increased 263 percent over that same period.27
    • Women had the greatest increase in incidence rates for both types of NMSC.27
    • NMSC incidence rates are increasing in people younger than 40.27
  • More than 1 million Americans are living with melanoma.28
  • It is estimated that 178,560 new cases of melanoma, 87,290 noninvasive (in situ) and 91,270 invasive, will be diagnosed in the U.S. in 2018.25-26
    • Invasive melanoma is projected to be the fifth most common cancer for men (55,150 cases) and the sixth most common cancer for women (36,120 cases) in 2018.25-26
  • Melanoma rates in the United States doubled from 1982 to 2011.23
  • Caucasians and men older than 50 have an increased risk of developing melanoma compared to the general population.25-26
  • Melanoma is the second most common form of cancer in females age 15-29.29
    • Melanoma incidence is increasing faster in females age 15-29 than in males of the same age group.30
  • Skin cancer can affect anyone, regardless of skin color.
    • Skin cancer in patients with skin of color is often diagnosed in its later stages, when it’s more difficult to treat.30-31
      • Research has shown that patients with skin of color are less likely than Caucasian patients to survive melanoma.32
    • People with skin of color are prone to skin cancer in areas that aren’t commonly exposed to the sun, like the palms of the hands, the soles of the feet, the groin and the inside of the mouth. They also may develop melanoma under their nails.31
  • On average, one American dies of melanoma every hour. In 2018, it is estimated that 9,320 deaths will be attributed to melanoma — 5,990 men and 3,330 women.25-26
  • The five-year survival rate for people whose melanoma is detected and treated before it spreads to the lymph nodes is 99 percent.25-26
  • The five-year survival rate for melanoma that spreads to nearby lymph nodes is 63 percent. The five-year survival rate for melanoma that spreads to distant lymph nodes and other organs is 20 percent.25-26
  • The annual cost of treating skin cancers in the U.S. is estimated at $8.1 billion — about $4.8 billion for NMSC and $3.3 billion for melanoma.22

1Bickers DR, Lim HW, Margolis D, Weinstock MA, Goodman C, Faulkner E et al. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. Journal of the American Academy of Dermatology 2006;55:490-500.

2Bhate K, Williams HC. Epidemiology of acne vulgaris. The British journal of dermatology 2013;168:474-85.

3Holzmann R , Shakery K. Postadolescent acne in females. Skin pharmacology and physiology 2014;27 Suppl 1:3-8.

4Khunger N , Kumar C. A clinico-epidemiological study of adult acne: is it different from adolescent acne? Indian journal of dermatology, venereology and leprology 2012;78:335-41.

5Tanghetti EA, Kawata AK, Daniels SR, Yeomans K, Burk CT , Callender VD. Understanding the Burden of Adult Female Acne. The Journal of Clinical and Aesthetic Dermatology 2014;7:22-30.

6American Academy of Dermatology/Milliman. Burden of Skin Disease. 2017. www.aad.org/BSD.

7Adelaide HA. Review of Pimecrolimus Cream 1% for the Treatment of Mild to Moderate Atopic Dermatitis. Clinical Therapeutics. 2006; 28(12):1972-1982.

8Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014 Feb;70(2):338-51.

9Beltrani VS, Boguneiwicz M. Atopic dermatitis. Dermatol Online J 2003;9(2):1.

10Rossi A, Anzalone A, Fortuna MC, Caro G, Garelli V, Pranteda G et al. Multi-therapies in androgenetic alopecia: review and clinical experiences. Dermatologic therapy 2016;29:424-32.

11Genetics Home Reference. National Institutes of Health U.S. Library of Medicine. https://ghr.nlm.nih.gov/condition/androgenetic-alopecia#statistics. Accessed March 30, 2018.

12Dainichi T , Kabashima K. Alopecia areata: What’s new in epidemiology, pathogenesis, diagnosis, and therapeutic options? Journal of dermatological science 2017;86:3-12.

13Menter A, Gottlieb A, Feldman SR, Van Voorhees AS et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol 2008 May;58(5):826-50.

14National Institutes of Health /NIAMS http://www.niams.nih.gov/Health_ Info/Psoriasis/default.asp (last accessed June 1, 2013).

15National Psoriasis Foundation – http://www.psoriasis.org/about/ (last accessed June 1, 2013).

16Gottlieb A, Korman NJ, Gordon KB, Feldman SR et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol 2008 May;58(5):851-64

17Steinhoff, M., Schauber, J., and Leyden, J.J. New insights into rosacea pathophysiology: a review of recent findings. J Am Acad Dermatol. 2013; 69: S15–S26

18Elewski, B.E., Draelos, Z., Dréno, B., Jansen, T., Layton, A., and Picardo, M. Rosacea – global diversity and optimized outcome: proposed international consensus from the Rosacea International Expert Group. J Eur Acad Dermatol Venereol. 2011; 25: 188–200

19Okhovat, J.-P. and Armstrong, A.W. Updates in rosacea: epidemiology, risk factors, and management strategies. Curr Dermatol Rep. 2014; 3: 23–28

20Rosacea. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/rosacea#tab-risk.

21Abram K, Silm H, Maaroos H-I and Oona M. Risk factors associated with rosacea. Journal of the European Academy of Dermatology and Venereology. 2010; 24 (5): 565-571

22Guy GP, Machlin SR, Ekwueme DU, Yabroff KR. Prevalence and costs of skin cancer treatment in the US, 2002-2006 and 2007-2011. Am J Prev Med. 2015;48:183–7.

23Guy GP, Thomas CC, Thompson T, Watson M, Massetti GM, Richardson LC. Vital signs: Melanoma incidence and mortality trends and projections—United States, 1982–2030. MMWR Morb Mortal Wkly Rep. 2015;64(21):591-596.

24Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the US population. JAMA Dermatol. Published online April 30, 2015.

25American Cancer Society. Cancer Facts and Figures 2018. Atlanta: American Cancer Society; 2018

26Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018; doi: 10.3322/caac.21442.

27Muzic, JG et al. Incidence and Trends of Basal Cell Carcinoma and Cutaneous Squamous Cell Carcinoma: A Population-Based Study in Olmstead County, Minnnesota, 2000-2010. Mayo Clin Proc. Published Online May 15, 2017. http://dx.doi.org/10.1016/j.mayocp.2017.02.015

28SEER Cancer Stat Facts: Melanoma of the Skin. National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/statfacts/html/melan.html

29NAACCR Fast Stats: An interactive quick tool for quick access to key NAACCR cancer statistics. North American Association of Central Cancer Registries. http://www.naaccr.org/. (Accessed on 3-10-2016).

30Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, et al (eds). SEER Cancer Statistics Review, 1975-2012, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER website April 2015.

31Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, Roberts WE, Draelos ZD, Bhushan R, Taylor SC, Lim HW. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748-62.

32Dawes SM et al. Racial disparities in melanoma survival. J Am Acad Dermatol. 2016 Nov; 75(5):983-991.

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