JMIR Publications

ABSTRACT

Skin cancers are concerning for unsheltered people experiencing homelessness (PEH) because of their high amount of sun exposure. Currently, there is little data on the prevalence of skin cancers in PEH. Skin disease is often untreated in PEH due to lack of access to healthcare, particularly for specialists. Miami Street Medicine (MSM) is an organization that provides PEH in the Miami Health District with medical care in a non-clinical street setting, near overpasses, sidewalks, and encampments. We present a case of an unsheltered 59-year-old male with a pigmented, 2x2 cm facial lesion that had developed over 15 years. Through a teledermatology consultation, his lesion was highly suspicious for melanoma and further evaluation was recommended. Due to lack of insurance, he could not be seen at any dermatology clinic. Coincidentally two weeks later, he developed cellulitis of his lower extremity and had to be admitted to the local safety-net hospital through the Emergency Department. By coordinating with his primary inpatient team, MSM was able to include a biopsy as part of his hospital stay. The results demonstrated melanoma in situ. The vital course of action was to ensure treatment before metastasis. After registration for insurance and follow-up with a surgical oncology team, he is weeks from excision and reconstruction surgery. His unsheltered status made follow-up difficult, but MSM bridged the gap from the street to the clinical setting by incorporating teledermatology into patient evaluations, and leveraging connections with community shareholders. This case also represents the barriers to care for cancer-based dermatologic outreach among PEH.