Underrepresentation of Black Individuals in Basal Cell and Squamous Cell Carcinoma Clinical Trials: A Comparison to an Insurance Claimant Cohort

Background Black patients often present with advanced skin cancer with worse outcomes compared to White patients. Underrepresentation of Black individuals in US basal cell carcinoma and cutaneous squamous cell carcinoma clinical trials may exacerbate these disparities. Objectives We aim to quantify this underrepresentation. Methods The proportions of Black participants in basal cell and squamous cell carcinoma clinical trials on ClinicalTrials.gov were compared to those of an insured cohort using χ 2 tests. A prevalence estimate from the American Cancer Society was used to estimate the number of unrepresented US Black basal cell and squamous cell carcinoma patients diagnosed annually. Results Black individuals are significantly underrepresented in basal cell ( χ 2 [1, N = 619,982] = 39.358, p < 0.0001) and squamous cell carcinoma ( χ 2 [1, N = 368,160] = 28.121, p < 0.0001) clinical trials. Only 0.64% of basal cell and 1.4% of squamous cell carcinoma clinical trial participants are Black. Consequently, an estimated 85% and 66% of Black individuals diagnosed annually with basal cell and squamous cell carcinoma, respectively, are unrepresented in clinical trials. Conclusion Black patients are underrepresented in US skin cancer clinical trials, limiting the generalizability of trial results to the US population.