Political determinants of melanoma: Global inequities in skin cancer care

Background: Melanoma outcomes differ across countries, income settings, and skin tones, reflecting not only variable environmental and genetic risks but also upstream political determinants of health that shape exposure, access, and resources. Objective: To apply the 3-I framework (Interests, Ideas, and Institutions) to synthesize global melanoma inequities and identify actionable dermatologic implications. Methods: A narrative review of the literature (1990-2025) examined melanoma, inequities, health-system and political determinants, financing, therapies, and global and low- and middle-income country (LMIC) contexts, mapping sources to the 3-I framework. Results: Interests of governments, payers, and industry determine financing priorities, creating access gaps to immunotherapy, surgery, and pathology, particularly in LMICs and underinsured US populations. Ideas in clinical trials, artificial intelligence tools, and education underrepresent skin of color and LMIC contexts. Institutions, including segregation, colonial legacies, and centralized services, create structural barriers to timely evaluation and treatment. Examples from Australia, the US, India, and African contexts reveal recurring patterns. Conclusions: The 3-I framework (Interests, Ideas, and Institutions) identifies levers (equitable financing expansion, inclusive evidence generation, and institutional reform) through which dermatologists can promote earlier detection and equitable care via total body skin examinations for all skin tones and advocacy for covered, integrated skin cancer screening in primary care and high-risk clinic networks.