Make A Difference: Start Checking Your Skin Today
People of color have a lower risk than whites of getting skin cancer. But they still have a risk. Monthly skin self-exams can help you find skin cancer early when a cure is likely.
ImagesImages 3 11: Used with permission of Journal of the American Academy of Dermatology:
Images 3, 4, 9, 10, and 11: J Am Acad Dermatol. 2014 70:748-62.
Images 5, 6, 7, and 8: J Am Acad Dermatol. 2006 55:741-60.
Image 12: Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
ReferencesAgbai ON, MD, Buster K, et al. Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public. J Am Acad Dermatol 2014 70:748-62.
American Academy of Dermatology. Dermatologists provide recommendations for preventing and detecting skin cancer in people of color. News release issued February 4, 2014.
Gloster HM and Neal K. Skin cancer in skin of color. J Am Acad Dermatol 2006 55:741-60.
Q: Does Uv Radiation Play A Role In These Cancers That Turn Up In Spots Where The Sun Doesnt Shine
We dont fully understand the risk factors for acral melanomas acral meaning on the hands and feet but sun is less likely to be a factor. In melanomas on the whole, UV radiation is certainly a major risk factor, and we see plenty of UV-induced melanomas and squamous cell carcinomas in people of color, who can have a wide range of complexions, from very fair to very dark. But the proportion of skin cancers that occur in non-sun-exposed sites is greater in darker-skinned populations.
Q: Prevention Is Key What Are The Challenges
Multiple studies show much less frequent use of sunscreen among people of color. The most important rule, as with everyone, is simply to make sure you use it. Nuances arise in helping darker-skinned patients overcome some of the aesthetic barriers to use. The mineral-based sunscreens that are least irritating often create an ashen look, with residue, and thats a big obstacle. Patients constantly ask, What sunscreen can I use thats going to be acceptable for my skin? Ive found that the sophisticated formulations that have nanoparticles, where the zinc oxide and titanium dioxide have been micronized to limit the chalky look, tend to work well on darker skin tones. Theres been a general call to action in the industry to test sunscreen formulations on diverse populations in order to establish cosmetic acceptability across a range of skin types and complexions.
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How Melanoma Strikes People Of Color
Skin cancer is the most common form of cancer. Two types, basal cell carcinoma and squamous cell carcinoma, account for about 5 million new cases each year. Melanoma is much less common, but it’s also a lot more lethal while less than 1% of skin cancer cases are melanoma, it causes the vast majority of skin cancer deaths, according to the Skin CancerFoundation.
Although most people affected by melanoma are white men over the age of 50, reports the Melanoma Research Foundation, its actually the leading cause of cancer death in women between 25 to 30 years oldand the second most common cause of death in women between 30 and 35.
Theres a dangerous misconceptionone which St. Ange also believedthat skin cancer, particularly melanoma, only targets people with fair skin and light eyes and hair, not those of color. Supposedly, the additional melanin darker-skinned people have offers more protection against the sun.
Thats true, to a point. On one hand, people with darker skin do have added protection from sun damage a 2017 study published in the Journal of the American Academy of Dermatology found that the melanin in black skin provides an SPF approximately equivalent to 13.4, compared with an SPF of 3.4 in white skin.
Even so, that extra protection isn’t enough to prevent skin cancer. Nearly 90% of melanoma cases are due to exposure to UV light. So if you spend any time in the sun, no matter the color of your skin, youre upping your chances of skin cancer.
Why Is Skin Cancer Less Common In Black People
To understand why skin cancer is less common in Black people, its important to understand a little skin biology.
Normally, all skin contains a pigment called melanin. However, compared with white skin, black skin has a higher amount of melanin.
Higher amounts of melanin absorb or reflect more UV rays from the sun, helping to better protect skin cells from harm. This level of protection isnt present in white skin, making it more vulnerable to damage from UV rays.
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The Prevalence Of Melanoma On Dark Skin
Cancer on white skin represents approximately 40% of all cancers, while on dark skin, they amount to about 2%. However, its prevalence on black skin also varies based on the region of the world. For example, on black skin subjects, melanoma diagnosis varies from 0.5 to 1.8 out of 100,000 in South Africa as opposed to 24.4 in light skin subjects. Its prevalence is 0.7 out of 100,000 in Togo and 1.6 out of 100,000 in the United States.
What About Skin Cancer
Darker skin tones are less likely to develop sun-induced skin cancers than lighter skin tones, but less is not never.
The number of sunburns, particularly the number of childhood sunburns, appears to be an important risk factor for the development of skin cancer. In addition, darker-skinned individuals develop less UV damage from equivalent amounts of sun exposure compared to lighter skin counterparts.
However, I have diagnosed basal cell carcinomas, squamous cell carcinomas, and melanoma in darker-skinned individuals. In fact, skin cancers tend to be diagnosed at later stages with worse outcomes in darker skin tones. Remember that Fitzpatrick V and VI individuals have a baseline SPF of 7-10. This is far less than the SPF 30 thats recommended by the American Academy of Dermatology. Although sunburns are rare, chronic, cumulative sun damage still occurs in darker skin tones. There are also other risk factors for skin cancers.
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Q: What About Vitiligo Which Is Sort Of Like The Flip Side Of Hyperpigmentation In That Its Primary Characteristic Is Patches Of Color
About 150,000 Americans are treated annually for vitiligo. While the condition affects people across all ethnic groups worldwide, it is of course more visually obvious in people of color. Vitiligo patients are at higher risk for sunburns, but their rates of melanoma and nonmelanoma skin cancers are lower than would be expected. Thats not to say that people with vitiligo wont get skin cancer, but the likelihood is no greater than among the population as a whole, thanks to various immunologic and genetic factors.
Are There Any Early Skin Cancer Signs I Should Watch For
Regularly taking a look at your skin can go a long way when it comes to identifying skin cancer early.
Remember, sun isnt the only skin cancer culprit. You can develop skin cancer in areas of your body that arent typically exposed to sunlight.
Youve probably heard about these common signs:
- large, changing, or asymmetrical moles
- sores or bumps that bleed, ooze, or curst
- unusual-looking skin patches that dont heal
All of the above are indeed things to look out for on visible parts of the body. But people with darker skin are to a type of cancer called acral lentiginous melanoma . It presents itself in spots on slightly hidden places, such as:
- the hands
- soles of the feet
- under the nails
Darker-skinned people are also encouraged to look in their mouth for abnormalities as well as elsewhere for the following:
- dark spots, growths, or patches that appear to be changing
- patches that feel rough and dry
- dark lines underneath or around fingernails and toenails
Give your skin a check once a month. Follow up with a dermatologist at least once a year to stay on top of things.
Sufficiently protecting your skin from the suns rays is key in preventing sunburn.
Here are the basics to follow:
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What Are The Symptoms Of Skin Cancer In Black People
The main symptom of skin cancer is a change in an area of skin. This sounds very general, so lets dive deeper into some general qualities to look for.
Not all skin cancers appear the same. Its possible that a cancerous area could have one, a few, or all the characteristics listed below.
Whats important is that you make an appointment with a dermatologist if you have concerns about a certain area. They can evaluate the area to help determine whether it may be skin cancer.
How Is Skin Cancer Treated
Overall, the treatment thats recommended for skin cancer depends on factors like the type of cancer, its stage, and where its located on your body.
Surgery is often used as a treatment for many types of skin cancer, particularly if cancer hasnt spread to other areas. There are several types of procedures that may be used:
- Excision.Excision uses a small blade to cut away the affected area.
- Curettage and electrodesiccation. In curettage and electrodesiccation, a sharp tool called a curette is used to remove the cancerous area. Then, a tool that generates an electric current is used to burn and kill remaining cancer cells and stop bleeding.
- Cryosurgery.Cryosurgery uses a special instrument to freeze and kill cancerous cells in the affected area.
- Mohs surgery.Mohs surgery aims to remove as little tissue as possible. Its often used for areas like the face, genitals, and fingers. Small layers of tissue are removed. Each layer is checked under a microscope for cancer cells until no cancer cells are observed.
There are also other treatments that may be used in addition to or instead of surgery, particularly if cancer has spread to other parts of the body. Some examples include:
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Treatment For Skin Cancer
For the most part, skin cancer is treated the same way indark-skinned people as it is in those with lighter skin.
It begins with surgery to remove the cancer. However, takingadditional precautions can reduce scarring in people with darker skin, as theytend to suffer from thick scars, known as keloids.
If a patient comes to me with basal cell carcinoma, whichis the most common type of skin cancer, I ask about any previous experiencewith scars, Dr. Kyei explains. The reason I ask that question is that I dontwant someone to end up with a thick scar somewhere noticeable like their face.If youre someone who tends to get thick keloids and your cancer is verysuperficial and not high-risk, we might start with a chemotherapy cream as aninitial treatment method instead of surgery.
Despite the potential for scarring, surgery is the onlytreatment method for melanoma. Melanoma is deadly, Dr. Kyei says. It has tobe cut out no matter what.
Injected steroids can sometimes help minimize scarring.
What Are The Risks Associated With Skin Cancer In Black People
Due to the fact that skin cancer is less common in Black people, some may perceive their risk of skin cancer as low. They may not seek care for potentially cancerous skin changes.
A 2018 study used focus groups to evaluate Black and Latino peoples knowledge and attitudes about skin cancer. Researchers found that:
- Many study participants perceived themselves to have a low risk of skin cancer due to having a darker skin tone or a lack of family history of skin cancer.
- Black participants reported skin cancer symptoms more inconsistently than Latino participants.
- Few study participants reported regular use of sun protection behaviors.
Many times, skin cancer isnt diagnosed in Black people until its later stages. In fact, according to the American Academy of Dermatology, 25 percent of melanomas in Black people are diagnosed after the cancer has already spread to surrounding lymph nodes.
Receiving a diagnosis at a later stage can make skin cancer much harder to treat. It can also negatively impact outlook.
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A Dermatologist Discusses How Often A Mole With Melanoma Is A Black Color
I wondered how common is it that a melanoma lesion is black not dark brown, but true black. And can a perfectly normal mole be black?
Yes, normal moles can be black, more commonly in darker skinned individuals, says Dr. Rebecca Baxt, a board certified dermatologist with Baxt CosMedical.
Most moles are brown, but some can be pink or black, continues Dr. Baxt. Generally, darker skinned people get darker moles fair skinned people get lighter moles.
The general rule is if its new or changing, it needs to be evaluated by a doctor, preferably a dermatologist.
If the mole has changed and turned black, that mole needs a biopsy to rule out melanoma.
Melanoma can definitely appear black .
Signs And Symptoms Of Melanoma
The most common sign of melanoma is the appearance of a new mole or a change in an existing mole.
This can happen anywhere on the body, but the most commonly affected areas are the back in men and the legs in women.
Melanomas are uncommon in areas that are protected from sun exposure, such as the buttocks and the scalp.
In most cases, melanomas have an irregular shape and are more than 1 colour.
The mole may also be larger than normal and can sometimes be itchy or bleed.
Look out for a mole that gradually changes shape, size or colour.
Superficial spreading melanoma are the most common type of melanoma in the UK.
They’re more common in people with pale skin and freckles, and much less common in people with darker skin.
They initially tend to grow outwards rather than downwards, so they do not pose a problem.
But if they grow downwards into the deeper layers of skin, they can spread to other parts of the body.
You should see a GP if you have a mole that’s getting bigger, particularly if it has an irregular edge.
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How People Of Color Can Reduce Their Skin Cancer Risk
Dermatologists in the United States tell their patients with skin of color to reduce their risk of getting skin cancer by doing the following:
Seek shade whenever possible. The sun causes many skin cancers.
Wear clothing that protects your skin from the sun. A wide-brimmed hat can shade your face and neck. You also want to wear shoes that cover the entire foot. African Americans often develop skin cancer on their feet.
Wear sunscreen. Yes, people of color should wear sunscreen. Dermatologists recommend that people of color use sunscreen that has:
Apply sunscreen to dry skin 15 to 30 minutes before going outdoors. You want to apply sunscreen to skin that will be bare. Be sure to apply sunscreen every day even on cloudy days.
When outdoors, reapply sunscreen. You want to reapply:
Never use tanning beds or sunlamps. These emit harmful UV rays, which can cause skin cancer.
Skin of color: How to prevent and detect skin cancer
Although people of color have a lower risk of developing skin cancer than Caucasians, when skin cancer develops in people of color, it is often diagnosed at a more advanced stage making it more difficult to treat.
Follow these tips from dermatologists to protect your skin from the sun and reduce your risk of skin cancer.
Q: When You Cite A Lower Awareness Is It Just Not Knowing Or Is It Misplaced Faith That Having More Melanin In The Skin Is Itself Sufficient Protection
I think its both. Melanin does confer some natural protection against the risk of skin cancers from UV, but everyone, of any complexion, is still at risk for sun-related skin cancers. So yes, sometimes theres a false sense of immunity because of increased melanin. And then theres also just an overall lack of awareness that these cancers actually do occur in patients of color. Day in and day out, patients are shocked to learn that you can get a melanoma on your foot, in your nailbed, in your eyes or some other place that seems protected from the sun. This information is simply not well known. So weve got to educate people about where to look and what to look for.
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Melanoma Can Develop In Anyone
- Male and females
- Old people and young people
- People with light- or dark- coloured skin
About one in fifteen fair-skinned New Zealanders can expect to get melanoma in their lifetime. New Zealand has the highest rates of melanoma in the world. In 2009 it was the fourth most common cancer registered and the sixth most common cause of death from cancer.
In New Zealand, older men of non-European ethnicity are more likely to be diagnosed with a difficult-to-treat thick melanoma. Men are twice as likely to die from melanoma than females of similar ethnic background.
So Can Dark Skin Tones Still Sunburn
In short, yes. Darker skin tones originate in parts of the world closest to the equator where UV exposure is highest. Melanin absorbs and scatters UV energy in a similar fashion to sunscreen providing Fitzpatrick V and Fitzpatrick VI individuals with a baseline estimated SPF of 7-10. This natural SPF allows darker skin tones to better tolerate UV exposure and typically results in tanning without burning. However, darker skin tones can still develop sunburns with high sun exposure, use of treatments that make the skin more sensitive to the sun , and/or rapid changes in UV exposure (say, winter Caribbean vacations and/or beach time.
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What Does A Sunburn Look Like On Darker Skin
Sunburn appears differently in lighter and darker skin tones. For lighter-skinned people, it will typically look red and feel hot, painful, or both. The burned skin may also feel tight.
But darker-skinned people may not notice any redness. Still, theyll have all the other symptoms, such as heat, sensitivity, and itchiness. After a few days, any skin tone may also experience peeling.
See a healthcare provider or contact emergency services if your sunburn comes with any of the following:
- a high temperature
Darker-skinned people can get skin cancer, though the risk is lower than it is for white people.
In fact, a notes that white people have the highest risk of melanoma, followed by American Indians and Alaska Natives, Hispanics, Asians and Pacific Islanders, and, finally, black people.
But skin cancer can result in more dangerous consequences for darker skin tones. That same 2016 study also found the rate of death from skin cancer was higher in people with darker skin.
Thats because theyre more likely to be diagnosed at a later stage for a variety of reasons, including medical bias.