How Is Skin Cancer Diagnosed
First, your dermatologist may ask you if you have noticed any changes in any existing moles, freckles or other skin spots or if youve noticed any new skin growths. Next, your dermatologist will examine all of your skin, including your scalp, ears, palms of your hands, soles of your feet, between your toes, around your genitals and between your buttocks.
If a skin lesion is suspicious, a biopsy may be performed. In a biopsy, a sample of tissue is removed and sent to a laboratory to be examined under a microscope by a pathologist. Your dermatologist will tell you if your skin lesion is skin cancer, what type you have and discuss treatment options.
Making Sense Of The Link Between Skin Color And Skin Cancer
While those with lighter skin tones are generally the most at risk for skin cancer, anyone with any skin color can get skin cancer. Unfortunately, many patients are under the impression that those with darker skin are not at risk for skin cancer. People who have darker skin tones often believe that theyre not at risk for developing skin cancer, but that is a dangerous misconception, says dermatologist Maritza Perez of the Skin Cancer Foundation. This is at least one reason people with darker skin tones are diagnosed in the later stages, when the disease may be more advanced. While most skin cancers are curable if caught and treated early, delayed discovery and diagnosis of skin cancer can lead to more difficult treatment, involving possible disfigurement and even death.
Most skin cancer is caused by prolonged exposure to ultraviolet radiation from the sun and tanning beds. While UV exposure plays a huge role in skin cancer in Caucasians, the primary reason for skin cancer in people of color is often unclear. The CDCreported that among those of African descent, Asians, Hawaiians, and Native Americans, skin cancers are most likely to appear in the mouth or on the palms of the hands, soles of the feet and under the nails.
Skin Color and Skin Cancer Types
To protect your patients skin and reduce their risk of skin cancer, recommend that they:
Early Detection And Prevention
Many dermatologists do not have experience in treating people with darker skin. Implicit bias during assessment and diagnosis can also play a role, so it is important that Black people know the signs of skin cancer.
No matter what type of skin cancer a person has, detecting it early improves their outlook. Knowing the signs and symptoms of skin cancer can help a person detect suspicious skin growths early.
An individual can try :
- Doing regular skin checks every few months: When a person is familiar with their skin, it makes it easier to detect potentially harmful changes in moles and freckles.
- Visiting a dermatologist for an annual skin cancer screening: This is particularly important if a person has a family history of skin cancer.
- Wearing sunscreen in the sun: Black people can burn, too. The melanin in Black skin has an estimated
usually begins as a change in the skin. This can be a new growth like a freckle or a mole or changes to an existing growth.
Being familiar with their skin can help a person detect abnormalities. Regular skin self-exams can help a person get to know their skin and how their moles and freckles typically look.
When people find a questionable mole or freckle, they can wonder whether or not it may be melanoma. Try using the acronym ABCDE to check growths when doing a skin exam:
Diagnosing skin cancer starts with an exam. A doctor will use a scope to look at suspicious skin growths.
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When Should I See My Healthcare Provider
Make an appointment to see your healthcare provider or dermatologist as soon as you notice:
- Any changes to your skin or changes in the size, shape or color of existing moles or other skin lesions.
- The appearance of a new growth on your skin.
- A sore that doesnt heal.
- Spots on your skin that are different from others.
- Any spots that change, itch or bleed.
Your provider will check your skin, take a biopsy , make a diagnosis and discuss treatment. Also, see your dermatologist annually for a full skin review.
Skin Cancer: More Deadly In People Of Color
One disturbing new trend is the apparent increase in skin cancer mortality in people of color.
The increase in skin cancer is attributed to lower public awareness of the risk of the disease among individuals of color. Because of this, this group of people is also less likely to practice sun-safe behaviors like using sunscreen, to go to the doctor for skin exams, or to do skin self-exams.
In addition, healthcare providers may be less diligent about looking for skin cancer in patients of color because they dismiss the risk, too.
The notion that they are immune to skin cancer is particularly strong in some cultures. The belief that Hispanic people dont have to worry about skin cancer has existed among Latinos for generations, says , a dermatologist at the Icahn School of Medicine at Mount Sinai in New York.
They hear it from their parents and grandparents, and then they pass this belief on to their children, says Dr. Perez. Perez cites a study of high school students in which 43 percent of Latinos never or rarely used sunscreen. This same group of students was also 2.5 times more likely to have used tanning beds in the last year.
In a study published in March 2019 in the Journal of Drugs in Dermatology, Perez found a 20 percent increase in the number of Hispanics diagnosed with melanoma in the past 20 years.
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Skin Cancer: More Deadly When Diagnosed Later In Nonwhite People
Skin cancer is the most common of all human cancers. Each year, 1 million people in the United States are diagnosed with one of the three main types of the disease: basal cell carcinoma , squamous cell carcinoma , and melanoma.
BCC and SCC are both classified as nonmelanoma skin cancer and account for the overwhelming majority of cases. Melanoma accounts for just 1 percent of all skin cancers, but it is the most deadly.
In 2020, it is estimated that there will be 100,350 new cases of melanoma in the United States and 6,850 deaths from the disease. The good news is that when diagnosed and treated early, almost all skin cancers are curable. The bad news: Because of a lack of awareness, skin cancer tends to be diagnosed at a later stage in nonwhite people.
We know that 52 percent of black patients and 26 percent of Hispanics present with advanced-stage melanoma, compared to only 16 percent of white people, just because of lack of awareness and perceived risk, says Francis.
Because skin cancer is most treatable and curable when caught at early stages, delayed diagnosis results in a disparity in survival. The average five-year melanoma survival rate is 65 percent in Black Americans, for instance, versus 91 percent in white Americans, according to the The Skin Cancer Foundation.
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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What Is Skin Of Colour
Skin of colour is a subjective term used to refer to a natural skin pigmentation darker than white . When compared against a graded assessment of skin colour, such as as the Fitzpatrick phototypes, skin of colour may refer to skin classified as type IV or higher . In some contexts, skin of colour is also used to describe the skin of different non-white ethnic groups, including those of African, Asian, South American, Pacific Island, Maori, Middle Eastern, and Hispanic descent . See ethnic dermatology.
How Common Is Skin Cancer On Darker Skin
Darker skin has more melanin, a pigment that determines skin tone. Having more melanin can absorb and deflect UV radiation, protecting the skin from sun damage.
Because their skin is less vulnerable to damage, Black people have lower rates of skin cancer. For example, melanoma occurs in about 1 in 38 white people compared with 1 in 1,000 Black people.
However, this does not mean people with darker skin cannot get skin cancer. When they do get it, it often goes undiagnosed until it has reached a more advanced stage. Because advanced cancer is harder to treat, Black people are
Some signs of BCC to look for include:
- a new or unusual growth on the skin
- a smooth patch with a translucent bump
- a growth with jelly-like contents
- a lesion that bleeds spontaneously
Black individuals commonly get BCC that is darker and less pearly in appearance.
What Is The Outcome For Melanoma
The prognosis for melanoma in skin of colour may be poorer overall compared to melanoma in white skin. This could be due to late presentation or detection leading to thicker melanomas or more aggressive subtypes of melanoma . Regardless of skin colour, prognosis is generally dependent on the AJCC stage of melanoma, Clark level of invasion, and Breslow thickness at the time of excision of the primary lesion .
The 5-year survival rates according to the simplified AJCC staging classification are as follows:
- Stage I: 9095%
- Stage III: 2666%
- Stage IV: 7.511%.
The 5-year survival rates at different tumour depths for differing ethnic groups from 17 US population-based cancer registries in the period from 1999 to 2005 are shown in Table 1 .
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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Health Disparities And Skin Cancer In People Of Color
Skin cancer diagnosis and treatment may be delayed in people of color, contributing to poor prognosis.
People of color is a phrase commonly used in the United States to refer to ethnic and racial minorities. Dermatologic literature highlights health disparities in POC across a number of diagnoses, notably including skin cancer.1,2 While POC have a wide range of backgrounds, they most often have Fitzpatrick skin types III to VI.1 As the US population continues to transform, with projections of non-whites being the majority by 2060,1,3 it is imperative for dermatologists to understand potential disparities that affect patient presentation, management, and outcomes in POC.
Most research in skin cancer has been in whites, and completing research in POC has been a long-standing challenge within the dermatologic community.4,5 Without this knowledge and research, racial disparities in skin cancer mortality will likely remain unchanged. In this article, we will present a brief overview of the problem of disparities in skin cancer, known and hypothesized causes of such disparities, and potential strategies to overcome them.
Q: What Other Skin Cancer Precautions Do You Recommend To Patients Of Color
I constantly stress the importance of monthly self-examinations of the skin that include not just sun-exposed areas but also the soles of the feet, the palms, the toenail and fingernail beds and also the genital areas places that one might not even think to look. Thats really where the biggest learning gap is. And everyone should get a full-body examination from a dermatologist once a year or any time they see something unusual, such as a new or changing growth or mole or, particularly in skin of color, a sore that doesnt heal. Unfortunately, most people of color are not doing this.
However, Ive observed growing awareness of the dangers of skin cancer among populations of color. We have a long way to go, but the interest is there. I think in the next phase were going to see larger-scale change that results in actual reduction of some of the disparities. Im very optimistic about the future. Interview by Lorraine Glennon
About the Expert:
Andrew Alexis, MD, MPH, is chair of the Department of Dermatology at Mount Sinai St. Lukes and Mount Sinai West in New York City. He is also professor of dermatology at the Icahn School of Medicine at Mount Sinai. As director of the Skin of Color Center in New York City, he is actively involved in advancing patient care, research and education pertaining to dermatologic disorders prevalent in ethnic skin.
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Q: What Other Skin Cancer Warning Signs Are Different In Skin Of Color
About 50 percent of basal cell carcinomas are pigmented in darker-skinned patients. If you look at the typical photos of BCCs used in educational materials most of which focus on fair skin youll see a pink, pearly growth that may or may not be crusted. What youll almost never see is an image of a brown, slightly translucent lesion. Yet about half of BCCs in darker-skinned patients are brown, or pigmented, and thus easier to miss.
A basal cell carcinoma may be pigmented, like this one, on skin of color.
What Questions Should I Ask My Healthcare Provider
Questions to ask your dermatologist may include:
- What type of skin cancer do I have?
- What stage is my skin cancer?
- What tests will I need?
- Whats the best treatment for my skin cancer?
- What are the side effects of that treatment?
- What are the potential complications of this cancer and the treatment for it?
- What outcome can I expect?
- Do I have an increased risk of additional skin cancers?
- How often should I be seen for follow-up checkups?
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Where Does Skin Cancer Develop
Skin cancer is most commonly seen in sun-exposed areas of your skin your face , ears, neck, arms, chest, upper back, hands and legs. However, it can also develop in less sun-exposed and more hidden areas of skin, including between your toes, under your fingernails, on the palms of your hands, soles of your feet and in your genital area.
Q: One Way Dermatologists Can Often Get Buy
Exposure to ultraviolet radiation from the sun can cause fine lines, wrinkles and age spots known as photoaging. People of color generally have less severe, and also delayed, photoaging. Still, the knowledge that UV radiation accelerates skin aging has helped many patients of color see the value of sunscreen use. But the biggest motivator for patients of color is that sunscreen addresses one of their most common dermatologic concerns hyperpigmentation . One of the best ways to manage melasma or other hyperpigmentation disorders is with sun protection. For this population, the idea that sunscreen will keep their hyperpigmentation in check makes them quite vigilant about sunscreen use.
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What The Patient Can Do
- Clean the skin gently with warm water, gentle soap, and a soft cloth.
- Rinse the affected area carefully and pat dry.
- Ask your cancer care team what the best skin products for the affected skin may be. Keep your skin moisturized.
- Protect the affected area from heat and cold.
- Wear loose-fitting, soft clothing.
- Apply medicines prescribed for skin reactions.
- Protect all of your skin from the sun.
- Apply broad-spectrum sunscreen with an SPF of 30 or higher on any skin exposed to the sun. Re-apply every 2 hours if in the sun, and after bathing or sweating.
Brown Spots With Dark Speckles
If you realize one of your moles has some darker speckles on it, you might have just discovered melanoma, says the Mayo Clinic. Even if it’s subtle, it’s better to be safe than sorry: have a doc look at it so you don’t have issues in the future. And for more info on this common disease, in all its various forms, learn the 15 Most Common Types of Cancer.
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