Melanoma skin cancer deadlier in skin of color
MARITZA PEREZ, MD and MONA GOHARA, MD
NEW YORK — According to recent studies, the five-year survival rate for African Americans with melanoma, the deadliest form of skin cancer, is 59 percent compared to 85 percent in Caucasians. And the incidence of melanoma among Latinos increased by 32.4 percent in a little more than a decade between 1992 and 2005, according to one study. Additionally, recent studies suggest that by the time Hispanics are treated for melanoma, they are more likely than their Caucasian counterparts to have thick tumors with a poor prognosis.
“While there is no question that people of color are less likely to become afflicted with skin cancer, they are much more likely to die from it due to a delay in detection,” said Perry Robins, M.D., President, The Skin Cancer Foundation. “Therefore, we feel it’s our job to make these populations aware of the importance of early detection, prompt treatment and effective prevention.”
Educating people of color about skin cancer is especially important considering that the US Census Bureau projects that by the year 2050, 50 percent of the U.S. population will be comprised of Asians, African Americans and Hispanics.
“We often use ethnicity as a proxy for skin color which is a mistake,” says Mona A. Gohara, MD, educational spokesperson for The Skin Cancer Foundation. “Within each ethnic group there is a range of skin tones all of which are at risk for skin cancer.”
Skin Cancer in Skin of Color
The most common forms of skin cancer are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. Each of these has been linked to intermittent and/or chronic sun exposure. Tanning and sunburns are analogous to cigarettes in that just one can increase your risk of cancer, regardless of skin color.
Basal cell carcinoma is the most common skin cancer in Caucasians, Hispanics, Chinese, and Japanese Asians, and the second most common skin malignancy in African Americans and Asian Indians. In all races, BCC is usually linked to ultraviolet (UV) light exposure and is mainly found on body parts that receive the most sun exposure. A study from Howard University, Washington, DC, revealed that 89 percent of BCCs on naturally brown skin occur on the head or neck. The correlation between UV light and BCC in darker skin types explains the relatively higher incidence of this malignancy among darker-skinned populations living in sunnier climates, such as Hispanics residing in New Mexico and Arizona.
Squamous cell carcinoma is the most common skin malignancy among African Americans and Asian Indians, and the second most common skin cancer among Hispanics and Chinese/Japanese Asians. Information from the Singapore Cancer Registry suggests that UV light plays an appreciable role in skin cancer development among fair-skinned Asian populations. Conversely, UV light is not the primary risk factor for the development of SCC in brown-skinned persons within the African Diaspora, and the head and neck are not the most common sites for SCC. Among African Americans and native Africans, SCCs occur mainly on the legs, followed by the anogenital region (including both the anus and genitals). Skin conditions that result in scarring or chronic inflammation, such as discoid lupus; leprosy; burn scars and non-healing skin ulcerations are the main risk factors, along with radiation therapy and physical or thermal trauma. Unlike the SCCs that most Caucasians develop, those occurring in people of African descent due to scarring or chronic inflammation can be aggressive, and have a higher tendency to lead to metastasis and death.
Melanoma is the third most common type of skin cancer among all racial groups. Although UV light, along with heredity, plays a role in the causation of melanoma in Caucasians, the primary risk factor for melanoma in people of color is undetermined.
Among African Americans and others of African descent, Asians, Hawaiians, and Native Americans, melanomas are most likely to appear in the mouth, or in the form of acral lentiginous melanoma – melanomas on the palms of the hands, soles of the feet and under the nails. Evidence suggests the trunk and legs as the most likely areas affected among fair-skinned Hispanics and the feet are the most common location in dark-skinned Hispanics. Other reported risk factors for melanoma in minority populations include: albinism, burn scars, radiation therapy, trauma, immunosuppression, and preexisting moles (especially on the palms/soles and mouth). Due to delayed diagnoses, melanoma is frequently fatal for African Americans, Latinos and Asians.
The Skin Cancer Foundation’s Prevention Guidelines
To stop the development of skin cancer and delay skin aging, people of all ethnicities are encouraged to follow a comprehensive sun protection regimen (see below).
– Seek the shade, especially between 10 A.M. and 4 P.M.
– Do not burn.
– Avoid tanning and UV tanning booths.
– Use a sunscreen with an SPF of 15 or higher every day.
– Apply 1 ounce (2 tablespoons) total of sunscreen to all exposed areas, 30 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating.
– Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
– Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
– Examine your skin from head-to-toe every month.
– See your physician every year for a professional skin exam.
For more information, visit www.skincancer.org
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