Clinicians emphasize risk of skin cancer in patients with skin of color

Denver - There is a misconception that people with skin of color are not at risk of skin cancer, and dermatologists are responsible for better educating themselves and their patients about this danger, says an expert who spoke at the 72^nd Annual Meeting of the American Academy of Dermatology.

Diane Jackson-Richards, M.D., says it’s a misbelief that skin cancer is not a big issue in patients with skin of color (SOC).

“The numbers are much lower, but the outcomes are not as good” compared to patients with lighter skin types, because skin cancer in SOC presents at a more advanced stage. Dr. Jackons-Richards is senior staff dermatologist at Henry Ford Health System, Detroit.

“We do need to educate ourselves about how to best recognize it and treat it early,” she says.

Nonmelanoma skin cancer (NMSC) and melanoma account for approximately 40 percent of skin neoplasms in Caucasians, she says.

“But by contrast, these cancers account for 5 percent of cancers in Hispanics, 4 percent in Asians and 2 percent in blacks.” Somewhat similarly, she says that while basal cell carcinoma (BCC) represents the most common skin cancer in Caucasians, Hispanics, and Asians, squamous cell carcinoma (SCC) occurs more commonly in blacks than does BCC. Because BCC in black skin is usually pigmented, she adds, “We can’t just say that a hyperpigmented lesion is just irritated seborrheic keratoses if it does not resolve.”

Regarding SCC, Dr. Jackson-Richards says it’s the most common skin cancer in blacks and Asian Indians, and the second most common skin cancer in Hispanics, East Asians and whites. Along with the standard risk factors for whites, such as chronic sun exposure, she says, “In people of color, there seem to be other risk factors. These include chronic inflammatory processes such as lupus, hidradenitis suppurativa and chemical and thermal burns.”

SCCs in black patients also are more likely to appear in different locations - such as the lower leg and anogenital region - than in whites, she says.

Regarding melanoma, Dr. Jackson-Richards says acral lentiginous melanoma (ALM) is the major subtype seen in African-American, Asian and Hispanic skin.

“The median age at diagnosis is usually later - 50 to 65 years - in darker skin groups. African-Americans and Hispanics usually present with more advanced disease and have lower survival rates.”

One study showed that 32.1 percent of melanomas in African-Americans present at stage 3 or 4 (Byrd KM, Wilson DC, Hoyler SS, Peck GL. J Am Acad Dermatol. 2004;50(1):21-24). Five years post-diagnosis, according to another study, blacks had the lowest survival rate: 78 percent (Wu XC, Eide MJ, King J, et al. J Am Acad Dermatol. 2011;65(5 Suppl 1):S26-S37).

For such reasons, “We must question all our patients about their sunscreen use. I make it part of my history whenever I do a skin exam. I ask them if they’re applying it just to their face, or to all sun-exposed areas. And do they use it only on vacation?” Dr. Jackson-Richards says. “We must educate their patients on the proper use of sunscreen and skin exams. And we must educate our healthcare professionals that when we do a complete skin exam, we must include the palms, soles, perianal area and oral cavity.”