What Should I Know About Skin Cancer in Skin of Color?
No matter the color of our skin, the building blocks are the same: the top layer, called the epidermis, comprises basal cells, squamous cells, and melanocytes. Any of these cells can grow erratically and out of control and become cancerous, leading to basal cell carcinoma (BCC), squamous cell skin cancer (SCSC), or melanoma.
Skin cancer is much more prevalent in those with lighter-colored skin—in fact, fair-skinned individuals are almost 30 times more likely than Asian, non-Hispanic Black, or Pacific Islanders to develop skin cancer. Skin cancer represents only 1% – 2% of all cancers in Black people; approximately 2% – 4% of all cancers in Asian people; and 4% – 5% of all cancers in Hispanic people. But the reality is that many people are a mix of different races and ethnic origins.
Despite skin cancer being less prevalent in people with dark complexions, it does occur, and the appropriate awareness of this fact saves lives, particularly as there are misconceptions that “skin cancer doesn’t affect darker complexioned individuals.” In fact, the incidence of melanoma among Hispanics/Latinos has risen by 20% in the last several decades.
Because skin cancer is less common in people of color, there is often a lack of community awareness of the disease—including how to prevent it and what to look for on your skin. Additionally, the medical community may lack suspicion or awareness of how it presents in skin of color, which often leads to it being diagnosed at a more advanced stage, which contributes to disparities and outcomes in care.
For example, darker-toned individuals are more likely to be diagnosed with melanoma at later stages compared to fair-toned individuals. In one study, the most striking disparity was between White and Black individuals: 34.1% of Black patients presented with regional or distant melanoma (Stage III or Stage IV) while 12.6% of White patients presented at these later stages. In the same study, looking at patients diagnosed with localized melanoma (Stage I and II), patients with skin of color were more likely to have ulcerated—meaning the skin over the melanoma is not intact—and significantly thicker melanomas. Not surprisingly, given the above data, melanoma is associated with worse survival rates among those with skin of color.
The prevalence of the three main types of skin cancer—BCC, SCSC, and melanoma—differ based on race and ethnicity. BCC is the most common type of skin cancer in Asians, Hispanics, and Whites, while SCSC is the most common skin cancer in Blacks. Additionally, certain subtypes of melanomas favor certain ethnic heritages and races. Acral lentiginous melanoma—a rare form of melanoma that occurs on the palms, on the soles of the feet, or beneath the nails—accounts for over 17% of melanomas diagnosed in non-Hispanic Blacks, over 19% in Hispanic non-Whites, and over 11% in non-Hispanic Asian/Pacific Islanders. A higher percentage of patients with skin of color are diagnosed with mucosal melanoma—the type found on mucosal surfaces such as inside your mouth, vagina, and anus.
While the incidence of skin cancer is lower in people with skin of color, it is critical that we improve community awareness and awareness in the medical profession, in order to improve prevention and timely identification of the disease.
