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Dermatological Conditions in Skin of Color — A Look at Skin Cancer in Skin of Color

J Clin Aesthet Dermatol. 2022;15(6 Suppl 1):S17–S18

by Archana M. Sangha, MMS, PA-C

Ms. Sangha is a medical science liaison for Incyte in Wilmington, Delaware. Prior to that, she spent over a decade as a dermatology PA specializing in general, surgical, and cosmetic dermatology. She is a fellow of the American Academy of Physician Assistants in Alexandria, Virginia. She is also Immediate Past President of the Society of Dermatology Physician Assistants.

FUNDING: No funding was provided for this article.

DISCLOSURES: Ms. Sangha is an employee of Incyte in Wilmington, Delaware.


It’s no surprise that non-Hispanic White patients have a much higher risk of developing non-melanoma and melanoma skin cancers compared to skin of color (SOC) populations. Melanin has long been attributed to the lower incidence rates of skin cancer in SOC populations. Melanin functions as a broadband ultraviolet (UV) light absorbent and has antioxidant and radical scavenging properties.1 However, melanin does not decrease the risk of developing skin cancer to zero in SOC populations. Let’s take a closer look at skin cancer affecting SOC populations. 

Incidence

Skin cancer represents 1 to 2 percent of all cancers seen in Black people, 2 to 4 percent total in Asian people, and 4 to 5 percent total in Hispanic people.2 

Squamous cell carcinoma (SCC). SCC is the most common type of skin cancer seen in Black and Asian-Indian populations and is the second most common skin cancer seen in Hispanic, Chinese, and Japanese populations. SCC accounts for 30 to 65 percent of all skin cancers seen in SOC populations, compared to 15 to 25 percent seen in White populations.3 

Basal cell carcinoma (BCC). BCC is the most common skin cancer in White patients, accounting for 65 to 75 percent of total skin cancers in this population. It is the second most common skin cancer (following SCC) in Black patients and the most common skin cancer seen in Hispanic, Chinese, and Japanese populations. Development of BCC has been closely correlated to a history of UV light exposure. Thus, patients living closer to the equator have a higher risk of developing BCC.3 An estimated 90 percent of BCCs are found on the head/neck region in SOC populations.4

Melanoma. SOC populations have a 20-to 30- fold lower incidence of melanoma than non-Hispanic Whites. The lifetime prevalence of melanoma is 1 in 1,000 for Blacks, 1 in 167 for Hispanics, and 1 in 38 for Whites.5 Black (52%) and Hispanic (26%) patients are more likely to be diagnosed with advanced-stage melanoma than White (16%) patients. Black patients also have a lower five-year melanoma survival rate than White patients: 71 percent versus 93 percent, respectively.2

Clinical Nuances in SOC 

SCC. SCC is often seen on the buttocks, hips, legs, knees, and feet in Black patients. Chronic scarring and areas of chronic inflammation are associated with SCC.3

BCC. BCC most commonly presents in its pigmented variant—a dark brown to black, pearly, translucent growth—in SOC patients. SOC populations have 50-percent higher incidence of pigmented BCC than White populations.3 

Melanoma. In SOC populations, melanoma is more commonly found on non-sun-exposed areas, such as the palms, soles, mucosal surfaces and under nails. Risk factors include genetics, burn scars, radiation, immunosuppression, and cutaneous trauma.3 The plantar foot is the most common site of melanoma in SOC patients, accounting for 30 to 40 percent of all cases.6,7 Tables 1 to 3 describe helpful diagnostic characteristics of melanoma: the ABCDEs of Melanoma, the Alphabet of Nail Melanoma, and the CUBED acronym (which is useful for detecting plantar melanoma; the presence of any two criteria should prompt referral or excision).8,9 

Increasing Awareness and Patient Counseling 

There are several steps clinicians can take to help increase awareness of skin cancer in SOC populations. Clinicians should educate SOC patients on skin cancer prevention and management, including the following:

1. Importance of annual skin exams. A thorough yearly skin exam should include subungual, acral, mucosal, and genital areas. 

2. Identifying skin changes and when to seek care. Educate patients on the signs and symptoms of different skin cancers and when it is appropriate to seek care. Review ABCDEs of Melanoma (Table 1),  Alphabet of Nail Melanoma (Table 2), and CUBED acronym (Table 3).

3. Using sun protection. Counsel patients on the importance of applying daily broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or higher and its proper use (i.e., apply 30 minutes before going outdoors and reapplied every 2 hours while outdoors). 

4. Performing skin self-examinations. Encourage patients to perform monthly self examinations, paying close attention to subungual, acral, mucosal, and genital areas. 

References

  1. Brenner M, Hearing VJ. The protective role of melanin against UV damage in human skin. Photochem Photobiol. 2008;84(3):539–549. 
  2. American Cancer Society. Cancer facts and figures. 2022. American Cancer Society website. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2022.html. Accessed 16 May 2022.
  3. Gupta AK, Bharadwaj M, Mehrotra R. skin cancer concerns in people of color: risk factors and prevention. Asian Pac J Cancer Prev. 2016;17(12):5257–5264. 
  4. Almahroos M, and Kurban AK. Ultraviolet carcinogenesis in nonmelanoma skin cancer. part I: incidence rates in relation to geographic locations and in migrant populations. Skinmed. 2004;3(1):29–35.
  5. National Cancer Institute. SEER*Explorer: an interactive website for SEER cancer statistics. Recent trends in SEER age-adjusted incidence rates, 2000-2019. Surveillance Research Program. https://seer.cancer.gov/explorer/. Accessed 18 Apr 2022. 
  6. Bradford PT, Goldstein AM, McMaster ML, Tucker MA. Acral lentiginous melanoma: incidence and survival patterns in the United States, 1986–2005. Arch Dermatol. 2009;145(4):427–434. 
  7. Ward-Peterson M, Acuña JM, Alkhalifah MK, et al. Association between race/ethnicity and survival of melanoma patients in the united states over 3 decades: a secondary analysis of SEER data. Medicine. 2016;95(17):e3315. 
  8. United States Centers for Disease Control and Prevention. What are the symptoms of skin cancer? 18 Apr 2022. 2022. https://www.cdc.gov/cancer/skin/basic_info/symptoms.htm. Accessed 29 Apr 2022.
  9. Levit EK, Kagen MH, Scher RK, et al. The ABC rule for clinical detection of subungal melanoma. J Am Acad Dermatol. 2000;42(Pt 1):269–274.
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