HEALTH ALLIES
Spotlight on your Skin:
Malignancies in Skin of Color
Of all cancers that physicians see, it is a well-known fact
that skin cancer is the most common type of cancer.
More than 20% of our fellow Americans will develop skin
cancer over their lifetimes; yet, if detected early, the cure
rates can be more than 95%, as is seen in the case of
squamous cell carcinoma. What do we know about skin
cancer in patients of color? We know plenty that should
make you take an extra moment on your physical exams
with all of your patients, no matter the hue of their skin.
Although less likely to occur in patients of color,
skin cancer often is found at a more advanced stage
with reduced life expectancy in these patients than in
Caucasian patients. The type of malignancy is influenced
by ethnicity, with Japanese, Chinese, and Latin Americans
at higher risk of basal cell carcinoma than other types
of skin cancer. Squamous cell carcinoma is found at
higher rates among Blacks and Asian Indians. Although
most cancers are found in areas of high sun exposure,
skin cancer is not limited to these areas and regular
monitoring is key to detection. In fact, darker-skinned
patients are at highest risk for acral lentiginous melanoma
(melanoma of the palms, soles, nailbeds), which has a
disproportionately higher morbidity and mortality than
patients with melanoma on other areas of the body. The
five-year survival rate for white patients diagnosed with
melanoma is 91%; conversely, black patients have a fiveyear
survival rate of only 65%.
What is the cause for this discrepancy? Some can
be explained by genetics. Additionally, frequency and
intensity of exposure to ultraviolet radiation has a direct
correlation with the incidence of skin cancer, contributing
to more than 90% of non-melanoma cancers. I would,
however, contend that some of it is due to both patients
and physicians having a virtual blind spot with regard
4 Dallas Medical Journal April 2019
to the potential for cancer in skin of color. Cancer most
certainly does occur, and the screening is relatively simple
and low-cost. Counseling on daily sun protection (use
of protective clothing, such as wide-brimmed hats, and
sunscreen with an SPF of 30 or higher) should already be
a standard part of anticipatory guidance for all patients,
from childhood to those of advanced age. Children
younger than 18 are restricted from using indoor tanning
salons in Texas and in 17 other states and the District
of Columbia; do not forget to discourage outdoor sun
tanning as well.
What else can we do as physicians to increase
detection, treatment, and survival? Our exam time is
limited by various constraints, but skin cancer screening
does not have to be time consuming. A scan of the scalp,
oropharynx, palms and soles, and general body check
only takes an extra moment. Ask patients if they have new
or changing moles — they, or their spouses, are often the
best detectors of problematic moles. Counsel patients on
the ABCDEs of skin cancer (Asymmetry, irregular Borders,
Color irregularities, Diameter greater than 6mm, Evolution
or change of lesions including bleeding or ulceration) as
features patients should monitor on their monthly selfexams.
And when you see something concerning, send
your patient to your trusted board-certified dermatologist
for a total-body skin screening.
With April designated as National Minority Health
Month, I encourage all of you to take a look at your own
medical practices and make a few small shifts that could
benefit all of your patients. And don’t forget to look ahead,
May is Skin Cancer Awareness month. Help all of your
patients find a free American Academy of Dermatologysponsored
skin cancer screening near them at www.
spotthespot.org. DMJ
O
by Dornechia George Carter, MD