Think just because you have darker skin you can skip the sunscreen? Bad news: You can’t. It’s no secret that anyone of any skin color can get skin cancer. But a study by Case Western Reserve University found that patients with black skin had the worst survival rates for melanoma, the most deadly form of skin cancer. White patients had the best survival rates, followed by Hispanic patients, with Native Americans, Asian-Americans, and Pacific Islanders next.
“I think awareness and myths about skin cancer play a large role in this,” says Seemal R. Desai, a clinical assistant professor of dermatology at the University of Texas Southwestern Medical Center in Dallas. “Patients with darker skin tones think, I can’t get skin cancer; [I have] tanned skin. But that is actually not true. If patients think they can’t get skin cancer, they don’t look for suspicious lesions and, thus, get a delay in diagnosis and subsequent treatment. In addition, I think access to care and minority health issues play a role as well.”
“When we talk about health outcomes, medical access, health behaviors, socioeconomic and educational status, and lower awareness by health professionals are all factors that could lead to the results that we’re seeing,” says J. Leonard Lichtenfeld, the deputy chief medical officer of the American Cancer Society.
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Some research has shown that black patients receive worse-quality medical care than whites. On top of that, one study surveying dermatologists found that 47 percent of those surveyed reported receiving inadequate training to properly prepare to diagnose skin cancer in black patients. Nearly 50 percent! That leaves fewer medical options if you’re not white and find a suspicious mole.
“I think this is an awareness and access issue,” says Lichtenfeld. “If you come in with darker pigmentation, the health professional might not know to look carefully. Because the incidence is lower” according to a CDC analysis of national cancer registries over 15 years, more white people are diagnosed with melanoma more than any group.
Another issue? Health insurance. Lichtenfeld pointed out that there’s a correlation between cancer treatment and health insurance. A recent study published in the journal Cancer Medicine analyzed the New Jersey State Cancer Registry over the course of 15 years and showed treatment disparities between the insured and uninsured.
Beyond those highly problematic factors, there’s also the matter of the lesions themselves. Some lesions—hidden lesions—occur in unusual places, making it difficult for patients and doctors alike to find them.
“Not every melanoma is related to sun exposure,” Lichtenfeld explains. “Most are; some are not. So you can get melanoma in usual places, and in the genital area. And you can get also get melanomas on the soles of your feet and under your toenails.” Lesions can also occur in your eyes. As Desai points out, melanoma can have a genetic component, in any skin color and type, which is partially why melanoma can happen in areas that haven’t been exposed to sun. “But we know that acral lentiginous melanoma [on the palms and soles] has a more aggressive behavior in African-Americans,” says Desai.
Hidden melanomas, though rare, are obviously harder to find. And currently there isn’t enough information to determine what causes them, though researchers in a small study of 123 patients in Japan did find that putting pressure on your feet could be a risk factor for melanomas on your soles.
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“The problem is, when melanoma shows up in these areas, on the soles of the feet, people don’t recognize it’s a problem. Health professionals don’t recognize it’s a problem [in patients of color],” says Lichtenfeld, who adds that these types of lesions “present at a later stage because of the unusual location. That’s part of the discussion of why the mortality rates are different.”
And that’s the crux of it. Black patients and people of color are being diagnosed at later stages—for many reasons—which leads to worse outcomes.
What does all this mean for you? Vigilance and medical care are necessary to increase survival. If a mole shows up under your fingernail or on your foott (or anywhere else), go to the doctor, no matter what your skin color. If your doctor doesn’t take it seriously, go to another one who will. And of course, use sunscreen to avoid any other types of skin issues.
Desai pointed us to the Skin of Color Society (of which he is president-elect) and suggests visiting the site for info on doctors who work with a variety of skin tones. So if you’re having trouble finding a dermatologist, check it out.
Be consistent with your sunscreen use and do regular mole checks—we know we’re going to.
Now watch this video on the importance of sunscreen: