Ryan M. Wells, M.D., Ph.D., Pharm.D.
In Dermatology, we are trained to treat various skin types. One frequently heard misconception in Dermatology is that individuals with darker skin tones do not get skin cancer. While it is true that lighter skin individuals are at higher risk for most skin cancers, people with medium to darker skin tones can and do develop skin cancer.
Before we dive into common skin cancers among people of color, it is important to take some time to understand one’s skin type. In 1975, the concept of skin phototypes, also called Fitzpatrick Scale or Fitzpatrick skin phototype, was first developed by Thomas B. Fitzpatrick. Skin phototypes are based on the amount of pigment (melanin) that is in an individual’s skin. Melanin is what gives our skin its color and determines its response to sun exposure in terms of tanning or burning. There are six different skin types. These range from very fair skin (type I) that burns easily, to very dark skin (type VI), which almost never burns. Melanin plays a key role in protecting the DNA within skin cells against UV radiation from the sun. It acts as an umbrella and sits over the nuclei of cells in the skin, protecting the DNA within the nucleus.
Despite melanin’s function of protecting DNA from UV radiation, skin cancer affects people of all colors. People with skin of color are often diagnosed with skin cancer much later and with more advanced disease than individuals with lighter skin types. In the United States, individuals with skin of color often include people of African, Asian, Latino, Mediterranean, Middle Eastern, and Native American descent. The most common types of skin cancer include basal cell carcinoma and squamous cell carcinoma (known as nonmelanoma skin cancer), and melanoma. It is important to know your skin type and to have strategies in place to protect your skin from the sun. Checking your skin monthly at home and making note of any changes is a good habit to start. Equally important is to see your Dermatologist for a baseline Skin Exam and then regular follow up exams every year. Some people may need more than one annual Full Skin Exam, depending on the skin cancer risk.
The most common skin cancer is basal cell carcinoma (BCC), which is a cancer that arises from the basal cell layer of your skin. It accounts for 80% of skin cancers overall. Basal cell carcinomas are the most common skin cancers in people of Asian and Hispanic descent and the second most common in African Americans. These skin cancers tend to be shiny or have a pearlescent appearance with abnormal-appearing surface blood vessels. In individuals of color, they are often pigmented and can look light to dark brown. They can ulcerate and tend to spread locally. Basal cell carcinomas have the lowest risk of spreading to the rest of the body and causing metastases.
The other non-melanoma cancer is squamous cell carcinoma (SCC), which accounts for 20% of skin cancers overall, but in darker skin tones, these are the most common skin cancers. In lighter skin individuals SCCs are associated with frequent sun exposure, while in those with very dark skin tones they are most often associated with chronic scarring and inflammatory skin conditions. Because of this, they can often be found on skin that is not frequently exposed to the sun. SCCs have a low tendency to lead to metastatic disease, but this risk is higher than it is for BCCs. SCCs often present as tender, scaly, non-healing papules and plaques on the skin.
Melanomas are skin cancers that derive from the melanin-producing cells of the skin called melanocytes. Patients with melanomas have the lowest survival rates compared with BCCs and SCCs. The likelihood of melanomas spreading to other parts of the body and causing metastatic disease is significantly higher. Patients with darker skin types who are diagnosed with melanoma have an estimated five-year survival rate of 71% versus 93% in fair skin patients. Later detection of melanomas in patients with skin of color is likely a major contributor to this disparity. Lower public perception along with a lower index of suspicion on the part of healthcare Providers are possibly contributing to later detection rates. You see, as mentioned in the opening paragraph, it is a common misconception that people of color do not get skin cancer. In fact, patients with skin of color tend to get melanomas on body areas that get little sun exposure. Acral melanomas, which are melanomas that occur on the palms, soles, and nailbeds, are more common in patients with skin of color than in lighter skin patients. These skin cancers present as a new or changing mole on the skin.
Monthly at-home skin checks, wearing sunscreen daily, and annual Full Skin Exams with a Board-Certified Dermatologist are three key tips to help prevent skin cancer – in all skin types.
At the Dermatology Clinic of Idaho, our trained Providers will take the time to answer any questions you may have specific to your skin type along with additional tips to help prevent skin cancer. Book your Full Skin Exam online.