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Skin Cancer and Cutaneous Photodamage in People of Color

Summary and Comment |
March 14, 2014

Skin Cancer and Cutaneous Photodamage in People of Color

  1. Craig A. Elmets, MD

Cutaneous malignancies are associated with greater morbidity and higher mortality in people with darker pigmentation; our author speculates as to why.

  1. Craig A. Elmets, MD

Nonmelanoma skin cancer and melanoma are more common in the white population but also occur in people of color (POC). Researchers sponsored by the American Academy of Dermatology reviewed information on skin cancer and adverse effects of ultraviolet (UV) radiation exposure in this group.

Basal cell carcinoma (BCC) is the most common skin cancer in Hispanics and Asians. BCCs are rare in blacks, and incidence correlates with the amount of pigmentation. Major risk factors for squamous cell carcinomas (SCCs) in POC are chronic inflammatory conditions (e.g., hidradenitis suppurativa, lupus erythematosus, burn scars, and skin ulcers) and herpesvirus infection. Unsurprisingly, most SCCs occur on non-sun-exposed body sites in POC. Cutaneous SCC is the most common skin cancer in blacks and Asian Indians and the second most common in Hispanics and East Asians. SCC is associated with higher mortality in blacks than in whites, due in part to delays in diagnosis but also to more aggressive lesion behavior.

Melanoma incidence has increased significantly among Hispanics in the past 3 decades; the anatomic distribution resembles that in whites. Acral lentiginous melanoma is the most common form in blacks and Asians; UV exposure does not appear to affect risk for these lesions. Melanoma is associated with poorer 5-year survival in blacks and Asians than in whites, a difference not attributable to lack of access to medical care or differences in socioeconomic status, suggesting that melanomas in Asians and blacks are inherently more aggressive.

Misconceptions about skin cancer are widespread among POC, which may delay diagnosis and suppress use of sunscreen, especially by blacks. When sunscreens are applied to pigmented skin, the SPF values may actually be lower than on white skin. Pigmentary disorders due to UV exposure are more common in POC, where it is often the most disturbing aspect of photoaging.

Comment

Nonmelanoma skin cancer and melanoma are more common in the fair-skinned, but people of color are also susceptible to these cancers and to adverse effects of ultraviolet radiation exposure. Cutaneous malignancies are associated with greater morbidity and higher mortality in POC, perhaps due to a lack of tailored educational efforts. This report highlights the need for the medical community to educate POC about skin cancer and its unique manifestations in darker skin. Patients should be advised to regularly examine their nails, mouth, palms, soles, groin, and perianal area for skin cancer signs.

  • Disclosures for Craig A. Elmets, MD at time of publication Consultant / Advisory board Astellas Pharmaceuticals Grant / research support NIH; NIH/NCI; Veteran’s Administration; Abbott Laboratories; Biogen; Clinuvel; Covan Basilea Pharmaceutica; Genentech; TenX Biopharma; University of California Editorial boards Cancer Prevention Research; Journal of the American Academy of Dermatology; Photodermatology, Photoimmunology, & Photomedicine; UpToDate Leadership positions in professional societies American Academy of Dermatology (Psoriasis Guidelines Subcommittee and Chair Designate, Clinical Guidelines and Research Committee); Photomedicine Society (Board of Directors)

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