Why Melanoma is Rising in People of Color?

Skin cancer in people of color absolutely happens. It has been stated that it tends to be a perfect storm, which is why people those who have darker skin and who develop skin cancer tend to have a much poorer prognosis. With the incidence of skin cancer on the rise, it has never been more important for the public to practice the prevention and detection steps that are key to avoiding melanoma, the deadliest form of skin cancer.

Yet in the case of African Americans, detection may be more difficult because studies of African Americans who are diagnosed with melanoma have shown that the condition most often develops on non-sun-exposed areas of the body. This finding, along with the misconception that melanoma is not a significant threat for individuals with darker skin, may contribute to the higher mortality rates for this population.

Melanoma is the deadliest form of skin cancer and is one of the few cancers where the cause is known  - overexposure to the ultraviolet rays of the sun and artificial light.  According to the National Cancer Association, it is estimated that 68,720 people in the U.S. will be diagnosed with melanoma in 2019 and approximately 8,650 deaths will be attributed to melanoma this year. At this rate, one person dies of melanoma every hour.

Melanoma in People of Color

According to the most recent data available from the American Cancer Society, the five-year melanoma survival rate is 93 percent for white people, but only 69 percent for black people. There’s a whole host of complex reasons why black Americans are more likely to die from skin cancer than white Americans. To fully explore them, you first have to know a bit about what skin cancer really is.

Skin cancer happens when your skin cells grow abnormally and out of control. 

Melanoma, which starts in those pigment-providing melanocytes, can be much more lethal. We know that melanoma isn’t the most common cancer, but we hear about it so often because it is the deadliest form of skin cancer. Melanoma usually shows up as a new mole on your skin that may change in size, shape, or color. Experts use what’s known the ABCDE rule to summarize melanoma warning signs:

A ‐ Asymmetry. Pigmented lesions should look the same on both sides when folded in half.
B ‐ Border irregularity. The borders should be smooth and regular–usually round or oval in shape.
C ‐ Color variation. The lack of uniform and even color.
D ‐ Diameter. Size of greater than 6mm or about the size of a pencil eraser.
E ‐ Evolving. Any change (including size, shape, color) in an existing mole or skin lesion

It's true that melanin does offer some protection from the sun by absorbing or deflecting harmful ultraviolet rays (invisible radiation from the sun that can damage the DNA of genes that control skin cell growth), but it's not enough to completely ward off the threat of skin cancer, no matter how dark your skin may be.

That’s why sunscreen, and people knowing they need it, is essential; it absorbs, reflects, or scatters sunlight to protect against UV rays, according to the CDC. The American Cancer Society suggests wearing a broad spectrum sunscreen (meaning it protects against both UVA and UVB rays) with SPF 30 or higher. Experts also recommend wearing accessories like hats and sunglasses, long-sleeved clothing in dark colors (or even with SPF) and trying to stay in the shade between 10:00 A.M. and 4:00 P.M. when UV rays are most intense.

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Most skin cancer warnings are directed towards fair skinned individuals with blue eyes and blond or red hair who sunburn easily, as these individuals are at greatest risk. Given this fact, one may mistakenly assume that people with darker skin types such as Hispanics, Asians and African-Americans do not need to worry about melanoma.

This is not correct. It is true that darker-skinned races produce more melanin, the pigment that gives color to skin and hair and protects the skin against damage from ultraviolet radiation. However, increased pigmentation does protect individuals from UV induced melanomas, but there is a type of melanoma called acral lentiginous melanoma (ALM) that occurs even without UV exposure. This type of melanoma, which is sometimes ignored or mistaken for an injury or a nail fungus. Because this form of melanoma is often misdiagnosed or ignored, it is often more deeply invasive when it is finally discovered.

Common Locations for ALM

  • On the soles of the feet
  • The palms of the hands
  • Between toes and fingers
  • Under toenails and fingernails (especially the large toenail and thumbnail).

Late Diagnosis

  • By the time many African-Americans are diagnosed, melanoma has often spread to other parts of the body. A recent Washington Cancer Institute research study of 649 people with melanoma showed that 32% of African-American patients were diagnosed with Stage III or Stage IV melanoma, while only 13% of Caucasian patients were similarly diagnosed.
  • One factor that may prevent African-Americans from seeking early treatment is that they usually develop melanoma in areas that are different from Caucasians. A recent study showed that while 90% of Caucasian patients develop melanoma on skin that is regularly sun-exposed, only 33% of African-American patients developed it in sun-exposed areas.

Melanoma may be less common in people of color, but when found early, there is a very high cure rate.

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