Skin cancer is the most prevalent cancer in the United States, affecting approximately one in five Americans during their lifetime, according to the American Academy of Dermatology. This form of cancer can present differently across various skin tones, particularly between darker and lighter complexions. While individuals with darkly pigmented skin are generally less likely to develop skin cancer, they often face poorer outcomes when diagnosed, a trend linked to a lack of awareness and educational resources regarding skin cancer symptoms specific to their skin tone. Starling Haynes, MD, an assistant professor of dermatology at Yale School of Medicine, emphasizes that misconceptions surrounding skin cancer’s occurrence in darker skin can contribute to delayed diagnoses and, consequently, worse prognoses.
The Appearance of Skin Cancer on Black Skin
The three primary types of skin cancer—basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma—can manifest distinctly on darker skin.
Basal Cell Carcinoma in Dark Skin
Basal cell carcinoma is the most common skin cancer type, typically occurring in sun-exposed areas. Zaineb H. Makhzoumi, MD, MPH, a dermatologic surgeon at the University of Maryland, explains that BCC often appears as reddish to brown spots with a sheen or pearlescence. Although the pigmented subtype of BCC is relatively rare, it predominantly affects individuals with darker skin, appearing as darker patches of brown, blue, or gray. While BCC usually arises in the head and neck, it can also occur in less sun-exposed areas, such as the anal and genital regions.
Squamous Cell Carcinoma in Dark Skin
According to Dr. Haynes, squamous cell carcinoma is the most common skin cancer found in Black individuals. This cancer leads to an overproduction of squamous cells on the skin’s outer layer and typically presents as ill-defined scaly brown hyperpigmented plaques, papules, or nodules that may bleed or ulcerate. In contrast, lighter skin may show scaly red patches or open sores. SCC generally arises in areas not constantly exposed to sunlight, such as the anogenital region and limbs.
Melanoma in Dark Skin
Melanoma, the deadliest form of skin cancer, is more frequently diagnosed in white individuals. However, when melanoma occurs in people with darker skin, it is often detected at more advanced stages, resulting in worse outcomes. Contributing factors include lower screening rates, reduced access to healthcare, inadequate education within communities of color, and underrepresentation in research. Melanoma develops in melanocytes, the cells that produce the pigment melanin, and may cause changes in the shape, size, or color of existing moles, or appear as new moles or discolored spots with irregular features. Dr. Makhzoumi notes that melanoma can manifest as rapidly expanding brown or black spots, especially on the palms, soles, and nails, which may indicate acral melanoma, a rare but lethal variant.
Recognizing Symptoms and Detection Methods
Familiarity with skin cancer symptoms and their appearance on darker skin tones is crucial for early detection and treatment. Symptoms common in people of color include:
- Dark spots, growths, or patches that are changing, growing, or bleeding.
- Sores that do not heal or that recur after healing.
- Rough, dry patches of skin.
- Dark lines appearing under or around fingernails or toenails.
To conduct a thorough skin self-examination, individuals with dark skin tones should check all areas of their body, not just those exposed to sunlight. The American Cancer Society provides a step-by-step guide for performing skin self-exams:
- Use a mirror to inspect your face, ears, neck, chest, and belly. Women should lift their breasts to examine the skin underneath.
- Examine your underarms, arms, hands, and spaces between fingers and under fingernails.
- Check your thighs, shins, feet, and spaces between toes.
- Use a hand mirror to inspect the bottoms of your feet, calves, and thighs.
- Examine the buttocks, genital area, back, and behind the neck and ears with the hand mirror, or use a wall mirror for the back.
- Part your hair to inspect your scalp with a comb.
During this self-examination, look for any blemishes, moles, or birthmarks that are new or changing. If any concerning signs arise, it is essential to consult a dermatologist.
Skin Cancer Risk Factors in Dark Skin
Research indicates that prolonged exposure to ultraviolet (UV) radiation is a significant risk factor for skin cancer, irrespective of skin tone. Genetic predispositions also play a role, with several hereditary syndromes linked to skin cancer risk, including basal cell nevus syndrome and oculocutaneous albinism. Despite these known risk factors, misconceptions persist, such as the belief that skin cancer does not affect individuals with darker skin. Dr. Makhzoumi stresses that anyone, regardless of skin type, can develop skin cancer and that any non-healing or newly expanding spot should be evaluated by a dermatologist.
Preventing Skin Cancer in Black Individuals
To reduce the risk of skin cancer, individuals with darker skin tones can adopt several preventive measures:
UV Protection for Dark Skin
The most effective methods for lowering skin cancer risk include using sunscreen and wearing protective clothing. Dr. Haynes recommends a broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or higher that is water-resistant. Protective clothing such as long-sleeved shirts, pants, and wide-brimmed hats can shield the skin from harmful UV rays. It is also advisable for individuals with darker skin to avoid direct sunlight between 10 a.m. and 4 p.m. and to refrain from using indoor tanning beds.
Regular visits to a dermatologist are also crucial for early skin cancer detection and to mitigate the risk of complications.
Conclusion
Skin cancer can present differently in individuals with darker skin tones compared to those with lighter complexions. People of color may develop lesions in less visible areas, making it essential to remain vigilant about skin health. Proactive measures, including sun protection, regular skin self-examinations, and consistent dermatologist visits, can significantly enhance the chances of early detection and successful treatment of skin cancer.
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