SKIN CANCER IN PEOPLE OF COLOR

The correct answer is A. The statement is true. People with darker skin are less likely to develop skin cancer than light-skinned individuals.

White individuals are almost 30 times more likely than non-Hispanic Black, Asian, or Pacific Islander individuals to develop skin cancer.

BUT

• The risk for skin cancer in people of color is not zero
• Skin cancer often has worse outcomes in people of color. Read on

The correct answer is B. The statement is false. Black individuals who develop melanoma are actually more likely to die from melanoma than their White counterparts. Melanoma survival rates for people of color are generally lower than for white-skinned individuals, particularly for men.

In fact, the risk of dying from melanoma is 2-3 times greater for minorities than it is for white-skinned individuals.

This graph from a recent research study shows that Black men have the lowest survival rates from melanoma when compared with other ethnic groups.

The correct answer is A. The statement is true. Everyone should practice sun-protective behaviors.

While we may not fully understand the risk factors for skin cancer in people of color, we do know that the sun’s rays damage your skin. So, beyond skin-cancer prevention, practicing sun protection can help prevent wrinkles, discoloration, and other signs of sun damage. This is why the AAD recommends that everyone, regardless of skin tone, seek shade, wear protective clothing, and use sunscreen to protect their skin from the sun’s harmful rays.

The correct answer is C. Tinted mineral-based sunscreens (e.g., containing zinc or titanium oxide) may be preferable to chemical-based sunscreens.

The AAD recommends that people of color consider tinted mineral-based sunscreens (eg, containing zinc or titanium oxide) over chemical-based sunscreens. The mineral-based sunscreens may be preferable to chemical-based sunscreens because the tinting allows the user to find a shade that looks good on their dark skin. In addition, the minerals in the sunscreen actually deflect the sun’s rays. This helps protect against other negative effects from the sun, such as skin darkening. Let’s look at the reasons why the other answers are incorrect.

Answer A. The AAD and other expert groups recommend that people target vitamin D levels through nutrition and not through sun exposure because of the skin-cancer risk. So even though people with darker skin tones may not make as much vitamin D in the skin as lighter-skinned individuals, they should still wear sunscreens for sun protection. If you are concerned about maintaining adequate vitamin D levels, please speak with your health care provider about safe strategies to achieve those levels.

Answer B. People with darker skin need protection against both UVA and UVB rays and not just UVA. While more research is needed on the role of ultraviolet radiation in causing skin cancer in people of color, we know that people of color should still protect themselves from the sun’s harmful rays. For instance, UVB rays are associated with sunburns, and people of color can sustain sunburns. Therefore, the AAD recommends that everyone, regardless of skin tone, should use a broad-spectrum sunscreen that protects against both UVA and UVB rays.

Answer D. An SPF of 15 is considered too low. The AAD currently recommends use of a broad-spectrum sunscreen of at least 30 Sun Protection Factor (SPF) regardless of skin tone.

The correct answer is D. All of the above are known risk factors.

Immunosuppressed patients, including patients taking medications to suppress the immune system after receiving an organ transplant or who have received biologics or other treatments for inflammatory conditions, are at risk for skin cancer.  Scarred or damaged skin is at higher risk for skin cancer. A family history increases one’s risk of skin cancer, potentially through inherited syndromes or a shared sun exposure history.

The correct answer is A. Basal cell carcinomas are the most common skin cancer in Hispanics.

The prevalence of the 3 main types of skin cancer—basal cell carcinoma, squamous cell skin cancer, and melanoma—differ based on ethnicity. As shown in the table below, basal cell carcinoma is the most common type of skin cancer in Whites, Hispanics, and Asians, while squamous cell skin cancer (also known as cutaneous squamous cell carcinoma) is the most common skin cancer in Blacks. Even the predominant types of melanomas that occur differ based on ethnicity. Acral lentiginous melanoma, which is an aggressive form of melanoma that occurs on the palm, soles of the feet, or beneath the nail, accounts for the majority of melanomas in Blacks and Asians, while superficial spreading melanoma (flat spots on typically sun-exposed areas) is the most common type in Whites.

The correct answer is B. Pigmentation is common.

As shown in the images below, basal cell carcinomas can look differently in people of color than they do in White individuals. In the first three images, basal cell carcinomas show the classic features of rolled edges (first image), pearly appearance (second image), and blood vessels growing into the tumor (third image). The third image also illustrates how basal cell carcinomas can be dome-like (nodular).

Images of BCC in light skin showing typical features.

In the next 3 sets of images, you can see that basal cell carcinomas in people of color are often pigmented. In people of color, it’s often difficult to appreciate the pearly appearance because of the pigmentation, which also tends to hide any blood vessels growing into the tumor.

Images of BCC in skin of color showing pigmentation, lack of rolled borders, and lack of visibility for blood vessels growing into the tumor.

The correct answer is C. You should look for anything that is new, different, or changing.

You should become familiar with your skin and exam your entire body at least once a month. People of color are predisposed to skin cancer in non-sun-exposed areas, so it’s particularly important to examine the bottom of your feet, toenails, lower legs, the groin, and buttocks. Some things to look out for are:

• Anything that is new, different, or changing, such as a dark spot or patch of darker skin that is growing, bleeding, or changing in any way
• A sore that won’t heal or that is bleeding, especially if it is taking longer than 2 weeks to heal. You should also be on the lookout for a sore that comes back
• Rough or dry patches of skin
• A dark line in or below a fingernail or toenail

The correct answer is D. You can develop melanoma in all of the above locations.

There are several types of melanoma. Some occur on typical sun-exposed areas, such as the face, arms, and legs. Others tend to occur on non-sun-exposed surfaces such as the palms of the hands and bottoms of the feet. There are also melanomas that occur around the genital areas and inside the mouth. In people of color, a greater proportion of melanomas occur in non-sun-exposed areas, so it’s important to check those locations when you do your monthly skin exam.

The correct answer is D. Call a trusted health care provider right away (and consider taking a picture).

If you see something on your skin that is concerning to you, you should follow your instincts and get it checked out by a trusted health care professional right away. Going on social media and asking questions from other people is not going to be helpful. Those individuals are not trained health care professionals. Waiting 3 months is also not appropriate. If the area of concern is cancer, waiting that extended period to recheck could give the cancer an opportunity to grow and spread. You should also not try to freeze the area off. A health care professional can determine whether something needs a biopsy or whether it could be destroyed with something like liquid nitrogen. Destructive treatment is typically reserved for precancers or very early forms of only certain skin cancers. Again, you need a professional to determine if that’s an appropriate option.

If you find something concerning, you should call a trusted health professional right away. It’s great if that person is a trusted dermatologist, but you may not have an existing relationship with a dermatologist, or there may be a long wait to get in to see one. In those situations, a trusted primary care provider might be able to help. They may be able to look at the spot and determine if it needs a biopsy or not. In some cases, they may perform that biopsy themselves. In other cases, they may be able to send a picture of the spot to a dermatologist and get a second opinion. That’s where taking a picture yourself might be helpful for documentation. The bottom line is you should advocate for yourself until you get a trusted health care professional to evaluate the spot and decide what the next steps are.