Patient to Survivor: Looking for Signs of Skin Cancer in People of Color By Jordyn Matlock

 Published online 2023 March 24

Patient to Survivor: Looking for Signs of Skin Cancer in People of Color

Jordyn Matlock

The Earth Shattering Discovery

Typically, people say that you are in your prime at the height of perfect health and a desirable age. Imagine being in the most crucial, energetic, and productive time in your life,  enjoying the journey and still waiting for the best to come. While you probably look back on all of life’s accomplishments, you often wonder how you reached them. Were you all work and no play? Or did you spend most of your memories outside going through everyday life under the sun or during annual vacations, unaware of how your health could change in an unimaginable way. You think to yourself, I have the career, but something else is still missing. Well, that was the unfortunate case for an ordinary couple named Daisy and David. 

Daisy, a 22 year old college student who happens to be a person of color and someone who wanted to find love as she began to launch herself into the real world. Through the help of her best friend, she was set up on a blind date for a dinner for two. A little apprehensive, Daisy agreed to go on the date where she met David, a 25 year old medical and healthcare professional, who is also a person of color. On the date, the two of them immediately clicked and they became inseparable. 

As time went on, David proposed the idea that it was time for her to meet his parents. Things had been serious for a while and little did she know, he was planning on proposing to her and spending the rest of their life growing old together. Excitedly, Daisy agreed and put on her best outfit. Upon arriving at an outdoor lunch where David’s parents were eagerly waiting on them, Daisy was wearing a sage green sundress, sunglasses, and a large beige sun hat in an effort to make a good impression on his parents while also avoiding the summer heat. 

 “It’s so nice to meet you! I’ve heard a lot about you.” David’s mom exclaims yet all she can think to herself is, I’d love to see the rest of her. David’s mother kindly asks Daisy to remove her sun hat and shades and immediately pauses, along with his father. “What, do I have something stuck in my teeth?” Daisy asks. “Or do I have crazy hat hair? I’m so embarrassed.” No one says a word which has both Daisy and David confused. On her neck are these oddly shaped dark spots, slightly raised above the skin but not sensitive to the touch. David, who has a background in healthcare, immediately suggests that she gets it checked out. No, it can’t be what I think it is. I would have noticed and so would she. 

A few days later, Daisy goes to see a dermatologist to seek out answers. She gets a physical exam and later a skin biopsy. After about a week, the pathologist determines Daisy’s results. Stage II melanoma. Her world halts. Cancer. Every suggestion after that goes in one ear and out the other. Cancer. Skin cancer. At 22 years old, all she could think about is how she got it as she believed only Caucasian and fairer toned individuals were susceptible to that sort of thing. She believed that melanin protects people against the sun. Going home crying to David and sharing the news, he immediately blamed himself and wondered, how did I not catch this? How did we not catch this in time?

Melanoma In People of Color

Skin cancer, particularly melanoma, presents itself differently in people of color such as African Americans, Asians, Pacific Islanders, multiracial individuals, and some Latin groups compared to Caucasians. The signs of skin cancer can either appear in obvious or atypical ways. In fact, African American and Latino communities have a 5 year survival rate, which means a higher mortality rate compared to Caucasians due to the presentation because of prolonged diagnoses and larger tumors (Bradford 2009). Furthermore, a study was conducted to determine the rates of cancer for the year 2020 communicated through mortality rates, gender, and various types of cancer. The study revealed that non-skin-related melanoma is the first leading type of cancer in Northern America while it is the second leading cancer in both of the Americas combined (Ferlay et al. 2021). The research in this paper suggests that melanoma is more common than people believe and although cancer patterns can be modeled through statistics, they cannot always predict future trends. 

Melanoma may be rare in African Americans, but this does not mean that they are immune to it. Another study was conducted at Washington Hospital Center to conclude whether African Americans with Melanoma had been significantly affected with the disease compared to Caucasians. By obtaining medical data from patients which show the stage and bodily location, the results show that African Americans are 32.1% more likely to have stages III and IV of melanoma compared to Caucasian, who only had a 12.7% appearance rate (Byrd et al. 2004).

 

American Academy of Dermatology Association

Statistics of Melanoma In Americans and Specifically POC (Skin Care Foundation 2023)

• Most cases of melanoma are caused by the sun

• 20% of Americans will develop skin cancer

• Actinic keratosis is the most common precursor for developing melanoma

• People of color have higher cases of acral lentiginous melanoma on the palms, bottom of feet, and on the fingers

•  African Americans, Asians, and Native Hawaiians are more likely to develop melanoma on parts of the skin with less pigmentation, with around 60-75% of tumors showing up in the previously mentioned parts of the body

• Skin cancer in Latinos appears 4-5% while it is 1-2% in African Americans

• The mortality rate of those with melanoma is predicted to increase by 4.4% in 2023

Causes and Risk Factors of Melanoma

Sunlight is the ultimate cause of melanoma. It is a source of UV radiation and significant amounts of it have been proven to be a human carcinogen over years of exposure. Prolonged sun exposure and sunburns, reaction to the sun, tanning, and skin pigmentation are all shown to be some of the most outstanding risk factors (Holman et al. 1986). Furthermore, hair dyes expose individuals to ionizing radiation, fluorescent lighting, dietary factors, and tanning are also causes of melanoma (Holman et al. 1986). Indoor tanning is also a cause of skin cancer. Indoor tanning releases 10 to 15 times more UV radiation than direct exposure to the sun and over 419,000 cases of skin cancer stem from indoor tanning, specifically 6,200 cases of melanoma (Skin Cancer Foundation 2023). If these statistics are not enough to reassess intentional causes of melanoma, women are more likely to get this illness in their 20s and increase their chances of melanoma by 75% (Skin Cancer Foundation 2023). 

Treatment Options for Melanoma

The most beneficial thing that anyone can do is regularly attend physical exams and do at-home check ups to make sure there are no odd spots or lesions on the body. When detected early, melanoma has a higher cure rate. Immunotherapy involves the termination of cancerous cells through an interaction between T cell receptors and tumor antigens and therapeutic monoclonal antibodies are incorporated to prevent the spread of tumor cells (Marzuka et al 2015). Surgery and radiotherapy are also common ways to treat melanoma. Radiotherapy uses high radiation to kill cancer cells and stop them from growing. The response rate depends on the variation in dosage yet sometimes tissues can have delayed responses to this treatment (Testory et al. 2009). 

If some are able to prevent skin cancer or lessen the risk of it occurring, then it shows that public human health is beneficial for public knowledge. Sometimes, treatments and advice are catered more toward the typical demographic, which does not always work for people of color. Individuals should be in control of their own health to some degree and with all of the significant environmental stressors such as climate change, humans should take the initiative to protect themselves against harmful exposure to UV light from the sun with the right information and resources. While everyone cannot prevent themselves from getting skin cancer especially following years of long term sun exposure, it is never too late to start treatments. While this blog is designed to help people of color, it is not limited to fairer-skinned individuals, as there are always advances to be made in modern medicine such as doctors and dermatologists who need to expand their knowledge on how to diagnose and treat skin cancers in other people who do not look like themselves as well as everyday people who should simply be aware of this issue on a broader spectrum.

General Measures of Safety to Prevent Skin Damage and Cancer

Limiting exposure to UV light as well as the use of sunscreen are key steps in preventing the development of melanoma, or any type of skin cancer for that matter. Applying unblock is one of the most crucial actions. The higher the sun protection factor (SPF), the more protected the skin will be. It is important to assess the ingredients of specific brands of sunblock and to do some research on the success rate of protecting others from harmful UV radiation. One dangerous material found in skin care products include heavy metals which counteract organic compounds which the skin can absorb and accelerate the depletion of human health (Attard et al. 2022). In addition, avoiding toxic substances of copper, nickel, and lead can cause dermatitis and discoloration of the skin (Attard et al 2022). Ideal sunscreen development includes titanium dioxide, zinc, molecules containing carbon and (di)oxybenzone in respective doses. It is important to note that there is a difference between molecular and chemical sunscreens based on the combination of ingredients which affects individuals differently based on genetic and environmental factors (Resende 2022). Furthermore, tanning should be reduced or eliminated completely and hats should be worn, especially if sunblock is not an available option. 

Image by Harold C. Simmons

Conclusion

    The biggest takeaway from this blog is simple: individuals should take care of their skin before it may be too late. Although the skin typically heals itself following minor or major injuries, it is not always certain that the skin is able to recover from the trauma of skin cancer. In the United States, the rate of cancer is prevalent and while many diagnoses of skin cancer cannot be predicted until more advanced stages, there are several ways to avoid developing skin cancer and looking into the right forms of treatment specific to one's own skin. Although people of color all fall under the specific categorical identifiers such as melanin and dark and light undertones, everyone's skin is different and preventative measures should be catered to them based on personal needs. The preconceived notion that people of color and darker skin do not get cancer should be eliminated. 

References

Attard T., Azzopardi L. M., Attard E. 2022. Daily Facial Skincare Formulations: Benefits and Risks. Acta Poloniae Pharmaceutica. 79(1):49-61.

Byrd MD K. M., Wilson MD D. C., Hoyler BS S. S., Peck MD G. R. 2004. Advanced presentation of melanoma in African Americans. Journal of the American Academy of Dermatology. 50(1):21-24. 

Bradford P. T. 2009. Skin Cancer in Skin of Color. Dermatology Nurses. 21(4):170-178.

Ferlay J., Colombet M., Soerjomataram I., Parkin D. M., Piñeros M., Znaor A., Bray F. 2021. Cancer statistics for the year 2020: An overview. International Journal of Cancer. 149(4):778-789. 

Holman C. D. J., Armstrong B. K., Heenan P. J., Blackwell J. B., Cumming F. J., English D. R., Holland S., Kelsall G. R. H., Matz L. R., Rouse I. L., Singh A. Ten Seldam S. E. J., Xu Z. 1986. The Causes of Malignant Melanoma: Results from the West Australian Lions Melanoma Research Project. Epidemiology of Malignant Melanoma. 102:18-37.

Marzuka A., Huang L., Theodosakis N., Bosenberg M. 2015. Melanoma Treatments: Advances and Mechanisms. Journal of Cellular Physiology. 230(11):2626-2633. 

Resende D. I. S. P., Jesus A., Lobo J. M. S., Sousa E., Cruz M. T., Cidade H., Almeida I. F. 2022. Up-to-Date Overview of the Use of Natural Ingredients in Sunscreens. Pharmaceuticals. 15(3):372. 

Skin Cancer Facts and Statistics. 2023. Skin Cancer Foundation. 

Testori A., Rutkowski P., Marsden J., Basthold L., Chiarion-Sileni V., Hauschild A. Eggermont A. M. M. 2009. Surgery and radiotherapy in the treatment of cutaneous melanoma. Annals of Oncology. 20(6):22-29.