African American colorectal outcomes | City of Hope

Skin cancer in people of color: Assessing risks and taking action

It's a common fallacy that skin cancers do not affect people with darker skin tones, but recent studies show a somewhat different reality. While it is true that, as a 2016 study in India found, people of color (POC) are "much less likely to become afflicted with skin cancer," the study shows that "they are much more likely to die from it due to delay in detection or presentation."
The American Academy of Dermatology notes that the annual incidence of non-Hispanic whites contracting skin cancer in the United States is over 31 per 100,000, while the rate is five per 100,000 Hispanics and just one per 100,000 non-Hispanic Blacks. However, recent studies have also shown an annual increase in the incidence of melanoma of nearly 3% among Hispanics in the United States.
These facts all combine to bring City of Hope's Christiane Querfeld, M.D., Ph.D., a dermatologist, dermatopathologist and associate professor in the Division of Dermatology, to an imperative conclusion: People of color need to recognize that they, too, are susceptible to skin cancer and need to take important steps to avoid it. It all comes down to smart skin care, she says.
Doctor Christiane Querfield
Christiane Querfeld, M.D., Ph.D.
"Patients of color are not exempt from skin cancers," Querfeld emphasized. "This is why everyone needs to use sunscreen, whenever they are out in the sun. And every person needs to be screened for skin cancer. It is very important. We recommend a once-a-year skin health screening for every patient of every color."
She points out that many darker-skinned people don't believe they can contract skin cancer and so go out in the sun without any skin protection, and even use tanning beds to darken their complexions. In addition, some use chemical products, such as hydroquinone, to “even out” or lighten skin tones. These bleaching creams, Querfeld says, can make the treated areas more vulnerable to skin cancer.
And while it is true that people with darker skin have more epidermal melanin in their skin than Caucasians, which "naturally filters out about twice as much ultraviolet radiation as the epidermis of whites," current studies show that people of every skin color are susceptible to skin cancer. According to the Centers for Disease Control and Prevention, the annual U.S. incidence of new skin cancer cases doubled between 1999 and 2018.
Querfeld's experience aligns with data that shows that people of color, particularly Asians, native Pacific Islanders and African Americans with darker skin tones, do not detect their skin cancers until much later than lighter-skinned people.
"People with very dark pigmentation can be susceptible to skin cancers in less usual places on their bodies," she explained. "On the soles of the feet, the palms, the private parts, the scalp, lips and nails. This means, unfortunately, that those patients seek very, very late medical care and often the cancer has progressed much further, with the result that the mortality and morbidity in this patient population is much higher compared to white patients."
Querfeld describes the different types of skin cancer as being nonmelanoma skin cancers (squamous cell and basal cell carcinoma) that are caused by the sun; melanoma, the deadliest form of skin cancer, often shown on the skin by a dark spot/mole "that's irregular, bleeding, growing, showing different colors or has irregular borders," and cutaneous lymphoma, which is a blood cancer that travels to the skin. All forms of skin cancer have a high cure rate, with the key being to catch the cancer as early as possible.
"We already know that skin cancers are aggressive types of cancer, which is why starting prevention is so important," Querfeld said. "Everyone needs to monitor their skin, to watch carefully. Ideally, I think people should look at their whole skin once a day, but check your skin at least once a month. Look for any changes."
Querfeld is specific about the ways people of any color can be proactive about their skin health. "Intuition on the part of the patient is very important. We [as doctors] have to listen to a patient, when the patient is feeling that something is not right. For example, noticing that a mole has enlarged, the borders are irregular or it has gotten painful or itchy. Or you feel something is wrong under a fingernail or toenail, or on your scalp or lips. This is when to take action and see your physician."
The dermatologist is also specific about the sunscreens that work best for both white skin and darker hues. "Make it happen every morning. Have a skin-care routine that includes sunscreen with an SPF of 30 or higher, and if you are out in the sun, reapply every two hours, especially to your scalp and lips," Querfeld advised.
"I recommend the sunscreens that are physical blockers, that have titanium dioxide or zinc oxide," she added. "Physical sun blockers, rather than chemical ones, cause less irritation and fewer allergic reactions.”