May is Skin Cancer Awareness Month and one of my goals is to educate and do my part to increase the survival rates of all skin cancer patients, but particularly those belonging to ethnic groups with lower survival rates. Multiple skin cancer studies have demonstrated that the five-year survival for melanoma, the most aggressive and harmful type of skin cancer, is only 72-81 percent for African-Americans versus 90 percent for Caucasians. Hispanics also tend to fare poorer than their Caucasian counterparts as it relates to prognosis and survival. These are alarming statistics! There are many reasons for the disparity beyond lack of awareness including differences in skin examinations, ultraviolet light exposure, affected non-sun-exposed sites such as the foot or under nails, general chronic inflammation, immune responses, and genes. I fundamentally want to people to understand what skin cancer is, who is at risk and what can be done to prevent it. Don’t get me wrong, I love the appeal of cosmetic dermatology as much as anyone but this information is the most important skin care advice you will ever receive.
Cancer of any sort is simply the uncontrolled growth of cells of a particular type. Some cancers are more aggressive than others, causing them to grow and damage the body. Skin cancer is the most common form of cancer in the United States, and affects more than 3 million Americans a year. According to the Skin Cancer Foundation, more Americans are diagnosed with skin cancer each year than all other cancers combined. The extraordinarily large number of cases in the United States can be largely identified as one of two main types of skin cancer - melanoma and non-melanoma skin cancer. The non-melanoma (basal cell and squamous cell carcinoma) form of skin cancer is more common, but the melanoma form is more aggressive and may be deadly. In the last two decades, melanoma incidence has increased by 20% in the Hispanic population. This troubling statistic should grab the attention of all of us because we all are at risk for skin cancer.
Traditionally, we may only think that Caucasians are at risk, and it is a commonly held belief that people with darker skin are not at risk. Although it is true that folks with lighter skin develop the majority of skin cancer because of the protective effects that melanin affords, however, people with darker skin complexion are also at risk because a deep skin tone only affords an individual with an effective SPF of about 8 (the American Academy recommends SPF 30 as a minimum for protection from the sun’s UV rays). The incidence of melanoma is rare in African Americans (about 1/100,000 individuals, compared to about 25/100,000 for Caucasians), however the tumors tend to be more advanced at the time of diagnosis. Personally, skin cancer has gone well beyond just statistics for me as I have several relatives (who are African-American) who have had basal cell carcinoma on the legs and face. I have also diagnosed several patients of color with basal and squamous cell carcinoma as well as melanoma in my practice.
The good news is that there are ways to decrease your risk for developing skin cancer, regardless of ethnicity or skin color! First, check your skin. Be comfortable looking at your body and observing any moles, lumps or bumps on your skin. Look at your scalp and full skin surface, including the back, genitals, hands, feet and under nails. Ask a close friend or loved one to help you look where you cannot. Take photos and document any changes that you may see over time. Watch for the ABCDE’s of melanoma:
Asymmetry
Border irregularity
Color variability
Diameter - greater than 6mm
Enlarging, or evolving in any way
Also, look for any mole that could be bleeding, growing, or causing a sore on any area, even in an area not exposed to the sun like the groin or foot. Dark streaks in nails that may be new or getting darker or broader may also be warning signs. Then, share your findings with a board-certified dermatologist to help you with the process of examination. He or she will be able to help you decide whether a mole is normal (benign) or abnormal, warranting a simple, safe, in-office procedure called a biopsy. Skin cancer is highly treatable when detected early, so don’t delay!
Protecting your skin from the sunlight’s ultraviolet rays has been shown to reduce skin cancer risk. This cannot be emphasized enough. So, the question is - do you wear sunscreen every day? If you have answered yes, that’s the answer we want to hear! Good job! If you answered no, then please start now. I recommend that everyone wear sunscreen on exposed areas daily, at least SPF 30 or higher. Thankfully, the products are very easy to find and may be used as part of a daily skincare routine with your moisturizer. If you may be outdoors for more than 2 hours, or are in and out of water, reapply the sunscreen to achieve proper protection. Certainly if you are visiting a sunny climate on vacation or live in one, remember to increase the level of protection to SPF 50 or higher (even up to 100) to prevent sunburn. Once again, this advice is for ALL SKIN TONES! Sunburn should clearly be avoided as it contributes to skin cancer and the development of abnormal moles, as well as skin discoloration and premature aging.
Skin cancer risk affects us all, but we can reduce our risk by watching our moles, getting skin checks with the dermatologist, and using protection for our skin in the form of sunscreen, hats and other clothing. Watch one another’s back and stay safe in the sun. Let us know if you have questions about sunscreen or moles by sending us questions on our social media channels. Visit the American Academy of Dermatology or the Skin of Color Society for videos and other content about skin cancer awareness.
LivSo free & clear,
Shari Hicks-Graham, MD