August 2020

Does skin cancer occur in skin of colour?

In Dermatology, “Skin of Colour” is not clearly defined but we often use it to describe Fitzpatrick Skin Type 4-6 and it is independent of ethnicity or racial origin. It’s important to recognise that there are specific skin conditions which are more prevalent in skin of colour and that skin conditions themselves can appear different in pigmented skin types, which can make diagnosis challenging. For this reason, there is a concerted effort in the UK to increase the exposure of dermatologists, particularly trainee doctors, to the diagnosis and management of skin conditions in darker skin tones.

Skin cancers remain the commonest form of cancer in the UK, these include melanoma and non-melanoma skin cancers (NMSC) such as squamous cell carcinoma and basal cell carcinoma. Exposure to ultraviolet radiation from sunlight remains the number one risk factor for skin cancer.

Darker skin types are often thought to be protected from UV-induced skin cancers because of their higher melanin content which offers and average SPF of 13.4 (depending on skin type) compared to lighter skin tones which have a natural SPF of approximately 3.4. 

Although skin cancers occur less frequently in skin of colour, they can actually have a worse prognosis and therefore it is important that individuals of all skin types are vigilant with new or changing skin lesions. 

Consultant Dermatologist, Dr Thivi Maruthappu

Why can skin cancer have a poorer prognosis in skin of colour?

Unfortunately, and often due to lower public awareness, skin cancer can present at a later stage of the disease in skin of colour.  The most serious form of skin cancer, malignant melanoma can present differently in darker skinned patients, more frequently occurring on the palms or soles, or under the nails, areas where changing skin lesions can easily be missed. Patients are often not aware that it is possible to develop skin cancers at these sites and physician misdiagnosis can also occur.

Although skin cancer comprises only 2-4% of all cancers in Chinese and Japanese Asians and 1-2% of cancers in African-American and Asian Indians, several studies have shown that the mortality rates are disproportionately higher.  Studies have shown that there is a up to 2-3 times increase in mortality rates in melanoma presenting in skin of colour and these individuals were more likely to present with Stage IV (advanced) melanoma than Caucasians

What can we do to prevent skin cancer in skin of colour

There are two ways we can help to reduce the incidence of skin cancer in skin of colour. Firstly, by improving public education on the fact that skin cancer can occur in darker skin. In addition, early recognition of the appearance of skin cancer in darker skin tones and the sites that can be affected, in particular the palms, soles and the nail bed for both the public and healthcare community. Secondly, several studies have also shown that sun protective behaviours (seeking shade, covering up and wearing SPF) also remain an obstacle in people of colour, generally due to the belief that it is not required to prevent burning.  It has also been suggested that sun protection creams are less cosmetically acceptable in darker skins, often leaving an ashy residue which can mean that products are not applied adequately or frequently enough.  There are however, newer formulations with micronized zinc oxide/titanium dioxide particles which blend to an almost sheer finish.  

When to see your doctor?

Any changes in new or existing moles that are asymmetric, irregular border, change in colour or size should be examined by a dermatologist (Find out more about skin cancer and mole monitoring here / sun safety and Vitamin D here.

Be particularly vigilant for skin lesions on the palms, soles or under the nails.

Dr Thivi Maruthappu, Consultant Dermatologist

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