Skin cancer is the most common form of cancer affecting all races and ethnicities. In the Black and African American communities, skin cancer is less common compared to individuals with lighter skin, but is often more deadly because it goes undiagnosed. Squamous cell carcinoma (SCC), basal cell carcinoma (BCC) and melanoma are the most common types of skin cancer in Black Americans.
SCC may appear on any part of the body, including areas not exposed to the sun. It typically appears as a firm, raised bump or a growing, scaly sore. BCC, the most prevalent type of skin cancer, develops in the basal cells of the skin and is usually associated with prolonged exposure to the sun.
Darker skinned people have a relatively low risk of melanoma compared to individuals with lighter skin. However, Black patients are more likely to have advanced melanomas at diagnosis, with a five-year survival rate of 70% compared with 92% for White patients. Melanoma in individuals with darker skin often appears in the palms, soles or under the nails, and can sometimes be mistaken for other skin conditions.
In 2023, it is estimated that there will be 186,680 cases of melanoma diagnosed, according to the American Cancer Society’s Cancer Facts and Figures report. Of those, 89,070 cases will be non-invasive and 97,610 cases will be invasive.
“Melanoma in Black populations tends to be diagnosed at later stages and as such has a worse prognosis,” says Andrew F. Alexis, M.D., M.P.H., professor of clinical dermatology and vice chair for diversity and inclusion at Weill Cornell Medicine in New York City.
Over the years, Black people have not been the focus of melanoma public health and educational campaigns. Researchers at Stanford University gauged awareness levels of melanoma among Black people to inform the development of relevant public health messages to promote early detection of melanoma. A total of 26 Black or African American people from 10 different states participated in the study. Researchers identified five main themes around melanoma awareness, including:
- Lack of understanding of the term “melanoma” and the features of skin cancer
- Did not feel at risk of melanoma skin cancer
- Surprise that melanoma can occur on palms, soles and nails
- Skin cancer awareness messages do not apply to or include Black people
- Importance of relationship with healthcare and habits of utilization.
The study results, published in BMJ Open, do not surprise Alexis. Low public awareness of the risk of melanoma in the Black community is one of the main reasons why advanced melanoma risk is high among Blacks. “There’s also lower rates of screening and the tendency for melanomas among the Black population to occur in less exposed areas such as the sole of the foot, nail unit or mucous membranes,” says Alexis.
According to Alexis, there are certain factors that may contribute to the development of skin cancer in Black people, including:
- Genetic factors: Specific genetic mutations can increase the risk of skin cancer, including melanoma, in individuals of African descent.
- Acral lentiginous melanoma (ALM): This subtype is the most common type seen in Black people and appears as dark, irregular patches on the palms, soles or under the nails.
- Late detection: Skin cancer in Black people is often diagnosed at a later stage, leading to poorer health outcomes and higher mortality.
- Sun exposure: While darker skin provides some natural protection against harmful UV rays, it does not eliminate the risk of skin cancer. Prolonged sun exposure, particularly without adequate protection, can still contribute to the development of skin cancer in Black people.
An effective public awareness campaign for the Black community should provide education around how patients can perform self-skin exams that include the palms, soles and nails. “An important step in melanoma screening is routine examination of those areas, and the rest of the body, during annual exams,” says Alexis.