ASK THE EXPERT: Can darker-skinned people get skin cancer?

By Maritza Perez, MD

Dr. Perez is director of cosmetic dermatology at St. Luke’s Roosevelt Medical Center and associate professor of clinical dermatology at Columbia University, New York City. Dr. Perez is the author of over 100 publications. She is co-author of Understanding Melanoma: What You Need to Know with Perry Robins, MD.

Q. Can darker-skinned people get skin cancer? As a person of color, what should I look for when examining my skin?

A. Yes, everyone can get skin cancer. Most skin cancers are associated with ultraviolet (UV) radiation from the sun or tanning beds, and many people of color are less susceptible to UV damage thanks to the greater amounts of melanin (the protective pigment that gives skin and eyes their color) darker skin produces. But people of color can still develop skin cancer from UV damage.

Additionally, certain skin cancers are caused by factors other than UV — such as genetics or other environmental influences — and may occur on parts of the body rarely exposed to the sun. For example, darker-skinned people are more susceptible to acral lentiginous melanoma (ALM), an especially virulent form of melanoma (the deadliest type of skin cancer) that typically appears on the palms of the hands and soles of the feet.

Different ethnicities are at higher risk for particular skin malignancies: Latinos, Chinese, and Japanese Asians tend to develop basal cell carcinoma (BCC), the most common skin cancer. But the second most common, squamous cell carcinoma (SCC), is more frequent among African Americans and Asian Indians.

I advise people of all ethnicities to do a monthly skin self-exam, looking for lesions that bleed, ooze or crust, don’t heal, or last longer than a month; these may indicate basal cell carcinoma. Squamous cell carcinomas may appear as non-healing ulcers, growths, and sores next to scars or areas of previous physical trauma/inflammation, particularly if they appear on the legs. New or existing moles (brown, pink, black, red, or flesh-colored spots) that are asymmetric, have an irregular border, change in color, are larger than a pencil eraser, or change in any way may indicate melanoma. Any of these warning signs should be examined by a dermatologist, including growths on the hands, soles, or under the nails. Such spots could signify ALM.

Because many doctors and patients believe people of color are immune to skin cancer, diagnosis is often delayed, sometimes until the disease is advanced and potentially fatal. Furthermore, dangerous skin cancers such as the fast-moving ALM and a metastasizing (spreading) form of squamous cell carcinoma are more common among darker-skinned people. So while skin cancer is much more common among lighter-skinned people, it tends to be more deadly among people of color.

Published in the Fall 2009 Edition of Sun and Skin News