Awareness of variation in skin cancer presentation is vital
Types of lesions and their locations on the body vary in different skin colour groups (888 words, 4.5 minutes)
It is important to recognize how the frequency and locations of different skin cancers vary among populations with different skin tones, Dr. Joël Claveau reported during a presentation at the 2020 virtual Skin Spectrum Summit.
Dr. Claveau (pictured below) is a dermatologist specializing in diagnosing and treating melanoma and other skin cancers. He is also an associate professor with the Department of Medicine at Laval University in Quebec City.
He noted there is a lack of awareness of the risks of skin cancer among darker-skinned people. “[They] do not know a lot about skin cancer; they think it is not a problem for them, and that has often delayed their time for diagnosis and treatment.”
Clinicians, too, are not as aware of skin cancer in these populations, and as a result, these patients often have poorer outcomes, he said.
Raising awareness of what to look for and where on the body to look for it is therefore important.
Basal cell carcinomas (BCCs) are the most common form of skin cancer. Overall, he noted, accounting for 80% of all such cancers. Looking at skin colour sub-groups, Dr. Claveau said that BCC is the “most frequent in the Hispanic and Asian, and the second most common [type of skin cancer] in black individuals.”
Squamous cell carcinomas (SCCs) make up approximately 20% of all skin cancers but are the most common type in black individuals and the second-most common type in Hispanic and Asian individuals, he said.
“We tend to talk a lot about melanoma and nail melanoma because we see those as very advanced cases,” said Dr. Claveau. However, he said physicians should have an elevated awareness of SCCs on the legs and in areas of chronic ulceration in dark-skinned patients.
Dr. Claveau provided a breakdown of the distribution of skin cancer lesions on the body among darker skin types.
BCCs are most commonly found on the face in all skin types
SCCs are more common in the genital area and legs, and areas of chronic ulceration, in Black, Asian, and Hispanic individuals
Melanoma in darker-skinned patients is typically found on the palms, soles and legs. It is also often found on the chest in Hispanic men
Key takeaway: While less common in darker skin, skin cancers do occur and often have poor outcomes due to late diagnosis. Dermatologists should educate their darker-skinned patients about the importance of sun protection and how to perform skin self-examinations. This self-exam education should include information on areas where increased suspicion is warranted.
From the literature on cancer in skin of colour
Mucoscopy of lip squamous cell carcinoma and correlation with skin phototype and histological differentiation: A multicentric retrospective observational study by the International Dermoscopy Society
Findings from this retrospective observational study suggest that the presence of vessels, scale or crust, and keratinization-associated white structures were the most common dermoscopic clues in squamous cell carcinoma (SCC) of the lip. Brown-to-grey dots or globules were exclusively seen in lip SCC cases in darker skin.
UV exposure and the risk of cutaneous melanoma in skin of colour: A systematic review
This review looks at the available evidence for the risk to darker-skinned individuals of cutaneous melanoma due to ultraviolet (UV) light exposure. The authors conclude that the literature suggests UV exposure may not be a significant risk factor in this population. Still, because the existing evidence is of moderate to low quality, more studies are needed.
Skin cancer in women of colour: Epidemiology, pathogenesis and clinical manifestations
The authors of this open-access review note there is limited data on skin cancer in patients with skin of colour and even more limited data on women of colour specifically. They review the existing data on skin cancer in women of colour and make recommendations on counselling this population.
Racial and ethnic disparities in melanoma awareness: A cross-sectional survey
This cross-sectional survey of 285 participants found that only 46.3% of Fitzpatrick skin types (FST) III and IV and 57.6% of FST V and VI knew that melanoma was a form of cancer. Hispanic participants were less likely to know what melanoma is, compared to white participants.
VIDEO: Skin cancer risk for patients with vitiligo does not increase after UVB phototherapy
At the intersection of skin and society
On Aug. 14, 2021, the Royal B.C. Museum in Victoria opened a new exhibition exploring the history of Black people in British Columbia. The exhibition runs until March 2022.
As described on the museum's website, the exhibit “daylights the living and ongoing history of Black belonging, told in this manner by the Black community for the first time.”
The exhibition, titled “Hope Meets Action: Echoes Through the Black Continuum,” is partnered with the BC Black History Awareness Society.
Stories of Black women are a key part of the exhibit. One example is Sylvia Stark, who was born an enslaved person in Missouri, taught herself to read by secretly listening to her master’s children’s lessons and later became a significant part of the Black pioneer community on Salt Spring Island, BC. Stark's daughter Emma was also the first Black teacher on Vancouver Island.
The pocket gallery features audio recordings of Black British Columbians and artwork by young Black artists.
This Week
August is National Immunization Awareness Month in the U.S.
Aug. 23 is International Day for the Remembrance of the Slave Trade and its Abolition
Something to think about during the week ahead…
Looking Ahead
We invite you to attend The 7th Annual Skin Spectrum Summit on Nov. 4 and 6, 2021. The Summit is Canada’s leading ethnodermatology medical conference for physicians.
Skin Spectrum Weekly will bring you news on faculty and topics for this year’s Summit as we get closer to the Summit.
Information on prior Summits is available at SkinSpectrum.ca