Identifying non-melanoma skin cancer in skin of colour
Locations and appearances to recognize for basal, squamous cell carcinomas in darker skin types (6 minutes, 1,300 words)
While Caucasians face elevated risks for most skin cancers, emerging data reveals the threat now transcends racial boundaries—with non-melanoma diagnoses increasingly occurring in patients with richly pigmented skin.
Patients with skin of colour are often diagnosed with these cancers later, often when the cancer is at a later stage and the prognosis is worse, said Dr. Maritza I. Perez in an interview with Prevention magazine.
Dr. Perez is a professor of dermatology at the University of Connecticut and specializes in Mohs micrographic surgery and laser and cosmetic surgery.
She notes that having darker skin can also make skin cancer more difficult to identify. A red or pinkish lesion stands out against pale skin, Dr. Perez points out in the interview. “But in people of colour, a BCC [basal cell carcinoma] and CSCC [cutaneous squamous cell carcinoma] growth can show up as a translucent or skin-colored bump, which is less noticeable,” she said.
The locations these lesions appear also can vary more in patients with skin of colour, she said.
“A main cause of mutations in immunosuppressed people include HPV, and—especially in people of colour—chronic inflammation and chronic scarring processes,” said Dr. Perez. So other regions of the body should be examined for lesions, including fingers and nail beds, between the toes, in the perianal and genitalia areas, and other areas usually covered by clothing.
While NMSC is rarely life-threatening, Dr. Perez noted that roughly 1% of BCCs can grow into surrounding tissues or metastatize. As well, research has shown that having one BCC lesion increases the risk of other types of cancer, including melanoma, she said.
Bottom line: Patients of every skin tone can develop non-melanoma skin cancers, but differences in presentation can lead to late diagnosis and worse outcomes in patients with skin of colour. Unmanaged, some of these cancers can progress to more severe disease. Examinations for lesions should include the fingers, nail beds, between the toes, and other areas typically covered by clothing.
From the literature on non-melanoma skin cancer in skin of colour
Race-specific and skin of colour dermatoscopic characteristics of skin cancer: A literature review
Researchers searched the PubMed database up to Dec. 30, 2022, using search terms referring to dermatoscopy, race (Caucasians, Hispanics, Asians, and Black/African) and skin cancer types (BCC, SCC, keratoacanthoma, Bowen's disease, and melanoma).
They ultimately included 30 race-specific records. Investigators compared nine SoC records for BCCs (two BCC studies in Hispanics, one BCC study in Black individuals and six BCC studies in Asians ), nine SoC records for SCCs (one SCC study in Hispanics, one SCC study in Black individuals and seven SCCs in Asian population) and eight SoC records for melanoma (two melanoma studies in Hispanics, one melanoma study in Blacks and five melanoma studies in Asians) were compared with four records that involved only Caucasian population, according to their participant section. They also compared them with studies on dermatoscopy characteristics without focusing on race origins and phototype of the patient.
In Hispanics and in both fair and dark-skinned Asians, BCCs were more often pigmented or at least had pigmented structures on dermoscopy. Squamous cell carcinoma (SCC) and keratoacanthoma were the least studied in SoC patients. Bowen's disease in SoC patients can be pigmented in a higher frequency compared to Caucasians, with glomerular vessels and a squamous surface being the most common dermatoscopic findings. The most frequent pattern of melanomas in SoC individuals were the parallel ridge pattern in palmoplantar region.
Non–melanoma skin cancer in solid organ transplant recipients with skin of colour
This retrospective review examined cases of solid organ transplant recipients (SOTRs) seen at a single centre’s primary care, transplant, or dermatology clinics between 2000 and 2020. Researchers grouped patients based on self-identified race. They compared rates of non-melanoma skin cancer (NMSC) for each race with White SOTRs.
White SOTRs had the highest prevalence of posttransplant NMSC, with 111 individuals (15.5%; 95% CI: 12.9%-18.3%) developing at least one NMSC and 28 (3.9%) developing three or more. Although Hispanic SOTRs had a decreased prevalence of posttransplant NMSC compared with White SOTRs, the authors say further exploration is needed to strengthen this claim. Only one Black and one Asian SOTR developed NMSC after transplant. Native American SOTRs had no reported skin cancer before the transplant, though nine developed NMSC after transplant. This rate was substantially lower than in White SOTRs. Metastatic NMSC was reported in two Hispanic and six White SOTRs, with three reported mortalities, all Whites.
Dermatopathology trends in African Americans: A retrospective analysis of biopsies
Researchers conducted this retrospective analysis of biopsies to determine the frequency of dermatologic conditions biopsied in African Americans (AA). From a total of 1,701 biopsies collected from 1,442 AA patients, the investigators found neoplasms were the most common diagnosis, accounting for 26.7%, predominantly in females. Cutaneous T-cell lymphoma was the most frequently biopsied malignancy, whereas pigmentary disorders were the least common at 1.4%.
The authors note their findings highlight the higher occurrence of squamous cell carcinoma compared with basal cell carcinoma in AA, contrasting trends in other racial demographics. “Future research could further explore the potential gaps between clinical expectations and histologic findings, improving diagnostic accuracy,” they write.
Skin of colour representation in dermoscopy studies distinguishing benign from malignant skin lesions: A scoping review
Researchers searched PubMed for peer-reviewed articles examining dermoscopic features of melanoma, squamous cell carcinoma, and basal cell carcinoma published from inception to Jan. 3, 2023. From 2,470 identified articles, 159 studies met inclusion criteria.
Of those 159 studies, only eight (5.0%) reported subject race or ethnicity, with seven studies including White patients. Only one study explicitly included Black, Native American, or Pacific Islander patients, two studies included Hispanic patients, and four studies included Asian patients. Fitzpatrick phototype was reported in 21 (13.2%) studies, with most including participants with phototypes I-III, fewer including phototypes IV-V, and none including phototype VI. Nationality was disclosed in 12 (7.5%) studies.
Noting that acral lentiginous melanoma (ALM) comprises a larger proportion of skin malignancies in skin of colour (SOC) patients, the authors examined a subset of 19 of the 159 studies that included ALM. Among three of those studies reporting race and ethnicity and four reporting phototype, most patients were White or light-skinned (phototypes I-III).
When the researchers examined the top 20 most highly cited publications among the included studies, none reported race or ethnicity, one reported phototype (with most participants in phototypes I/II), and one reported patient nationality.
VIDEO: Are skin cancers different in skin of colour?
Dr. Valerie M. Harvey, a dermatologist in Newport News and Virginia Beach, Va., discusses the differences in presentation of non-melanoma and melanoma skin cancers in darker skin types, as well as prevention practices.
At the intersection of skin and society
Findings from a recent survey of Indigenous Canadians show that more than half—58.6%—say they have experienced discrimination in their current workplace, and 56.2% said they have played down their Indigenous backgrounds to “fit in better at the workplace.”
The survey of 500 individuals who self-identified as Indigenous was conducted by ComIT.org, a registered charity that provides free training and professional development opportunities in information technology.
According to a press release from the charity, the survey was conducted to “take a pulse check” of current workplace prejudices and concerns for Canadian Indigenous communities and Indigenous Canadians working in the IT sector.
Other findings from the survey include:
61.60% of Indigenous Canadians surveyed think they are less likely to be promoted simply based on being Indigenous
97.2% of Indigenous Canadians surveyed say there is a lack of representation of Indigenous voices in C-Suite positions in the tech Industry
62.40% of Indigenous Canadians surveyed say they have experienced bias when applying for a job because they are Indigenous
33.80% of Indigenous Canadians surveyed choose to not list being Indigenous on their social media profiles
More findings from the survey can be found in the press release.
This week
February is Black History Month
February is Preventative Health Awareness Month in Canada
Feb. 4 is World Cancer Day
Something to think about in the week ahead. . .
—Gaston Bachelard, French philosopher (1884 to 1962)
Next week
Dermatologist Dr. Jonathan Shapero of Toronto discusses misconceptions and tips related to treating facial skin conditions in dark skin using laser devices.
Upcoming Indigenous health webinar
On Tuesday, Feb. 27, 2024, dermatologists Drs. Carolyn Jack and Rachel Asiniwasis are hosting a free virtual presentation titled “Practical Approaches and Considerations for Healthcare Practitioners Treating Indigenous Patients with Atopic Dermatitis: Closing Gaps in Health Disparities."
The presentation begins at 7:30 p.m. (EST) and is open to all healthcare practitioners.
Registration is open at the link below.
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Drs. Lauren Lam (Calgary), Sam Hanna (Toronto), Benjamin Barankin (Toronto), and Renée A. Beach (Toronto) discuss many of the new therapeutic options that arrived in 2023.
Dr. Andrew F. Alexis (New York) details pigmentary disorders in patients with skin of colour.
An essay from Dr. Sheila Wang (Montreal) submitted to the 2022 Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE) short essay contest. Dr. Wang wrote about the development of new imaging technology to detect and assess ‘beneath-the-skin’ inflammation, perfusion, and tissue oxygenation in any skin phototype.
Plus regular features, including the popular column “Vender on Psoriasis” by dermatologist Dr. Ron Vender
Read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary* subscription or to receive a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates new findings concerning dermatologic issues that affect women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether or not vitamin D has any impact on psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
And if you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.