Skin cancer presentation in richly pigmented skin
Awareness of differences in epidemiology, sites of basal and squamous cell carcinoma and acral melanoma in dark skin can improve outcomes (1,300 words, 6 minutes 30 seconds)
Patients with darker skin as well as physicians need to be better educated about skin cancer in people of colour, said Dr. Joël Claveau during a presentation at the 8th annual Skin Spectrum Summit. Knowing where and how lesions appear in darker skin could lead to earlier diagnosis and better outcomes.
Dr. Claveau is an associate professor in the Department of Medicine at Laval University and director of the melanoma and skin cancer clinic at Le Centre Hospitalier Universitaire, Hôtel-Dieu de Québec.
Basal cell carcinoma: These lesions are less common in darker skin, and are often pigmented rather than red. They tend to be found on the face and shoulders.
Squamous cell carcinoma: These are more common in darker-skinned populations where they are most frequently found on the legs and in the genital area, though they can also be found on the face and the backs of the hands. Wounds in these areas that do not heal should raise suspicion of squamous cell carcinoma.
Acral melanoma: Often achromic, acral melanoma is more common in dark-skinned patients. The lesions occur most commonly on the palms, soles, and nails, though they can also appear on the torso. Lesions on the torso are more common in Hispanic individuals. Physicians should make a point of examining the feet and nails of dark-skinned patients, including between the toes. In addition to dark spots, acral melanoma can present with a hyperkeratotic callous, potentially without pigment and with a red centre. Suspect lesions on the palms and soles of the feet should be biopsied.
From the literature on skin cancer in skin of colour
Differences in Merkel cell carcinoma presentation and outcomes among racial and ethnic groups
This retrospective cohort study included patients diagnosed with Merkel cell carcinoma (MCC) and followed up from 2000 through 2018. The data came from 18 population-based cancer registries of the U.S. National Cancer Institute's Surveillance, Epidemiology, and End Results Program.
Of the 9,557 patients with MCC identified, 222 (2.3%) were Asian American or Pacific Islander, 146 (1.5%) Black, 541 (5.7%) Hispanic, and 8,590 (89.9%) White. Hispanic patients had improved MCC-specific survival compared to White patients (hazard ratio, 0.82; 95% CI, 0.67-0.99; p=0.04). Black patients had the lowest MCC-specific survival, but it was not statistically different from White patients (hazard ratio, 1.19; 95% CI, 0.86-1.60; p=0.28). Hispanic and Black patients were less likely to present with a primary site of the head and neck than White patients (183 of 541 [33.8%] Hispanic patients and 45 of 146 [30.8%] Black patients vs 3,736 of 8,590 [43.5%] White patients; p<0.001 and p=0.002, respectively). Black patients presented more often than White patients with advanced disease at diagnosis (59 of 146 [40.4%] vs 2,510 of 8,590 [29.2%]; p=0.004).
Qualitative exploration of melanoma awareness in black people in the USA
Through analysis of in-depth semi-structured interviews, researchers explored awareness and perspectives of melanoma among Black people in the U.S.
A total of 26 participants from 10 different states were interviewed.
The investigators identified five key themes regarding melanoma awareness in Black people:
A lack of understanding of the term “melanoma” and the features of skin cancer
Participants did not feel at risk of melanoma skin cancer
Surprise that melanoma can occur on the palms, soles, and nails
A perception that skin cancer awareness messages do not apply to or include Black people
The importance of an individual’s relationship with healthcare providers and their habits of healthcare utilization
They conclude there is a pressing need for health information on melanoma designed specifically for Black people, including recommendations for the public and healthcare providers to check the palms, soles, and nail beds.
Characterizing skin cancer in transplant recipients by Fitzpatrick skin phototype
This study is a retrospective review of organ transplant recipients (OTRs) with Fitzpatrick skin types III-VI evaluated between Jan. 1, 2012, and June 1, 2022.
Of 530 OTRs evaluated at one facility, 193 had Fitzpatrick skin type III or higher and were included. Ten patients (5.18%) developed 87 skin cancers and one recurrence at a mean of 5.17 years post-transplant.
Among the patients with skin cancer, 70% self-identified as Black, 70% as male, and 70% were kidney transplant recipients, with a mean age of 58.20 years at transplant. Subjects with skin cancer were more likely to be former smokers (60%) and prescribed tacrolimus (p≤0.001 each).
The most common skin cancers to develop were cutaneous squamous cell carcinoma (66, 75.86%), basal cell carcinoma (17, 19.54%), and malignant melanoma (3, 3.45%). Skin cancer most often occurred on the face or scalp (60%, p=0.027), though it also developed in sun-protected sites (30%, p=0.002). Verruca vulgaris was present in 10% of patients (p=0.028).
The pursuit of equity in skin cancer prevention: A survey-based investigation of total body skin exam awareness and utilization across Fitzpatrick skin type
The authors of this paper investigated skin cancer monitoring practices in dermatology patients stratified by Fitzpatrick skin type (FPST). They administered a 51-item questionnaire to 202 patients at a tertiary academic dermatology centre.
The researchers found that the FPST I–II group had the highest proportion of participants who had received a total body skin examination (TBSE, 56%), followed by FPST III–IV (23%) and FPST V–VI (11%).
Of the patients who had never received a TBSE, the most selected reason in the FPST I–II group was ‘I didn’t think I needed one’ (22%). In contrast, in the FPST III–IV and V–VI groups, the most selected reason was ‘No one offered it’ (32% and 46%, respectively).
Those in the FPST III-IV and V-VI groups were also less familiar with the information on a brief TBSE fact sheet and were less likely to agree with the statement “I would feel vulnerable to getting skin cancer in my lifetime if I don’t protect my skin from the sun.”
VIDEO: Melanoma and Brown skin with Dr. Crystal Aguh, Associate Professor of dermatology and Director of the ethnic skin program at the Johns Hopkins school of medicine in Baltimore
At the intersection of skin and society
There is growing support from the Canadian film industry for Indigenous-created films, reports CBC News.
The news outlet quotes Marie Clements, Métis director of Bones of Crows, saying that funding mandates have changed over the past three to five years to ensure Indigenous storytelling plays a larger role in Canadian film. Those changes have come through years of struggle, she said, and a push for more equity.
“I think most Indigenous filmmakers would say it's been really tough. I think we kind of feel like the door is opening now,” said Clements.
Adriana Chartrand, Lead, Indigenous Initiatives and Content Analyst at Telefilm Canada, told the news outlet that she has recognized a level of “gatekeeping” regarding film funding.
“I think we're trying to work to change who are the players, who are the decision-makers,” said Chartrand, who has a budget of CAD$4 million per year for Indigenous films. Telefilm can fund those projects at any stage, from development to production and post-production.
“The decisions that people make over time, and contemporarily, are going to influence the movies that people see. But I think we are seeing a change.”
Chartrand also said there has been an increase in the diversity in the material coming from Indigenous film creators.
“We're seeing a wider breadth of genres coming from Indigenous creators, which is super exciting. Like, sci-fi, horror, comedies, you know, romantic comedies.”
April 3 to 7 is National Cancer Registrar’s Week in the U.S.
April 5 is International Day of Conscience
April 7 is World Health Day
Something to think about in the week ahead. . .
Henry Ford, American businessman, 1863-1947
There will be no Skin Spectrum Weekly on April 10 due to the Easter long weekend. We will return on April 17 with comments from Dr. Lionel Bercovitch on the unequal impact of vitiligo in skin of colour. Dr. Bercovitch is a professor of dermatology at Warren Alpert Medical School at Brown University in Providence, R.I.
NEW: An open call for original research, review articles, commentary, and case reports
Skin Spectrum Quarterly™: The Journal of Ethnodermatology is a new worldwide dermatology journal that focuses on the emerging subspecialty of "Ethnodermatology." The journal will be distributed in print and digitally and will champion "Skin Health for All," with a special focus on understudied groups of patients with richly pigmented skin (Fitzpatrick types IV-IV.)
Skin Spectrum Quarterly™ will publish high-quality original research, review articles, correspondence, clinical news with commentary, recent book and publication reviews, editorials, and first-person opinion articles. The journal's interests lie at the intersection of dermatology, race, and culture.
We invite authors to submit articles reflecting the journal's focus and interests. All submitted articles will undergo an independent, rigorous peer-review process prior to acceptance. To request more information on submitting an article, please email email@example.com. We are excited to hear from you.
The journal will launch separate editions in the USA and Canada in 2023, and begin distribution in other areas of the world the following year.
The submission deadline for Inaugural Issue is May 15, 2023.
Articles should be original and not previously published or under consideration for publication elsewhere.
Articles should be written in English and adhere to the highest standards of scientific writing.
Articles should be between 2,000 and 4,000 words, not including references, tables, or figures.
Authors should also include an abstract of their article, at most 250 words in length.
Authors should provide a list of three to five keywords that accurately describe the content of their article.
The journal uses the Vancouver citation style; all references should be numbered and listed at the end of the article.
Manuscripts should be submitted in Microsoft Word format and double-spaced throughout, including references, tables, and figures.
Figures and tables should be submitted as separate files in high-resolution formats, such as TIFF or JPEG.
A cover letter should accompany the submission, indicating the article's title, the author's name, affiliations, and contact information.
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