Why are people of color more likely to die from skin cancer?

Why are people of color more likely to die from skin cancer?

When Jacqueline Smith volunteers at events promoting the importance of skin cancer screening, she offers sun protection to everyone who visits her booth or booth.

Jacqueline says she’s heard “no, I don’t need to” from many black people.

He repeats it with determination. “You need it,” she says. “You really need it. Just take it. “Do it for me.”

There is a story behind Jacqueline’s tenacity. More than 15 years ago, when Jacqueline was 21, she was diagnosed with melanoma, the most serious type of skin cancer. It develops in the cells that produce melanin which determines skin tone. If only 1 in 10 skin cancer diagnoses It is melanoma, the condition that causes the majority of skin cancer deaths.

Statistically, Jacqueline’s risk should be very low. Although melanoma is one of the most common cancers for young adults, especially for women, the median age at diagnosis is 65 years. Jacqueline is also African-American, and melanoma diagnoses are rare for people with darker skin. According to the American Cancer Society, the risk of developing melanoma it is 1 in 38 for non-Hispanic whites, 1 in 167 for Hispanics, and 1 in 1,000 for non-Hispanic blacks.

However, once Jacqueline received her diagnosis, she faced an increased risk of death. Despite the rarity of melanoma diagnoses for people of color, those who are Black, Hispanic, Asian American, Native American, and Pacific Islander have more chance to die of the disease than whites.

“Melanoma is not very common for people with darker skin types than for people with lighter skin,” she said. Janine Luca, MD, a board-certified dermatologist and associate professor and resident program director in the department of dermatology at Loma Linda University in California. “The problem is that melanomas are diagnosed in more advanced stages for people with darker phototypes and, consequently, the survival rate tends to be lower”.

When is delay deadly?

Jacqueline didn’t fit the profile of darker-skinned melanoma patients for another reason. I had skin melanomawhich is associated with both ultraviolet (UV) and non-ultraviolet (UV) exposure acro lentiginous melanoma which is more frequent in darker skin. Acro lentiginous melanoma, which develops on the palms of the hands, soles of the feet and the nail bed (connective tissue that connects the finger to the nail), is most commonly associated with reggae legend Bob Marley, who died of the disease. He had a dark spot on his toenail that was initially mistaken for a football injury and died four years after being diagnosed with melanoma.

What often makes finding and treating melanoma in black people difficult is that acro-lentiginous melanoma has no clear association with sun exposure because it appears in areas not usually exposed to the sun. Additionally, the fact that people of color are at low risk for melanoma may make it less likely that many will be diagnosed early.

Diagnoses can also be delayed if people don’t travel to see a dermatologist or if they can’t pay for a consult to examine a suspicious growth. Janiene says more research is needed to help determine additional melanoma risk factors for people of color, along with more education for healthcare professionals and people in general to identify melanomas on darker skin.

“It’s important to make sure, as we train new dermatologists, that they can see a wide range of images and can understand that clinically there might be some differences in appearance in light-skinned people versus darker-skinned people,” Janiene said.

Joel Bervell, a Washington State University medical student who uses social media to educate his audience about racial bias in health care, shares information about skin cancer and darker complexions in some of his videos. In one, show pictures of acro lentiginous melanoma in darker skin and explains how it’s more common in people with darker skin tones, as well as those of Asian descent.

Joel said he later received a message from a follower who noticed an unusual dislocation on the ball of his foot. After watching the video, that person made an appointment with a healthcare professional, had a biopsy done, and the mark was found to be precancerous. That person indicated that without Joel’s video it would not have occurred to him to check his feet for discoloration and perhaps he would not have considered that he should be concerned about those marks.

“Stories like these demonstrate the importance of sharing diverse images and challenging common beliefs we hold about various medical conditions,” Joel said.

Share your story

Although moles and blemishes can be common in people of any skin tone, healthcare professionals like Janiene suggest that people check for any enlargement, change, irregular shape, bleeding, or pain and report it to a healthcare professional.

That’s what Jacqueline did when she first noticed an almond-shaped bulge near her bikini line. She has noticed that she has grown over time. She was growing slowly, but she was getting bigger. Two different health care workers thought it wasn’t serious, but Jacqueline had a feeling something was wrong.

Finally, he had a healthcare professional order a biopsy. The result was stage 3 melanoma.

“When they hear melanoma, they think of middle-aged white people,” Jacqueline said. She didn’t fit into any of the high-risk categories for the disease and she didn’t spend much time in the sun growing up in New Jersey. About one in 10 people with melanoma have it family history of the disease but Jacqueline said she is the only person in her family who has been diagnosed with melanoma. To this day, she does not know what may have caused it.

Jacqueline had the lump removed and for the next four years she was tested to make sure the cancer hadn’t returned. “Watch and wait” was the plan until another lump appeared in the same spot. And again, the diagnosis was stage 3 melanoma.

This time, his medical team said he may not have long to live.

Jacqueline decided to have the entire chain of lymph nodes in her groin removed hoping to prevent the cancer from spreading to other organs. She also became one of the first people to enroll in a clinical trial of a modified version of interferon which was not as difficult to administer as the existing medicine at the time. He also received radiation every day of the week for four months.

To date Jacqueline has lived without cancer for 15 years. She holds a doctorate in medical sociology and has studied the experiences of women under 30 who are survivors of melanoma. In 2023, she also prepared to welcome her first child, an experience she considers a miracle that she thought would not be possible after undergoing cancer treatment.

Jacqueline has made melanoma awareness a part of her life ever since her surgical oncologist asked if she would like to serve on the education committee at the Moffitt Cancer Center in Tampa, Florida, where she continues to receive treatment. Continue to educate others about the disease, the importance of participating in clinical trials, and how melanoma can affect anyone, regardless of age or skin tone.

“Stand up for your medical rights,” she said. “You know your body and as good as it feels to hear ‘there’s nothing wrong’, when you have a feeling and you know something is wrong, go back to the office. Ask for a second opinion. This can mean the difference between life and death.”

This resource has been prepared with support from Merck.

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