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’ll offer sunscreen to anyone who stops by her table or booth.

Smith said she hears “No, I don’t need to,” a lot from people of color.

Determined, she offers it again. “Yes, you do,” she says. “Really. Just take it. Indulge me.

There is a story behind Smith’s tenacity. More than 15 years ago, when he was 21, Smith was diagnosed with melanoma, the most serious type of skin cancer. It develops in the cells that produce melanin, which is responsible for skin tone. While melanoma just accounts for
1 in 10 of all skin cancer diagnosesit is responsible for the majority of skin cancer deaths.

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

Once diagnosed, however, Smith faced a greater risk of death. Despite the rarity of melanoma diagnoses among people of color, those who are Black, Hispanic, and Asian American/Native American/Pacific Islander are
more likely to die from disease than whites.

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

When delay is deadly

Smith didn’t fit the profile of darker-skinned melanoma patients for another reason. He had one
skin melanomawhich is associated with exposure to ultraviolet (UV) light and not the acral lentiginous melanoma more commonly seen in darker skin. Acral lentiginous melanoma, found on the palms of the hands, soles of the feet, and the beds of the fingers and toenails, is most commonly associated with reggae legend Bob Marley, who died of the disease. He had a dark spot on his toenail initially mistaken for a football injury and died four years after being diagnosed with melanoma.

The thing that often makes finding and treating melanoma in black people difficult is that acral lentiginous melanoma has no clear association with sun exposure, as 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 for many to get an early diagnosis.

Diagnoses can also be delayed if people can’t travel to see a dermatologist or pay to have a suspicious growth examined. Luke said more research is also needed to help determine additional risk factors for melanoma among people of color, along with more education for healthcare professionals (HCPs) and people about identifying melanoma in darker skin .

“It is important to make sure that as we are training new dermatologists that they are able to see a wide variety of images and understand that clinically there may be some differences in appearance in someone with light skin versus someone with darker skin” Luke said.

Joel Bervell, a Washington State University medical student who uses social media to educate viewers about racial bias in healthcare, shares information about skin cancer and darker skin in some of his videos. In one, he showed images of acral lentiginous melanoma on darker skinand explained how it was more prevalent in people with darker skin as well as people of Asian ancestry.

Bervell said he later received a message from a follower who noticed unusual discoloration on the ball of his foot. After seeing the video, they made an appointment with a healthcare professional, received a biopsy, and the mark was found to be precancerous. Without Bervell’s video, the person said, they wouldn’t have thought to check their feet for discoloration and probably wouldn’t have seen the marks there as a cause for concern.

“Stories like this show the importance of sharing different images and also challenging the common beliefs we hold about different health conditions,” Bervell said.

Sharing his story

While moles and spots can be common on people of any skin tone, healthcare professionals like Luke suggest people watch if they grow, change, shape, bleed or hurt, and report them to a healthcare professional.

That’s what Smith did when she first noticed an almond-shaped lump near her bikini line. As she watched him through time, she noticed that he was growing. It was growing slowly, but it was still getting bigger. Two different providers didn’t think it was serious, but Smith had a feeling something was wrong.

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

“When people think of melanoma, they think of middle-aged Caucasian people,” Smith said. She didn’t fall into any of the high-risk categories for the disease and didn’t spend much time in the sun when she was growing up in New Jersey. About 1 in 10 people with melanoma have a
family history of the disease, but Smith said she’s the only one in her family who’s been diagnosed with melanoma. To this day, she doesn’t know what might have put her at risk.

Smith removed the lump and for the next four years had scans to make sure the cancer hadn’t returned. “Watch and wait” was the plan until another lump returned to exactly the same place. And again, the diagnosis was stage 3 melanoma.

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

Smith decided to remove the entire chain of lymph nodes in his groin in hopes of preventing the cancer from spreading to other organs. She also became one of the first people to enroll in a clinical trial for a modified version of
interferon, which was not as difficult to take as the existing drug at the time. He also received radiation every day of the week for four months.

Smith has been cancer-free for 15 years. She went on to complete a doctorate in medical sociology and studied the experiences of women under 30 who are melanoma survivors. In 2023, she also prepared to welcome her first child, an experience she considers a miracle, something she thought would not be possible after undergoing cancer treatment.

Smith has made melanoma advocacy 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 received treatment. She continues to spread awareness about the disease, the importance of participating in clinical trials, and how melanoma can affect anyone, regardless of age or skin tone.

“Be your own health advocate,” she said. “You know your body and as much as you appreciate hearing, ‘Oh, nothing’s wrong,’ when you have a feeling and you know something is wrong, it keeps coming back. Ask for a second opinion. It can make the difference between life and death.”

This resource was created with support from Merck.

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