Melanoma: Blacks are not immune
The summer solstice is now upon us. Warnings against skin cancer will abound: wear sunscreen, sunglasses and a wide-brimmed hat. Cover up and avoid the sun between 10 a.m. and 2 p.m. when it is the hottest and most damaging.
There’s good reason for this caution. Skin cancer is the most common cancer. The National Cancer Institute (NCI) estimates that more than 3 million cases will be diagnosed in 2014. Fortunately, the two most common types of skin cancer — basal cell carcinoma and squamous cell carcinoma — very seldom spread to other parts of the body and are less likely to result in death.
Melanoma, on the other hand, is an entirely different story. Melanoma accounts for about 2 percent of skin cancer cases, but causes the majority of skin cancer deaths. The American Cancer Society estimates that 76,100 new cases of melanoma will be diagnosed in this country in 2014, and almost 10,000 people will die from it.
Yet, many African Americans will ignore the warnings — for many reasons. Words of caution of skin cancer and the sun are directed toward those with fair skin or blond or red hair — a description that eludes most blacks. In addition, there is a misperception that blacks and other people of color are exempt from skin cancer and that darker skin offers protection.
Unfortunately, that is not entirely true. While the incidence of skin cancer is significantly higher in whites, blacks are not immune.
What’s even more confusing is that the type of melanoma more frequently seen in blacks has nothing to do with the sun. Acral lentiginous melanoma (ALM) is the rarest form of the four types of melanoma. Although ALM accounts for only about 5 percent of the cases of melanoma in white people, it occurs in more than half of all cases in darker skinned patients, and is extremely aggressive.
ALM is called a “hidden melanoma” because it occurs in parts of the body not exposed to the sun.
Rather, it forms more frequently on the soles of the feet or the palms of the hands. It begins as an irregularly shaped tan, brown or black spot, and is often mistaken for a bruise.
Another typical site is under the fingernails or toenails — particularly the thumb and big toe — and has a distinctive look. The cancer shows itself as a vertical black, brown or tan streak that appears without known injury to the nail. Bob Marley mistook the streak under his toe nail as a soccer injury. It turned out be ALM. By the time he sought treatment, the cancer had spread. He succumbed at the age of 36.
Other sites of ALM are mucous membranes, such as the mouth, nose and genital area.
This lack of awareness of ALM carries a stark penalty. While death rates from melanoma are higher in whites, the death rates in blacks are greater than expected based on the frequency of its incidence. A contributing factor is a delay in treatment. By the time many African Americans visit a doctor, the cancer is in an advanced state and often has metastasized. According to the Skin Cancer Foundation, late-stage melanoma is diagnosed in 52 percent of black patients in comparison to 16 percent of white patients.
The survival rate also suffers. The five-year survival rate from melanoma is 91 percent in white patients versus 71 percent in black patients, as noted in NCI statistics.
Unfortunately, the medical community shares part of the blame for the problem. Dermatologists associated with the Skin Cancer Foundation report that “even some physicians are under the impression that non-Caucasian people are immune to this disease.”
The good news is that skin cancer is largely preventable or more easily treated when discovered early. But it takes awareness of not only what to look for but also where to look. A mole that changes size, shape or color is a typical sign, as well as color variations or an irregular border of a mole.
Minorities must pay special attention to their palms, soles of the feet and nails. Symptoms may include a new nail streak not caused by an accident; an enlarging nail streak, or a nail that is separating from the nail bed.
Prevention is key. Although ALM is not related to the sun, blacks can still get skin cancer that is attributed to ultraviolet rays and should seek protection. Wear sunscreen (SPF of 30 or more), sunglasses, a wide-brimmed hat and cover up.
Dr. Deborah A. Scott, co-director of the Multicultural Dermatology Program at Brigham and Women’s Hospital, suggests that in order to detect melanoma in its infancy, people should check their skin once a month, and also request a full-body exam by their doctors each year.
“Any spot that is changing, bleeding, growing, or any sore that is slow to heal warrants evaluation,” Scott explained. “Ninety-nine percent of the time, it’s nothing. But you should have it checked.”