May 11th, 2023

The “hidden” melanoma

The first Monday in May is Melanoma Day. In all probability, most people of color completely ignored it. That’s understandable. Melanoma, the most dangerous form of skin cancer, is more common in Whites. For instance, the rate of new cases in White men is 37.9 per 100,000 men versus 1.0 per 100,000 men in Blacks.

Melanoma should not be ignored, however. It is the fifth most common cancer in this country. According to the National Cancer Institute, it is estimated that in 2023, it will account for 97,610 new cases and 7,990 deaths.

But Black people do not escape the disease altogether. Actually, a rare form of melanoma is more prevalent in Blacks. Acral lentiginous melanoma (ALM) accounts for roughly eight percent of all melanomas, but is the most common melanoma in dark-skinned people. It represents up to 70 percent of melanomas in Black people and up to 46 percent in Asians, according to the NCI.

The main reason it is missed is the misperception that darker toned people do not get skin cancer; they are therefore not looking for it. The other main reason is the misperception that skin cancer is caused only by the direct rays of the sun. ALM, however, typically occurs on the palms of the hand, soles of the feet and nail beds — places hidden from the sun’s exposure.

Because of these misunderstandings Black people are diagnosed at a later stage of the disease and pay the price. ALM is very aggressive and progresses rapidly. The five-year relative survival rates are lower than for the more common melanomas diagnosed among White people. One study suggested that the atypical location of lesions on the sole of the feet is what leads to the delay in diagnosis. Patients ultimately present with deep tumors at late stages that are hard to treat successfully.

Most melanomas are characterized by ABCDE, which stands for asymmetry, border, color, diameter and evolving of a mole. ALM, on the other hand, is characterized by CUBED, which stands for color, uncertain diagnosis, bleeding, enlargement and delay in healing. It is often mistaken for a bruise or foot ulcer rather than a mole. According to the Skin Cancer Foundation, Bob Marley attributed his lesion to a soccer injury. He died of ALM at the age of 36.

The bottom line is – regardless of your skin tone, it is wise to check regularly for moles and other skin lesions. Although skin cancer is rare among Blacks, it can still occur.  Heed the advice of the American Academy of Dermatology. When out in the sun, particularly between the hours of 10 a.m. and 2 p.m., apply a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher and reapply every two hours. Wear sun-protective clothing. Perform regular skin self-exams.

But people of color should take an extra step and see a dermatologist if any lesion looks suspicious.

• Examine the soles of your feet and palms of the hand for changing or growing lesions. It may resemble a bruise or stain.
• Check your nails (fingers and toes) for dark lines or unexplained streaks. The thumb and big toe are common sites.
• Look for flat gray, brown or black marks with irregular borders. Some lesions, however, may be reddish or orangish in color.

ALM often starts out smooth but becomes rougher as it evolves and can cause pain when walking.

ALM is rare but deadly. But here’s the good news. When caught early, it is highly curable, and the survival rate is high. You just have to look for it.

melanoma, skin cancer