Melanoma Prevalence In African Americans

Melanoma is an aggressive form of skin cancer. While occurrence is less common in African Americans, black patients are more likely to die from melanoma. Lack of awareness of skin cancer in skin of color and racial inequalities in health care contribute to late diagnoses. It is very important to understand the signs of melanoma, including how to detect it early.

What Causes Melanoma?

Melanocytes are specialized cells that produce the melanin or pigment that gives skin its color. All skin types have the same number of melanocytes, however, these cells differ in the types and the amount of melanin that they produce. In black skin, melanocytes produce more melanin than in other skin types. Melanin protects the skin from sun damage. Despite having more melanin, there is a common misconception that black skin cannot burn from the sun or develop skin cancer.

Melanoma develops from melanocytes in the skin due to several factors, including UV damage and genetics. While melanoma most commonly develops on the arms, legs, trunk, and face; it can also develop in areas that have not been exposed to sunlight like the feet, nails, and mouth. Melanoma is these non-sun exposed areas is more common in black skin.

How Common is Melanoma in Black Skin?

Approximately 1 in 1,000 black people will develop melanoma. As a comparison, 1 in 38 white people will be diagnosed with the same condition.

Types of Melanomas

There are several types of melanomas, which include the following:

• Acral Lentiginous Melanoma accounts for up to 60% of melanoma cases in people with black or brown skin, making it the most common type of melanoma in skin of color. Learn more about Acral Lentiginous Melanoma
• Nodular Melanoma is aggressive and quick growing, making it the most dangerous type of melanoma. The 5-year survival rate for black people with nodular melanoma is just over 50%.
• Superficial Spreading Melanoma is the most common form of melanoma in the general population. It grows more slowly than other types of melanomas.
• Lentigo Maligna Melanoma generally has some of the best survival rates. It is less common in skin of color

Why Is Melanoma More Dangerous in Black Skin?

While melanoma is less common in brown and black skin, people of color are more likely to die from it. A late diagnosis of melanoma can be deadly. People of color are less likely to be diagnosed early due to the following reasons:

The myth that skin of color cannot get skin cancer: Black skin is less likely to burn, leading some to mistakenly believe African Americans cannot get skin cancer. This may prevent people with dark skin from performing self-skin checks and seeking medical attention when they notice a concerning lesion.

Difficulty identifying lesions: Doing a personal skin-check can be difficult in darker skin types, as lesions may be harder to recognize. Photo-based or Ai skin cancer detectors may not be as sensitive to melanoma on dark skin, and may not be programmed with enough, if any, examples of melanoma on dark skin.

Inadequate medical training: Medical training and educational resources are biased toward white skin. Many physicians may not have adequate experience viewing and identifying cancerous lesions in skin of color.

Distrust of medical professionals: People of color may delay seeing a doctor for skin concerns due to past negative experiences with those in the medical profession.

Diagnosing Melanoma

Performing a self-check at home remains one of the best ways to improve the likelihood of early diagnosis. Regularly examine your skin from head to toe. Use a mirror or ask a trusted person to help check your back and other areas you cannot see. Remember to check your fingernails, toenails, and the soles of your feet.

People should look for the following:

• Patches of skin that are darker than normal, bleeding, painful, changing or growing
• Sores on the skin or in and around the mouth that don’t seem to heal
• Patches of skin that feel rough, flakey or dry
• Dark lines underneath or around fingernails or toenails

Because symptoms may be more subtle in skin of color, immediately address any concerns you have with your doctor. In addition to at-home skin checks, visit a dermatologist for annual skin cancer screenings.

If your doctor suspects a lesion may be cancerous, they will perform a biopsy. After numbing the area, a small portion of the growth will be shaved off to be sent to a lab for a diagnosis.

Melanoma Treatment Options

If you have melanoma, your treatment will depend on your general health, the type of melanoma you have and whether or not it has spread to any other part of the body.

• Surgery (like Mohs surgery) will remove the growth and any cancerous cells surrounding it.
• Chemotherapy, radiation and other systemic treatments will address cancer that has spread beyond the lesion.

The Outlook on Melanoma

Early detection may be the single most important factor that impacts survival rates. Additional factors include your general health and the type of melanoma you are diagnosed with.

Performing at-home skin checks and seeing a doctor who treats patients of color can improve the odds of early detection. In addition, because skin cancer is less common in African Americans, you may need to be a more forceful advocate for areas of concern or lesions that seem suspicious. Always seek a second opinion if you feel your concerns are being dismissed.

Dr. Morgan Covington received her medical degree from the Pritzker School of Medicine at the University of Chicago. She completed her intern year training at Presence Resurrection Hospital and stayed in Chicago for her dermatology residency at the John H. Stroger Jr. Hospital. Dr. Covington is a member of the American Academy of Dermatology, Skin of Color Society, and Texas Medical Association.