Lack of awareness makes skin cancer rare but more severe for minorities

Chances of developing skin cancer were proportional to a patient’s skin type, not necessarily their nationality.

Issue: September 1, 2007

While skin cancer in blacks and Hispanics is not as common as in whites, it is more likely to be diagnosed at a later stage when it is found.

“Even if you do not have a high risk for skin cancer, you can still get it. That concept has been lost among both doctors and patients,” Robert S. Kirsner, MD, PhD, associate professor in the department of epidemiology and public health at the University of Miami, told Hem/Onc Today.

Since skin cancer is such a rare occurrence in the black and Hispanic populations, when physicians do see it in these populations, the patient is usually at a later stage.

Steven R. Feldman, MD, PhD, professor of dermatology, pathology and public health sciences at Wake Forest University School of Medicine, told Hem/Onc Today that although blacks have a low chance of developing a melanoma they may think that they could never develop one.

“Unfortunately, since there is a low risk of skin cancer in African-Americans, people do not worry about it until they let things like potential melanomas go longer than they should. They do not come in and get those things checked. Then when they do get skin cancer, it is in a late stage,” Feldman said.

Kirsner said that the chances of developing skin cancer are related to a patient’s skin type and not necessarily their nationality.

“So, for example, in south Florida you could be Hispanic, but you could be a fair-skinned Hispanic with blue eyes or you could be a swarthy Hispanic. A fair-skinned Hispanic with blue eyes may have the same risk [for melanoma] as a Caucasian with blue eyes,” Kirsner said.

In data from Kirsner that has already been published and in data sets he is currently studying, Kirsner has found that blacks and Hispanics seem to be diagnosed consistently at a later stage. This is linked to melanoma survival.

Lack of awareness

Kirsner said that doctors, patients and skin cancer educators have overlooked the fact that the Hispanic population is at risk for developing skin cancer and in certain cases could have the same risk as whites. Kirsner suggested several possibilities for the lack of awareness about skin cancer outside of the white population and has published studies that showed that despite being Hispanic, black, or white, sunlight seems to be a cause in the onset of melanoma in all three populations.

“Everybody would agree that sunlight is related to the development of melanoma in Caucasians. Using state databases, which accounted for 75% of the black and Hispanic populations in the United States, we showed a correlation between some proxies to sun exposure, such as latitude and ultra-violet index, and found that there was a correlation with melanoma development,” Kirsner said.

The uncommon occurrence of skin cancer in blacks is a main reason Feldman suspects much of the black population may not seek medical attention for skin cancer and why doctors may not be that concerned with skin cancer in black patients.

“I suspect that people see things and they are not expecting skin cancers so they are late to come in, so even self-screenings are pretty poor. There should be concern that skin cancers (in African Americans) are being detected late,” Feldman said.

Late stage diagnosis

Kirsner said that a reason a larger percentage of later stage skin cancers are discovered in the Hispanic and black populations may be because blacks and Hispanics seem less prone to examining their own skin, and if they find something are less prone to taking secondary measures such as doctor visits and biopsies.

“Even though blacks and Hispanics, in some cases, have more baseline pigmentation that may protect them from the sun that does not make them immune to skin cancer,” he said.

The misconceptions regarding the risks of skin cancer in blacks and Hispanics were recently studied by Kirsner in an as-yet published report. The report indicated that even if you control for a patient’s skin type, white Hispanic students had less knowledge regarding skin cancer and practiced less sun protective behavior than non-Hispanic whites.

“Clearly the message did not get to the white Hispanic students that they may be at the same risk because the risk is related to the skin cancer risk factors including family history and skin type. All those reasons support my idea that the message has not gotten to both patients and caregivers about the risk of skin cancer in Hispanics,” Kirsner said.

Although Kirsner said there was little information regarding skin cancer in non-white populations, it is now being researched in part because of the increasing Hispanic population in the United States. Because of the growing amount of research on skin cancer in the Hispanic population, Kirsner said the Hispanic skin cancer experiences could have an important effect on skin cancer in general.

Proactive treatment

To lower their risk of skin cancer, Kirsner said that blacks and Hispanics should be more proactive and use protective measures. In addition, he said, if they see a spot, they should have it evaluated.

“The doctor who is seeing that patient should not think that it could not be a melanoma because the patient is black or Hispanic. They should use the same criteria and think of all patients similarly when they make evaluations,” he said.

Currently, Kirsner said that studies are in place to determine whether the increased public message about the risks of skin cancer has had any affect. Researchers are also in the process of determining the role of genetics vs. clinical features in the development of skin cancer.

“A hot topic is what we call molecular epidemiology. Not only do we look at a patient and say they have clinical features that put them at risk for developing skin cancer — whether they are white or Hispanic — such as sun sensitivity or fair eyes, but whether at a molecular or genetic level we could actually predict who is going to be at the highest risk,” Kirsner said.

“If you have a certain genetic feature — for example, mutations in certain genes or genetic profile — you are going to be more likely to develop skin cancer than the Hispanic child next to you who may look exactly the same. The next level [will involve] studies that will soon be ongoing, the idea of molecular epidemiology of skin in both white and non-white populations,” Kirsner said. – by Paul Burress