Skin Cancer: Skin Color Doesn't Matter
By Martha Hemenway
As summer approaches, research confirms that the incidence of new skin cancer cases not only increases each year but far surpasses numbers reported for several other cancers combined. In fact, there are more than 1.5 million diagnoses annually according to the Skin Cancer Foundation, a frightening truth to trample. While it can be easy to get lost in the brilliance of the sun, recognizing its merciless toll on the human body could ultimately save your life.
There is a common misconception that fair-skinned, sun-sensitive Americans are the only part of our population with reason to worry about prolonged periods of unprotected sun exposure, the primary cause of skin cancer’s deadliest threat: melanoma. However, specialists agree that even though skin cancer cases are more prevalent with patients of lighter skin color, anyone — light or dark — is at risk.
“It is biologic behavior,” says James Spencer, board-certified dermatologic surgeon of Spencer Dermatology & Skin Surgery Center in Florida and Professor of Clinical Dermatology at the Mount Sinai School of Medicine in New York. “It’s irrelevant what color you are.”
According to Spencer, the pigment melanin (“nature’s sunscreen”) blocks skin cancer’s main aggressor, ultraviolet light. The darker your skin, the more melanin your body produces. Asian Americans and Middle Eastern Americans fall somewhere in the middle. However, dermatologists avoid generalizing skin type by a person’s ethnic makeup, because any nationality as a whole comprises of skin tone variations, and focus instead on an individual’s response to mid-day sun exposure during summertime. Sunburn vs. tan results determine skin cancer probability. This may help explain why some Asian Americans and Middle Eastern Americans, or others with dark skin, continue to believe they’ve inherited immunity.
“Even if over time they begin to tan, the effects of the sun don’t change,” says Kishwer Nehal, board-certified dermatologist of New York’s Memorial Sloan-Kettering Cancer Center. “Excessive sun exposure, repetitively, is still bad for you even if your skin is acclimating to it.”
Kalea Yoshida is a 26-year-old graduate student of Chinese, Japanese and Korean descent with olive-toned skin. She was born and raised in Hawaii where her mother “always, always” insisted she lather on sunscreen. During college, Yoshida had a tiny, benign mole removed just to appease her mother, although she felt indifferent about it at the time.
“Overall, I don’t think I’m a strong candidate for skin cancer,” says Yoshida who wears sunscreen occasionally but admits it’s usually more for anti-aging and sun spot prevention.
Angie Gilligan, 53, is 100 percent Korean. She also found herself less careful during younger years, a fact that could be partially attributed to lack of education at home. She says skin cancer was not a concern, but due to new studies, she understands the dangers of ignorance today. Yet, Gilligan still worries more about aging and only “a little bit about cancer.”
There are several forms of cancer found in the skin, including non-melanoma types referred to as basal cell and squamous cell carcinoma. According to CancerWise, an online publication by the University of Texas M.D. Anderson Cancer Center, these two classes are the most common and usually occur on sun-exposed areas such as the face, neck and hands. Melanoma, on the other hand, originates in melanocytes (where melanin is produced), often beginning with the development of a mole. Men should look for melanomas on the chest or back, and women should pay attention to their thighs, calves and back. Although less common, melanoma is life-threatening and can spread quickly throughout the body’s tissues. It currently accounts for approximately 100,000 cases in the United States annually, according to Memorial Sloan-Kettering Cancer Center.
The risk factors and symptoms of skin cancer are the same for every race, says Nehal, who is Pakistani. Though light-skinned individuals are more susceptible. Interestingly, people with darker complexions are believed to have a higher tendency for signs of melanoma on the palms, soles and fingernails because these areas have less pigmentation. Generally, risk increases based on exposure to ultraviolet radiation, age, skin type and existence of moles, family history, climate of residence, experience with severe sunburns and intake of medicines that suppress the immune system, CancerWise reports. Occupation also can be a factor in some cases. And the majority of melanoma diagnoses are for men over age 50, though it’s the second most common cancer in 20-something women, according to the Skin Cancer Foundation.
Prevention should start during childhood with year-round sunscreen use. The sun’s rays are powerful and unrelenting, regardless of season. Even on an overcast day, the American Academy of Dermatology verifies that 80 percent of the sun’s rays pass through the clouds. Sunburns in children are believed to be more harmful, Spencer adds. For this reason, experts recommend that everyone apply sunscreen with SPF of 15 to 30.
Tess Dumlao, 37, moved from the Philippines to the United States at age 5. She grew up in California and put on sunscreen anytime her Caucasian friends did.
“Honestly, I didn’t think that dark skin could sunburn, but it can,” she says. Dumlao recalls a couple of bad sunburns that remind her of the importance of sunscreen. Having two little boys who are half Caucasian only heightens her awareness.
Aside from prevention, early detection is a must. Specialists urge Americans to get to know their bodies through self-exams. In all cases, you are looking for change — change in an existing beauty mark or mole, or the appearance of a new, unfamiliar spot. When melanoma takes visible form, concern should arise with asymmetry, irregularity, changes in color, increasing diameter and elevation. Signs to watch for in non-melanoma cases include sores that are not healing or skin areas that are small, raised, flat, rough and possibly bleeding or crusty, according to the National Cancer Institute. Actinic keratosis, a rough discoloring (red, pink or brown) in patches of skin, is a precancerous condition that has slight potential to turn into squamous cell cancer if left untreated. Any concern is worth a visit to the doctor where a biopsy can determine if cancerous cells are present and sometimes, remove questionable lesions.
“Change is what we focus on,” Nehal says. “It often alerts us.”
If caught in early phases, many skin cancers are curable. Treatment depends on diagnosis, type, timeline and overall dialogue between patient and physician. Freezing or burning methods, topical creams, surgery, radiation therapy and chemotherapy are among many options. Both Spencer and Nehal are trained in Mohs Microscopic Surgery, which involves cutting out tumors and examining fresh tissue under a microscope. It has a 99 percent cure rate. And confocal imaging, a new noninvasive way to “image” the skin, is in the experimental stages at Memorial Sloan-Kettering Cancer Center.
Although new technology shows promise in the fight to cure skin cancer, prevention is still the best tool and the first step to this end is education. One critical lesson is that skin cancer does not discriminate by ethnicity. It touches people of every skin tone. And despite continuing research, numbers report alarming news about its impact: Even those with darker complexions, including Asian Americans and Middle Eastern Americans, should take responsibility for the risks associated with ultraviolet exposure. You don’t have to celebrate Melanoma Monday (May 1) or monitor the daily UV index to make a difference in your lifespan and be more brilliant than the sun. Sunscreen and a hat will do.
For more information, treatment or support
H. Lee Moffitt Cancer Center & Research Institute Tampa, FL
(888)-663-3488
www.moffitt.usf.edu
Mayo Clinic
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