Education key to diagnosing skin cancer in darker skin, saving lives

Published on Thursday, September 1, 2022

By: Andrea Wright Dilworth

Melanin, the natural pigment that gives skin its color, is in abundance in darker skin. But it does much more than create varying shades and hues.

It comes with a perk: Melanin absorbs harmful ultraviolet rays and helps protect the skin from sun damage. That’s a double-edged sword of sorts because it can create a false sense of security that those with melanin-rich darker skin are immune to developing skin cancer.

But don’t be fooled. That security blanket is a myth. Skin cancer can develop regardless of the amount of melanin in your skin, and though far less common in Black people, they are more likely to be diagnosed at a later stage and therefore less likely to survive. 

In fact, the five-year survival rate from 2011 to 2016 for Black patients with melanoma, considered the most serious form of skin cancer, was 66 percent, compared to 90 percent for white patients, according to a Centers for Disease Control and Prevention study.

One reason is that melanoma, in its earlier stages, is harder to recognize in Black patients, both by physicians and patients themselves.

That’s in part because melanoma manifests differently on darker skin. Though normally found on parts of the body exposed to sunlight -- the face, torso, or lower legs – in lighter-skinned patients, melanoma in Black patients usually develops on the palms, soles or under fingernails or toenails, according to the Mayo Clinic. It is therefore often overlooked until it is more advanced.

A 2021 review of dermatology medical student resources used to identify skin conditions found that almost all photos were of white patients. The study found that “across all images, only 15 percent were of skin of color,” which can put medical students at a disadvantage in diagnosing certain skin conditions, like melanoma, in darker-skinned patients.

“Currently there is a big movement in all the dermatology publications to increase photos of skin conditions in African Americans,” said Dr. Jeremy Jackson, chair of the Department of Dermatology. “Many skin conditions, including skin cancer, may appear different in skin of color patients, so this underrepresentation can make diagnosing skin conditions in skin of color patients more difficult. 

“At UMMC, we are fortunate to have a more diverse patient population than many academic institutions. African Americans make up almost 40 percent of our state's population, and this is also reflected in our dermatology clinics. This provides a great opportunity for our medical students and residents to observe and diagnose dermatologic conditions in skin of color. This experience is absolutely critical so we can better serve the people of our state and recognize conditions like skin cancer sooner, which hopefully leads to better outcomes.” 

Dr. Thy Huynh, assistant professor of dermatology and pediatrics, and director of Clinical Trials in Dermatology, said diversity in training materials for medical students should be a priority. Because she attended medical school at the University of Alabama-Birmingham and completed her residency at UMMC, both of which have diverse patient populations, she gained exposure to diagnosing conditions on darker skin. But that is not true for all medical students.

“When you have a darker pigmentation, it is very hard to see some of the redness that is underneath the skin tone,” she said. “It can mask it, especially in pictures. Even when you take the picture, the picture just does not highlight that degree of redness that is very obvious in lighter skin tones, and I think that could potentially contribute to some of the pictures that are selected.”

The American Academy of Pediatrics has been advocating for more awareness of the need for diversity, she said, and a few new books focusing on skin of color have been published recently. To contribute to awareness in the medical community, Huynh and two of her residents also published an article in June on dermatologic differences among different skin tones.

Even as the medical community gains more experience in diagnosing skin cancer in diverse groups, it is important that those with darker skin know not only what symptoms to look for on their own bodies, but also how to prevent it.

Dr. Robert Brodell, professor and chair in the Department of Pathology and former founding chair of dermatology, said to see a doctor if you notice a brown or black, flat or raised growth, especially one that is growing, changing, or ulcerating.

“Patients with totally asymptomatic lesions on their palms and especially the soles of the foot often do not seek treatment until they are quite large,” said Brodell. By then, it may be too late.

Fortunately, most skins cancers are preventable, according to The Mayo Clinic, which offers these tips:

• Avoid the sun during the middle of the day.
• Wear sunscreen year-round.
• Wear protective clothing.
• Avoid tanning beds.
• Be aware of sun-sensitizing medications.

Check your skin regularly and report changes to your doctor.

The above article appears in CONSULT, UMMC’s monthly e-newsletter sharing news about cutting-edge clinical and health science education advances and innovative biomedical research at the Medical Center and giving you tips and suggestions on how you and the people you love can live a healthier life. Click here and enter your email address to receive CONSULT free of charge. You may cancel at any time.