The Great Skin Cancer Myth:
Darker-skinned people can and do get melanomas, and with higher death rates - usually because their cases are detected later
BY ELLEN MITCHELL
June 28, 2005
David Estrada and his mother came to Long Island from their native El Salvador last fall for treatment of injuries both had suffered in a car accident. While David's injuries were less extensive than his mother's, it was a large, precancerous lesion that doctors found on the 16-year-old boy's scalp that turned out to be of far greater concern.
Estrada, his family, and doctors in El Salvador knew about the one-inch-wide, six-inch-long growth, but they felt it was not a threat of any kind. They didn't realize that the huge lesion, known as a nevus sebaceous of Jadassohn could eventually have become a basal-cell cancer.
This past spring Estrada underwent surgery to remove the lesion at the hands of Dr. Andrew Jacono, a facial plastic reconstructive surgeon in Great Neck. Jacono, and the other physicians who treated the Estradas are part of Beyond Our Borders, a small nonprofit Long Island-based group with provides free medical services and humanitarian relief in El Salvador and several other countries.
The operation required 20 injections for local anesthesia. The lesion had eroded into the underlying tissue and had to be removed in layers. Some 60 stitches were required to close the wound. "The lesion was thick, had a large circumference and, like a tree, had roots," Jacono said. "But it's much easier to treat this type of lesion in its early phase while it is precancerous."
"The great thing is that David is cured," he added.
A familiar sight
Estrada's case is one that is far too familiar to researchers, dermatologists and surgeons. Studies presented at the recent American Academy of Dermatology meeting in New Orleans show that in darker-skinned individuals, not only precancerous basal-cell lesions but also potentially deadly melanomas are far more likely to go undetected until they have reached an advanced stage.
The result is that African-Americans, dark Hispanics, Indians, Middle Easterners and other dark-skinned people, though they have fewer skin cancers than fair-skinned individuals, have a significantly higher death rate from these cancers.
Figures from the academy show, for example, that the five-year survival rate for whites with melanomas is 85 percent, while the five-year survival rate for blacks is 59 percent.
Dr. Susan C. Taylor, a dermatologist and director of the Skin of Color Center at St. Luke's-Roosevelt Hospital Center in Manhattan, cited a study that found later stages of skin cancers occur "in almost three times the number of blacks as opposed to whites."
Taylor said the popular misconception is that darker skin has enough natural pigment to protect fully against skin cancer. As a result many blacks and Hispanics don't bother to perform frequent skin self-exams and aren't taught the warning signs of skin cancer. Additionally, most skin cancer warnings are directed to those with fair skin, blue eyes and red or blond hair, who sunburn easily.
Taylor said the average African-American has a natural sun protection factor (SPF) of 13, as compared with the average Caucasian, who probably has an SPF of 2. An SPF of 13, however, is not sufficient to fully protect against skin cancer.
"The problem is that we have free skin cancer screening clinics, and the numbers of blacks and Hispanics who come to them is dismally low. We should be letting people know that while skin cancer occurs in blacks and Hispanics in a lower incidence ... it's still there," Dr. Ted Daly said. He is director of clinical pediatric dermatology at Nassau University Medical Center in East Meadow and has a private practice in Garden City.
One of his patients, Lisa Hodges-Holder of Roosevelt, makes an annual skin exam part of her routine medical care because she has a relative with a precancerous lesion.
But Dr. Fran Cook-Bolden, director of the Ethnic-Skin Specialty Group in Manhattan, said the vast majority of patients of color "still think the pigment in their skin is all they need to protect from skin cancer, and so they don't need to take further steps."
She said dark-skinned people should be aware that along with sunblock - which should be reapplied every two hours because it tends to diminish in power - they should wear protective caps and clothing. She said the need for sun protection is year-round, because the intensity of the sun can be just as great in climates where snow and rain intensify solar rays.
Cook-Bolden also said many people of color have been reluctant to use sunscreen, which can leave a chalky film on black skin. Now, however, she said manufacturers have started making sunscreen products that address the problem.
All three dermatologists noted that too many primary care physicians, dermatologists and other physicians tend to minimize the need to examine dark-skinned patients for skin cancer.
"The primary care physician is overloaded now. Their volume is increased, and skin cancer or skin problems are put down the line. They're more worried about everything else," Daly said.
—Ellen Mitchell is a freelance writer, Newsday