Racial Disparities in Skin Cancer:
Increased Vulnerability in BIPOC Melanoma Patients including African-Americans

​

​

​

Melanoma is a type of skin cancer that develops in the cells that produce melanin. Melanoma is considered a very serious form of cancer; however it is found that treatment in non-white patients is substandard.

Well, a reason could very likely be the  misconceptions surrounding how melanoma affects darker skinned populations. Though melanoma is low in BIPOC (approximately, 6.8 for Hispanics, 5.72 in Asian Americans, Pacific Islanders, and Native Americans, and 1.35 in Black Americans per 100,000 people, compared to 45.8 in white people), the mortality rate is 1.5 times higher compared to the rate for white people.

One study even showed an average five-year melanoma survival rate of only 66% in Black people compared to 90% in white people. Additionally, skin cancer is primarily found in white populations, however black populations are four times more likely to have stage IV of the disease.

It is no secret that there is systematic racism built into our society impacting education, healthcare, justice, culture, etc., but another reasoning for these disparities is the lack of representation and awareness in research about how melanoma affects BIPOC.

Where did it go wrong?

Dermatologists, doctors, and researchers have done studies on how exposure to UV light may cause melanoma, but these studies have left out people with more melanin. According to Adewole Adamson, MD. MPP., Assistant Professor of Internal Medicine in the Division of Dermatology at the University of Texas at Austin, “We have, I think, mistakenly taken that and applied it to darker-skinned folks, when there really isn't any solid data to show that it is, in fact, a risk factor.” To paraphrase, Adamson states that since researchers have not done any studies on UV exposure in darker skinned patients with melanoma, there is assumption that the effect on them is the same as lighter skinned patients. This type of assumption is extremely dangerous as there is no proof whether it is true or not, and this can negatively affect treatments. Researchers and doctors are currently working to combat this misconception.

Who is going to talk about it?

A large reason for the misconceptions and lack of studies and information is the lack of awareness around the issue. There are still BIPOC that think are not at risk of skin cancer, and because of a lower presence of skin cancer cases in African American populations, signs of it are often overlooked or misdiagnosed. One factor influencing this is the underrepresentation of BIPOC in dermatology: in 2020, dermatology was said to have the second lowest percentage of underrepresented minority physicians. With there being fewer BIPOC dermatologists, there are fewer people who are concerned with creating awareness and doing studies on issues concerning skin of colour, leading to them having a lower likelihood of visiting a dermatologist in comparison to white populations. An increase in BIPOC in the dermatology field would also create a more comfortable, fair, and impartial environment for BIPOC patients. While there are white dermatologists that do care about these disparities and are working to address them, there are just not enough. 

What can I do?

First, there is prevention. There is a common myth that darker-skinned people do not need to wear sunscreen; this claim is far from accurate. Sunscreen can be a strong defense from melanoma, and it has been highly normalized as such. A recent study showed that Black and Hispanic young adults were less likely to practice sun safety habits, compared to white young adults, due to not being aware of risks and rare history of sunburn or family history of skin cancer.

Self-checks are also important. BIPOC should pay attention to toes, fingers, palms, nails, and just any place you would never think to look because of acral lentiginous melanoma (ALM)— a form in which the cancer spot is in hard-to-find places like toes, fingers, palms, and nails. ALM is far more common in darker-skinned people, and melanoma in African American, Asian, Filipino, Indonesians, and Native Hawaiians often occurs in non-exposed skin with less pigment, with up to 65-70% of tumor arising on palms, soles, mucous membranes, and nail regions.

Another important action is going to a dermatologist for checks. Educated professionals will be able to find signs or spots people have missed or not paid attention to. It is important to have strong communication with a dermatologist so no risk factors will be kept secret.

These problems are not going to vanish overnight, but hopefully someday soon, they will; that will only happen if the solution is unyieldingly pursued. The first step of that is becoming educated and talking about it. By doing this, awareness of these disparities will be made and once everyone recognizes it, they can begin to be resolved.

Citations

Adamson, A. S.; Smith, A. Machine Learning and Health Care Disparities in Dermatology. JAMA Dermatology 2018, 154 (11), 1247. 

Adamson, A. S.; Zhou, L.; Baggett, C. D.; Thomas, N. E.; Meyer, A.-M. Association of Delays in Surgery for Melanoma With Insurance Type. JAMA Dermatology 2017, 153 (11), 1106. 

Alexis, A. Ask the Expert: Is there a Skin Cancer Crisis in People of Color? https://www.skincancer.org/blog/ask-the-expert-is-there-a-skin-cancer-crisis-in-people-of-color/.

Buster, K.; Ezenwa, E. Health Disparities and Skin Cancer In People of Color. https://practicaldermatology.com/articles/2019-apr/health-disparities-and-skin-cancer-in-people-of-color.

Cancer Facts & Figures for African Americans. https://www.cancer.org/research/cancer-facts-statistics/cancer-facts-figures-for-african-americans.html (accessed May 7, 2021). 

Cormier, J. N.; Xing, Y.; Ding, M.; Lee, J. E.; Mansfield, P. F.; Gershenwald, J. E.; Ross, M. I.; Du, X. L. Ethnic Differences Among Patients With Cutaneous Melanoma. Archives of Internal Medicine 2006, 166 (17), 1907. 

Dawes, S. M.; Tsai, S.; Gittleman, H.; Barnholtz-Sloan, J. S.; Bordeaux, J. S. Racial Disparities in Melanoma Survival. Journal of the American Academy of Dermatology 2016, 75 (5), 983–991. 

Lasisi, T. The Constraints of Racialization: How Classification and Valuation Hinder Scientific Research on Human Variation. American Journal of Physical Anthropology 2021. 

Nelson, B. How Dermatology Is Failing Melanoma Patients with Skin of Color. Cancer Cytopathology 2020, 128 (1), 7–8.