According to the Center for Disease Control, heart disease and cancer are the two leading causes of death in America. The Office of Minority Health defines cancer, not as one disease, but many diseases. Today, there are hundreds of types of cancer, and prostate cancer is listed as the leading cause of death for Non-Hispanic Black Men while breast cancer leads in the cause of death for Non-Hispanic Black women in America.
But, one type of cancer that is rarely found in Black males and females is skin cancer – known as Melanoma and caused by overexposure to the sun for those with lighter skin pigmentation. Still, while medical professionals state that melanin, a chemical compound found in those with darker skin pigmentation, acts as a protectant against the ultraviolet radiation emitted from the sun, Black patients are not completely immune to developing skin cancer.
Studies show that 1 in 1,000 non-Hispanic Black males will be diagnosed with skin cancer versus 1 in 33 for non-Hispanic white males. It has also been determined that Black men, in general, have a 26% higher chance of dying from melanoma than white melanoma patients. Studies show that Black men are also three times more likely to get diagnosed at an advanced stage, resulting in a higher probability of death.
Dr. Jennifer Gill, M.D Ph. D from the UT Southwestern Medical Center Dermatology Department shared with the Dallas Weekly insights into a research study of 48 Black male and female patients diagnosed with Melanoma skin cancer between 2006 and October 2022. In compiling the data for the study researchers were surprised that of the thousands of patients diagnosed with Melanoma at either Parkland Hospital or UT Southwestern Medical Center during this timeframe, there had only been 48 Black male and female patients in total diagnosed with Melanoma. Of the 48 patients, 37% were Black males, and in the majority the 48 patients, the cancer was not found on sun-exposed areas of the body.
There are three types of skin cancer: Melanoma, Squamous Cell Carcinoma, and Basal Cell Carcinoma. The study was limited to Melanoma patients due to lack of detail-specific data on Black patients with skin cancer. Gill says, “We know a lot about melanoma in White patients but not a lot about Black patients with melanoma. One of the challenges is because the number of cases reported is small.” Gill also shared that research, in the future, needs to focus on the 1 in 1000 black patients – those who seem to be the individuals at the highest risk for Melanoma. These patients, according to Gill, would need to have annual screenings. Gill also mentioned that education and clinical research focused on those susceptible to developing skin cancer would need to improve as a key to increasing the survival rates of Black patients with skin cancer.
Detection in Black patients with darker skin pigmentation is harder because, generally, the affected areas are in places on the body not normally exposed to the sun such as the soles of the feet, palms, genitals, eyes, mouth, or on the nail bed. As an example, Bob Marley’s cancer began with a sore on the nail bed of his toe.
- Melanoma attacks the melanocytes which produce melanin, and these cancerous lesions most often develop on parts of the body most exposed to the sun such as arms, legs, face, and back.
- Squamous Cell Carcinoma starts in the squamous cells that make up the middle and outer layers of the skin and studies have found that this type of cancer can develop in those with a history of HPV or a weak immune system. This type of cancer can also develop from scars or burns that are opposed to healing, rashes that stem from certain types of Lupus, or exposure to chemicals from work or the military.
- Basal Cell Carcinoma starts in the Basal, cells which produce new skin cells. This type of cancer appears as an open wound that won’t heal, a shiny lump or nodule, a scar-like area that is flat white, yellow, or waxy in color or appears as a small pink growth with a slightly raised, rolled edge and a crusted indentation in the center.
Of the two diseases, Basal Cell Carcinoma is the most common across the board, but studies indicate it is most prevalent within those small numbers of Black patients. Although Basal Cell Carcinoma is treatable, the accelerated death rate remains high for Black males. Gill pointed out that the reasons are multifactorial – but mostly because Black men are diagnosed at advanced stages. Gill referenced a 2023 study that highlighted factors such as limited access to healthcare, and men’s fear and resistance to going to the doctor, or refusal or unwillingness to participate in preventive care. The study also indicated that there might also be a genetic factor, though of the Black patients who died from Melanoma, while there was no family history of skin cancer, there was a family history of other types of cancers or they’d had cancer themselves. Gill shared that for patients with darker skin, the outcomes are not positive.
Because cases are so rare, national databases don’t track Basal Cell Carcinoma and Squamous Cell Carcinoma as closely as they do Melanoma. What is going to help researchers better understand these non-sun-induced cancers in Black people is simple more research. In the meantime, Gill says healthcare entities can awareness by creating campaigns and adding images to textbooks and articles so people can recognize these abnormalities when they occur. Researcher are currently reaching out to clinicians such as dermatologists, podiatrists, and emergency room doctors to push for awareness. Gill explained that many people will go to the emergency room for treatment, and with a little awareness, the emergency room doctors may spot early stages of Basal and Squamous Cell Carcinoma types of skin cancer in patients visiting for other reasons.