Skin Cancer in People of Color

• Skin cancer represents 1 to 2 percent of all cancers in Black people.²
• Skin cancer represents approximately 2 to 4 percent of all cancers in Asian people.²
• Skin cancer represents 4 to 5 percent of all cancers in Hispanic people.³
• Squamous cell carcinoma is the most common skin cancer in Black people.²
• Black patients with melanoma have an estimated five-year melanoma survival rate of 71 percent, versus 94 percent for white patients.¹
• Melanoma in people of color most often occurs on areas that get little sun exposure. Up to 60 to 75 percent of tumors arise on the palms of the hands, soles of the feet under the nail (subungual) and the nail areas. ²
• Black patients are more than three times as likely to be diagnosed with melanoma at a late stage than non-Hispanic white patients. 52 percent of non-Hispanic Black patients and 26 percent of Hispanic patients receive an initial diagnosis of advanced-stage melanoma, versus 16 percent of non-Hispanic white patients.⁴
• In people of color, the plantar portion of the foot is often the most common site of skin cancer, being involved in 30 to 40 percent of cases.³
• People of color have higher percentages of acral lentiginous melanoma (ALM, melanoma of the palms, soles and nailbeds) than Caucasians. Superficial spreading melanoma is the most frequent subtype in Caucasians and Hispanics.³

Q: While all types of skin cancer are less common in people of color, their outcomes are dramatically worse. What accounts for this gap?

A: Skin cancers are less prevalent in nonwhite racial ethnic groups, but when they occur, they tend to be diagnosed at a later stage. As a result, the prognosis is worse. One study showed that late-stage melanoma diagnoses are more common in Hispanic and Black patients than in non-Hispanic white patients.

First, there’s a lower public awareness of the risk of skin cancer among individuals of color. Second, from the perspective of health-care providers, there’s often a lower index of suspicion for skin cancer in patients of color. This is because the chances of it are smaller. So these patients may be less likely to get regular, full-body skin exams. And third, the places on the body where skin cancers tend to occur in people of color are often in less sun-exposed areas. This makes detection more difficult. For example, the most common location for melanoma in patients of color is the lower extremities — the soles of the feet in particular. Day in and day out, patients are shocked to learn that you can get a melanoma on your foot, in your nailbed (subungual melanoma) in your eyes or some other place that seems protected from the sun.[Read full blog post: Is There a Skin Cancer Crisis in People of Color?]

– Andrew Alexis, MD, MPH, is chair of the Department of Dermatology at Mount Sinai St. Luke’s and Mount Sinai West in New York City.