By Sarah Ayusa, Biology & Society ‘25
“The imminent death…”
“A life of hospitalization…”
“The biggest threat to medicine…”
It is ubiquitous knowledge that the diagnosis of cancer is a difficult and undesired reality. Cancer has always been synonymous with death. But for Black and Brown people, cancer, especially skin cancer, is an even harsher reality than people may think.
Skin cancer is the fifth commonly diagnosed cancer in 2024, just after breast, lung, colorectal, and prostate cancer. [1] The most serious form of skin cancer, malignant melanoma, affects the melanocytes in your skin which are responsible for producing the melanin pigment. Melanoma occurs when DNA is damaged as a result of exposure to ultraviolet (UV) radiation, as it triggers melanocytes to produce more melanin and allow the likelihood for DNA mutations to occur and ultimately result in uncontrollable cell growth. Thus, a major cause and factor which increases risk of melanoma is unprotected exposure to UV radiation, either from the sun or tanning beds. [2]
Eumelanin serves as the body’s natural defense against the damage done by UV radiation, which leads Non-Hispanic White people to experience the highest incidences of melanoma. However, despite experiencing a lower incidence in cases, Black and Brown people tend to suffer metastasis (the spreading of cancer growth beyond the primary site) and are more likely to die from it. When detected early, melanoma can have a 94.1 % 5-year survival rate. [2] However, because non-Hispanic Black patients are more likely to be diagnosed much later, they suffer the lowest 5-year survival rate of any other racial demographic at just 52%, while non-Hispanic White patients see the highest survival rate at around 75%. Because male mortality rate more than doubles that of females in melanoma, Black men especially suffer the lowest survival rates. [3]
Why do these statistics look so bleak for Black and Brown people?
The most common melanoma subtypes reported by Black patients are acral lentiginous melanoma, which affects the hands and feet, and subungual melanoma, which appears as stripes of dark lines under the nails. These uncommon areas are lower extremities which can easily go unchecked, and this—in tandem with the black or brown coloring of melanoma tumors—makes misdiagnosis and prolonging of diagnosis a lot more common for these cancers.
Another barrier is introduced when medical professionals are not taught how to diagnose skin cancer in darker skin. The skin noted in the pictures and diagrams of dermatological textbooks commonly show people with fairer skin. Brown and Black skin, categorized as types V and VI on the Fitzpatrick scale, are virtually nonexistent in the realm of medical education. [4] To worsen things, ethnic differences in the prevalence of certain conditions and symptoms are not even mentioned in textbooks. This produces generations of specialized medical providers who are ironically not educated enough to support their Black and Brown patients. Without proper medical training on the dermatological care of minority patients, the disparity in health outcomes will only continue to exacerbate.
The issue of skin color discrepancies in dermatological education are beginning to gain more recognition by U.S. medical schools, and some of them are taking action. The American Academy of Dermatology (AAD) established a new skin of color curriculum in March 2022. [5] Medical students have begun to take action on their own, as well. Malone Mukwende, a medical student at St. George’s University of London, has authored a clinical handbook titled Mind The Gap which details the signs and symptoms specific to Black and Brown skin. [6] Alongside this, efforts must be done to increase access to quality healthcare for low-income patients. Low-income individuals, who tend to be Black, are less likely to afford treatment for further developed cancer, which even further heightens the mortality rate.
As we live in a time where global warming only continues to get more aggressive, the risk of cancer, especially skin cancer, only proliferates. It is integral that once the summer sun blasts and the tropical vacations commence, everyone (including people with dark skin) is protecting themselves from future complications through sunscreen and avoiding sun exposure in excessive amounts of time.
References
National Cancer Institute. (2018). Common Cancer Sites - Cancer Stat Facts. SEER. https://seer.cancer.gov/statfacts/html/common.html
National Cancer Institute. (2018). Melanoma of the Skin - Cancer Stat Facts. SEER. https://seer.cancer.gov/statfacts/html/melan.html
Black men have lowest melanoma survival rate compared to other races, study finds - CBS News. (2023, August 7). Www.cbsnews.com. https://www.cbsnews.com/news/skin-cancer-black-men-melanoma-study-josh-paschall/
Ebede, T., & Papier, A. (2006). Disparities in dermatology educational resources. Journal of the American Academy of Dermatology, 55(4), 687–690. https://doi.org/10.1016/j.jaad.2005.10.068
Skin of Color Curriculum - American Academy of Dermatology Association. (n.d.). Learning.aad.org. https://learning.aad.org/Listing/Skin-of-Color-Curriculum-5719
About. (n.d.). Malone Mukwende. Retrieved May 5, 2024, from https://www.malonemukwende.com/about
Comments