Skin cancer in people of color

People of color

This term refers to diverse skin colors and includes people of African, Asian, Latino, Mediterranean, Middle Eastern, and Native American descent.

People of all colors, including those with brown and black skin, get skin cancer. Even if you never sunburn, you can get skin cancer.

When skin cancer develops in people of color, it’s often in a late stage when diagnosed. This can be deadly when the person has melanoma, a type of skin cancer that can spread quickly. Treatment for any type of skin cancer can be difficult in the late stages.

The good news is you can find skin cancer early. Found early, most skin cancers, including melanoma, can be cured.

There’s also a lot you can do to reduce your risk of getting skin cancer.

Talk to your hairdresser or barber

Ask the person who cuts your hair to tell you if you have a growth or odd-looking spot on your scalp.

How people of color can find skin cancer

Because skin cancer begins on the skin, this cancer can be found early. The best way to find skin cancer is to check your own skin.

Here’s what dermatologists recommend for people who have skin of color:

What you can do Skin self-exam: This is a full body exam of your skin
What you need A full-length mirror and a partner or handheld mirror
When Monthly
What to look for People who have skin of color want to look for the following:

  • Dark spot, growth, or darker patch of skin that is growing, bleeding, or changing in any way
  • Sore that won’t heal — or heals and returns
  • Sore that has a hard time healing, especially if the sore appears in a scar or on skin that was injured in the past
  • Patch of skin that feels rough and dry
  • Dark line underneath or around a fingernail or toenail
How to check your skin
  • Look at your skin from head to toe
  • Examine hard-to-see areas like the top of your head and back by using a handheld mirror or asking a partner to check these areas.
Where to look closely
  • Check places that get little sun — the bottoms of your feet, toenails, lower legs, groin, and buttocks.
  • Spend time looking at the skin on your head, neck, and hands. Be sure to look inside your mouth, examine your palms, and check for dark lines around and underneath your fingernails.
What to do if you find something See a dermatologist. You can find a dermatologist near you by using Find a Dermatologist.
Why this is important Performed monthly, you can find changes to the spots on your skin, which could be skin cancer. When treated early, treatment often cures skin cancer. In the later stages, skin cancer can turn deadly and treatment can be difficult.

Pictures of skin cancer in people of color

The following pictures show some examples of what skin cancer can look like in people of color.

Skin cancer in Asians: The most common sign of skin cancer in Asians is often a roundish, raised brown or black growth. Skin cancer also shows up in other ways, so be sure to check your skin carefully.Skin cancer in blacks: In people with brown or black skin, skin cancer often develops on parts of the body that get less sun like the bottom of the foot, lower leg, and palms. Skin cancer may also begin under a nail, around the anus, or on the genitals.

Skin cancer in Latinos: Skin cancer can appear on the skin in many ways. If you have a growth on your skin that is getting bigger, a patch of scaly skin, or a dark streak under or around a nail, make an appointment to see a dermatologist.

How people of color can reduce their skin cancer risk

Dermatologists in the United States tell their patients with skin of color to reduce their risk of getting skin cancer by doing the following:

  1. Seek shade whenever possible. The sun causes many skin cancers.

  2. Wear clothing that protects your skin from the sun. A wide-brimmed hat can shade your face and neck. You also want to wear shoes that cover the entire foot. African Americans often develop skin cancer on their feet.

  3. Wear sunscreen. Yes, people of color should wear sunscreen. Dermatologists recommend that people of color use sunscreen that has:

      Broad-spectrum protection
  4. SPF 30 or greater
  5. Water resistance
  6. Apply sunscreen to dry skin 15 to 30 minutes before going outdoors. You want to apply sunscreen to skin that will be bare. Be sure to apply sunscreen every day — even on cloudy days.

  7. When outdoors, reapply sunscreen. You want to reapply:

      Every 2 hours
  8. After sweating or getting out of the water
  9. Never use tanning beds or sunlamps. These emit harmful UV rays, which can cause skin cancer.

Skin of color: How to prevent and detect skin cancer

Although people of color have a lower risk of developing skin cancer than Caucasians, when skin cancer develops in people of color, it is often diagnosed at a more advanced stage – making it more difficult to treat.

Follow these tips from dermatologists to protect your skin from the sun and reduce your risk of skin cancer.

Make a difference: Start checking your skin today

People of color have a lower risk than whites of getting skin cancer. But they still have a risk. Monthly skin self-exams can help you find skin cancer early when a cure is likely.

Images
Images 1: Getty Images
Images 3 – 11: Used with permission of Journal of the American Academy of Dermatology:

  • Images 3, 4, 9, 10, and 11: J Am Acad Dermatol. 2014;70(4):748-62.

  • Images 5, 6, 7, and 8: J Am Acad Dermatol. 2006;55(5):741-60.

Image 12: Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Agbai ON, MD, Buster K, et al. “Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public.” J Am Acad Dermatol 2014;70(4):748-62.

American Academy of Dermatology. “Dermatologists provide recommendations for preventing and detecting skin cancer in people of color.” News release issued February 4, 2014.

Gloster HM and Neal K. “Skin cancer in skin of color.” J Am Acad Dermatol 2006;55(5):741-60.

Skin cancer

Skin cancers can look very different. They might be:

  • a spot or sore
  • a lump
  • a red or dark patch
  • itchy, crusty or bleeding

The earlier a skin cancer is diagnosed, the easier it is to treat. So it’s important you visit your GP as soon as possible if you notice a change in your skin.

Looking for signs of skin cancer

Non melanoma skin cancers tend to develop most often on skin that’s exposed to the sun.

To spot skin cancers early it helps to know how your skin normally looks. That way, you’ll notice any changes more easily.

To look at areas you can’t see easily, you could try using a hand held mirror and reflect your skin onto another mirror. Or you could get your partner or a friend to look. This is very important if you’re regularly outside in the sun for work or leisure.

You can take a photo of anything that doesn’t look quite right. If you can it’s a good idea to put a ruler or tape measure next to the abnormal area when you take the photo. This gives you a more accurate idea about its size and can help you tell if it’s changing. You can then show these pictures to your doctor.

Basal cell skin cancers

There are different types of basal cell skin cancers. These include:

  • nodular basal cell skin cancer
  • pigmented basal cell skin cancer
  • morphoeic basal cell skin cancer – also known as sclerosing or infiltrating basal cell skin cancer
  • superficial basal cell skin cancer

Nodular basal cell cancer

Nodular basal cell cancers can look see through (translucent) and shiny. You can often also see their blood vessels. Sometimes they have a sore (ulcerated) area and it may also have fluid filled sacs (cystic).

Pigmented basal cell cancer

Pigmented basal cell cancers have dark areas, often brown, blue or grey in colour. They can look like warts or sometimes a melanoma.

Morphoeic basal cell cancer

Pronounced mor-fee-ic, this type of basal cell skin cancer may look like a sore area on the skin that doesn’t heal. It might look skin coloured, waxy, like a scar or thickened area of skin that’s very slowly getting bigger. You might also see small blood vessels.

Squamous cell skin cancers

Squamous cell skin cancers can vary in how they look. They usually occur on areas of skin exposed to the sun like the scalp or ear.

Thanks to Dr Charlotte Proby for her permission and the photography.

When to see your doctor

You should see your doctor if you have:

  • a spot or sore that doesn’t heal within 4 weeks
  • a spot or sore that hurts, is itchy, crusty, scabs over, or bleeds for more than 4 weeks
  • areas where the skin has broken down (an ulcer) and doesn’t heal within 4 weeks, and you can’t think of a reason for this change

Your doctor can decide whether you need any tests.

Melanoma

Megan Brennard, BS and Kesha Buster, MD

Skin cancer is the most common type of cancer in the United States. Melanoma is the third most common type of skin cancer and the most deadly.1 Darker skinned people all have relatively low risk of melanoma compared to whites.1 Though uncommon in people of color, blacks and Hispanics are more often diagnosed with more advanced melanomas, and they often have higher mortality than whites.1-3 It has been observed that fairer-skinned persons have a higher rate of melanoma than darker-skinned persons–even within the same ethnic group. Accordingly, whites have an overall greater incidence than Hispanics, who have a higher incidence than blacks and Asians.1 Though it can appear on any skin surface, the common locations for melanoma on people of color are on non-sun-exposed skin including the bottoms of the feet, the palms, finger- and toenails, and inside of the mouth.1,4

What is the cause of melanoma?
In whites, increased exposure to ultraviolet radiation (UVR), including sunlight and tanning beds, is a significant risk factor for melanoma. UVR may also play a role in melanoma development in people of color, as blacks and Hispanics living closer to the equator (getting greater UVR exposure) have higher melanoma incidence, but this link is less-well established.5 In whites, more than 90% of melanomas are on sun-exposed skin.1 In contrast, nearly 75% of melanomas in people of color are on the palms, soles, mucosal sites (mouth, genitals) and under nails.1 Additional reported melanoma risk factors in people of color include radiation therapy, preexisting pigmented lesions, albinism, burn scars, and depressed immune system.1

How do I know if I have melanoma?
Any suspicious, changing, or new mole or freckle anywhere on your skin should be evaluated by your dermatologist. However, because many melanomas on dark skin are found on poorly visible areas, you should do a monthly self-skin examination. An easy way to remember the signs of melanoma is by the ABCDEs,6 a memory-aid for how to evaluate pigmented lesions:

A ‐ Asymmetry. Pigmented lesions should look the same on both sides when folded in half.
B ‐ Border irregularity. The borders should be smooth and regular–usually round or oval in shape.
C ‐ Color variation. The lack of uniform and even color.
D ‐ Diameter. Size of greater than 6mm or about the size of a pencil eraser.
E ‐ Evolving. Any change (including size, shape, color) in an existing mole or skin lesion

Also, because of the higher incidence of melanoma in a fingernail or toenail in people of color, the “alphabet of nail melanoma” is a useful guide for self and physician examinations7:

A – Age range 20-90 years
African-American, Native American, or Asian
B – Band of Brown or Black pigment in nail OR
Breadth of >3mm OR
Border that is irregular/blurred
C – Change in size or growth rate of nail band OR
lack of Change in irregular nail despite treatment
D – Digit involved (nail melanoma is most common in the thumb>big toe>index finger)
Pigmented band on a single Digit is more suspicious
Dominant hand involvement is more common
E – Extension of brown or black pigment to the side or base of the nail
F – Family or personal history of melanoma or irregular moles

In addition, any pigmented lesion that looks different than the majority of one’s moles and freckles (i.e., an ‘ugly duckling’) should be evaluated.

What are the best treatments for melanoma?
Any lesion suspicious for melanoma should be biopsied or completely excised (removed). Once melanoma is diagnosed, if the lesion was not completely removed initially, a second procedure will be done to remove all of the cancer with margins of normal skin. Depending on the depth, your dermatologist may send you to a cancer surgeon for removal and analysis of lymph nodes to determine if the melanoma has spread. Metastatic (distantly spread) melanoma is treated with various combinations of chemotherapy, radiation, interferons, and medications through clinical studies.

Melanoma may be less common in people of color, but when found early, there is a very high cure rate. Diagnosing melanoma in later stages is associated with a poorer prognosis. As such, patients should be proactive in examining all skin surfaces. Any concerning lesion should be brought to the attention of your dermatologist or other physician.

Additional Resources
The Skin Cancer Foundation
American Cancer Society
Melanoma Foundation

Skin cancer symptoms

Because many skin cancers develop where they can be seen, there is a good chance of catching them early. Regular examination of the skin for any new or unusual growths, or changes in existing moles is critical. If you find anything suspicious, you should discuss it with your primary care physician, a dermatologist (skin doctor) or a health care professional who is qualified to recognize the signs of skin cancer and diagnose the disease.

An unusual skin growth or sore that doesn’t go away may be the first indication of a non-melanoma skin cancer. Skin cancer may initially appear as a nodule, rash or irregular patch on the surface of the skin. These spots may be raised and may ooze or bleed easily. As the cancer grows, the size or shape of the visible skin mass may change and the cancer may grow into deeper layers of the skin. It may be difficult to differentiate one form of skin cancer from another, so consult a dermatologist if you notice suspicious or evolving marks on the skin.

Basal cell carcinomas on the head or neck may first appear as a pale patch of skin or a waxy translucent bump. You may see blood vessels or an indentation in the center of the bump. If the carcinoma develops on the chest, it may look more like a brownish scar or flesh-colored lesion. As the cancer develops, it may bleed if injured or ooze and become crusty in some areas.

Squamous cell carcinomas may also develop as a lump on the skin. These firm lumps are typically rough on the surface, unlike the smooth and pearly appearance of a basal cell carcinoma. If a nodule doesn’t form, the cancer may develop more like a reddish, scaly patch. Unlike a skin rash that goes away with time, these rough, lesion-like patches continue to develop slowly. This type of cancer is typically found on the head, neck, hands or arms, but they may also develop in other areas, such as the genital region or in scars or skin sores.

Merkel cell carcinomas may appear as red or flesh-colored moles that are raised and grow quickly. These small tumors usually appear on sun-exposed areas of the skin, such as the face, neck or scalp.

Checking for skin cancer symptoms

Regular examination of the skin for any new or unusual growths, or changes in the size, shape or color of an existing spot, is key to finding and treating skin cancers early. If you find anything suspicious, you should discuss it with your primary care physician or a dermatologist.

While many skin cancers develop in areas exposed to the sun, they may also develop in areas that are usually hidden from the sun. It is important to examine all of these areas. In addition to examining the legs, trunk, arms, face and neck, it is important to look for signs of skin cancer in the areas between the toes, underneath nails, palms of the hands and soles of the feet, genitals and even the eyes.

Next topic: What are the types of skin cancer?

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with a basal cell carcinoma, squamous cell carcinoma, or Merkel cell cancer may experience the following symptoms. Sometimes, people with non-melanoma skin cancer/keratinocyte carcinoma do not have any of these changes. Or, the cause of a symptom may be a different medical condition that is not cancer.

Changes in the skin are the main warning sign for skin cancer. Each type of skin cancer can appear differently, so it is important to talk with your doctor when you notice a change in your skin. The skin features that frequently develop are listed below.

For basal cell carcinoma, 2 or more of the following features may be present:

  • An open sore that bleeds, oozes, or crusts and remains open for several weeks

  • A reddish, raised patch or irritated area that may crust or itch, but rarely hurts

  • A shiny pink, red, pearly white, or translucent bump

  • A pink growth with an elevated border and crusted central indentation

  • A scar-like, white, yellow, or waxy area, often with a poorly defined border

See pictures of these features of basal cell carcinoma. (Please note that this link will take you to a separate website.)

Squamous cell carcinoma can often crust, bleed, and appear as:

  • A wart-like growth

  • A persistent, scaly red patch with irregular borders that may bleed easily

  • An open sore that persists for weeks

  • A raised growth with a rough surface and a central depression

See pictures of these signs of squamous cell carcinoma. (Please note that this link will take you to a separate website.)

Merkel cell cancer often occurs as:

  • Painless, firm, shiny lumps on the skin

  • These lumps can be red, pink, or blue

Some types of skin cancer spread along the nerves. If this happens, it can cause itching, pain, numbness, tingling, or a feeling like there is ants crawling under the skin. Other signs may include a lump or bump under the skin in areas such as the neck, armpit, or groin.

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This may include when you first noticed the skin feature, how long it has been there, and any other symptoms you may be experiencing. This is to help figure out the cause of the problem, called a diagnosis.

For most cases of skin cancer, removing the cancer with surgery or using a topical treatment will cure the disease. In more complicated cases, a multidisciplinary team of doctors will meet with a patient to discuss different types of treatments to develop a plan with the best chances of curing or controlling this disease (see Types of Treatment).

Particularly in advanced skin cancer, relieving symptoms will be an important part of cancer care and treatment. This may be called palliative care or supportive care. Once started, it is continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Dermatologists take a close look at pigmented lesions like this one because in rare instances they turn out to be melanoma – the most dangerous kind of skin cancer. But the raised lesion shown here is actually a basal cell carcinoma. skincancer.org

(CBS) What’s the secret to avoiding skin cancer? There’s no surefire strategy, but experts say it’s vital to avoid tanning booths and to minimize your exposure to harsh sunlight (with sunscreen, wraparound sunglasses, protective clothing, etc.).

In addition, periodically checking your skin can help you spot skin cancer at its earliest stages – when treatment is most likely to be effective. The Skin Cancer Foundation recommends monthly self-exams in which you check all of your skin, including between your fingers and toes, on your scalp, on your back and buttocks, etc.

Just what are you looking for? According to the American Melanoma Foundation, any mole or pigmented area that shows any of the four warning signs of melanoma, the deadliest form of skin cancer:

  • A is for asymmetry – half of the mole doesn’t match the other half;
  • B is for an irregular border – often notched uneven, or blurred;
  • C is for varied color – shades of brown and black are present;
  • D is for diameter – a mole that spans more than 6 mm (about the size of a pencil eraser – is more likely to be a melanoma.

Even if you can recite the skin cancer ABCD’s, it’s helpful to be able to eyeball photos of the various forms skin cancers and “precancers” can take. Here’s our quick-read photo guide.

38 photos that could save your life

Here’s a hand with several actinic keratoses – all those red, scaly patches. These back-of-the-hand lesions are common in older golfers and others who spend a lot of time outdoors. Without treatment, actinic keratoses can turn into a form of cancer known as squamous cell carcinoma. skincancer.org

Actinic keratoses: These precancerous lesions (like the ones shown above on the back of a hand) can turn cancerous. They’re common in older golfers and others who have spent a lot of time in sunlight.

This is a classic basal cell carcinoma – the least dangerous form of skin cancer. Note the red color and the almost pearlescent look. These cancers seldom metastasize but can grow larger – and so should be removed. To minimize scarring and disfigurement, a basal cell carcinoma on the face should generally be taken off with a specialized form of surgery called Mohs. Elsewhere on the body, the lesions are often simply burned off. skincancer.org

Basal cell carcinomas: This lesion might look like a hive or pimple, but it’s actually a basal cell carcinoma. This form of skin cancer is considered less serious than others but should be removed anyway.

Here’s a bluish-black melanoma. Sometimes melanomas start out as one color and slowly change. skincancer.org

Melanomas. The deadliest form of skin cancer, melanoma (like the one shown above) is characterized by dark pigmentation, often with different shades of color, and irregular, asymmetric shapes.

Click below for the next 35 slides.

Is it skin cancer? 38 photosHow to Stay Skin Cancer-Free

Factors like genetics can influence your risk of getting skin cancer, but the number-one culprit is still the sun. Naturally, the biggest thing you can do is use sun protection — all the time. “You really have to wear sunscreen every single day,” stresses Karen. When you’re actually at the beach or spending a lot of time outside in the sun’s rays, make sure to reapply every two hours, she says.

As much as we love our SPF, Karen stresses sunscreen alone isn’t enough. “It should be one component of a smart sun strategy that includes hats, long sleeves, sun protective clothing, and sitting in the shade,” she explains.

“If you don’t go in the sun, it doesn’t guarantee that you’ll never get skin cancer, but it does greatly decrease your risk of the big three,” Day adds.

Step two: Keep up with yearly skin checks. If you have a history of skin cancer, either personally or in your family, your dermatologist might recommend upping them to every six months. And in the meantime, don’t be afraid to see your derm about something that looks weird.

McNeill recommends making an appointment to see your dermatologist if a spot — a weird bump, sore, mole, or pimple that just won’t go away — is not healing after a month. “You should not have a pimple or a scab or new bump for a month,” she says.

Finally, the experts stress the importance of seeing a board-certified dermatologist, not just any doctor, for suspicious spots. “A board-certified dermatologist does at least three years of residency training just in skin conditions,” explains McNeill. Other doctors might not have as much experience in spotting something worrisome — especially the rarer types of skin cancer.

For more on how to prevent skin cancer:

  • Consumer Reports Reveals the Best Sunscreens for Summer 2018
  • The Best Wide-Brimmed Hats for Extra Sun Protection This Summer
  • The Best Sunglasses to Protect Your Eyes From UV Rays This Summer

Now, watch how sun protection has evolved over the past 100 years:

Overview


Skin cancer (non-melanoma)

Types of non-melanoma skin cancer

Non-melanoma skin cancers usually develop in the outermost layer of skin (epidermis) and are often named after the type of skin cell from which they develop.

The 2 most common types of non-melanoma skin cancer are:

  • basal cell carcinoma (BCC), also known as a rodent ulcer, starts in the cells lining the bottom of the epidermis and accounts for about 75 in every 100 skin cancers
  • squamous cell carcinoma (SCC) starts in the cells lining the top of the epidermis and accounts for about 20 in every 100 skin cancers

Basal cell carcinoma

Basal cell carcinoma (BCC) usually appears as a small, shiny pink or pearly-white lump with a translucent or waxy appearance. It can also look like a red, scaly patch.

There’s sometimes some brown or black pigment within the patch.

The lump slowly gets bigger and may become crusty, bleed or develop into a painless ulcer.

Basal cell carcinoma does not usually spread to other parts of the body. There’s a small risk (up to 5%) of squamous cell carcinoma spreading to other parts of the body, usually the lymph nodes (small glands found throughout your body).

Squamous cell carcinoma

Squamous cell carcinoma (SCC) appears as a firm pink lump with a rough or crusted surface. There can be a lot of surface scale and sometimes even a spiky horn sticking up from the surface.

The lump often feels tender when touched, bleeds easily and may develop into an ulcer.

For both SCC and BCC there can sometimes be considerable skin damage if the tumour is not treated.

Bowen’s disease

Bowen’s disease is a precancerous form of Squamous cell carcinoma SCC sometimes referred to as squamous cell carcinoma in situ. It develops slowly and is easily treated.

The main sign is a red, scaly patch on the skin that may itch. It most commonly affects elderly women and is often found on the lower leg. However, it can appear on any area of skin.

Although not classed as non-melanoma skin cancer, Bowen’s disease can sometimes develop into SCC if left untreated.

Actinic keratoses

Actinic keratoses, also known as solar keratoses, are dry, scaly patches of skin caused by damage from years of sun exposure.

The patches can be pink, red or brown, and can vary in size from a few millimetres to a few centimetres across.

The affected skin can sometimes become very thick, and occasionally the patches can look like small horns or spikes.

Like Bowen’s disease, actinic keratosis is not classed as non-melanoma skin cancer, but there’s a small risk that the patches could develop into squamous cell carcinoma (SCC) if untreated.

What Does Melanoma Look Like?

Melanoma is a type of cancer that begins in melanocytes (cells that make the pigment melanin). Below are photos of melanoma that formed on the skin. Melanoma can also start in the eye, the intestines, or other areas of the body with pigmented tissues.

Often the first sign of melanoma is a change in the shape, color, size, or feel of an existing mole. However, melanoma may also appear as a new mole. People should tell their doctor if they notice any changes on the skin. The only way to diagnose melanoma is to remove tissue and check it for cancer cells.

Thinking of “ABCDE” can help you remember what to look for:

  • Asymmetry: The shape of one half does not match the other half.
  • Border that is irregular: The edges are often ragged, notched, or blurred in outline. The pigment may spread into the surrounding skin.
  • Color that is uneven: Shades of black, brown, and tan may be present. Areas of white, gray, red, pink, or blue may also be seen.
  • Diameter: There is a change in size, usually an increase. Melanomas can be tiny, but most are larger than the size of a pea (larger than 6 millimeters or about 1/4 inch).
  • Evolving: The mole has changed over the past few weeks or months.

Melanomas can vary greatly in how they look. Many show all of the ABCDE features. However, some may show changes or abnormal areas in only one or two of the ABCDE features.

In more advanced melanoma, the texture of the mole may change. The skin on the surface may break down and look scraped. It may become hard or lumpy. The surface may ooze or bleed. Sometimes the melanoma is itchy, tender, or painful.

Photos of Melanoma

A large, asymmetrical melanoma with an uneven color and irregular border

A large, asymmetrical melanoma that is more than 10 millimeters (about 1/2 inch) wide

A melanoma with uneven color, an irregular border, and a scaly or flaky area

A melanoma with an irregular border

A melanoma with uneven color and an irregular border

Skin cancer look like

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