Skin Cancer Doesn't Discriminate: The Truth About Melanoma and People of Color

A recent study revealed that people of color tend to have poorer prognoses than white people when diagnosed with melanoma. 
BY Katie Kosko
PUBLISHED August 03, 2016
Skin cancer should be on the minds of people of all races, despite a common misconception that people of color will not be affected by the disease.

According to a new study published in the Journal of the American Academy of Dermatology, people with skin of color are less likely to survive melanoma, the deadliest form of skin cancer, even though white people are diagnosed at a higher rate.

In fact, black people had the worst overall survival among all races in a stage-by-stage setting, which may be closely related to when the disease is diagnosed.

“If you take everybody who has melanoma, people with skin of color present at a later stage of diagnosis, so when they get to the doctor their melanoma is already advanced,” says Jeremy Bordeaux, who is the director of the Melanoma Program at University Hospitals Case Medical Center and one of the authors on the study.

“The more concerning part is that people with skin of color, if you look at them at the same stage as white patients diagnosed at similar times, the outcome is not the same. What we found was that a white person, who has very early melanoma, their likelihood of survival is significantly better than if a person with skin of color is diagnosed with a melanoma at the exact same stage.”

Researchers at Case Western Reserve University in Cleveland reviewed nearly 97,000 patients diagnosed with melanoma from 1992 to 2009. They obtained the information from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database.

Of the races examined in the study, white patients had the best overall survival, followed by Hispanic patients and patients in the Asian American/Native American/Pacific Islander group.

In an interview with CURE, Bordeaux says he believes black patients present with disease at later stages because there is not enough awareness in the general public and the medical community.

“I think it has to do with lack of education or public perception that non-whites can’t get skin cancer, and I think that also is a perception that may be held by many of my physician colleagues,” he told CURE.

In a 2011 study, researchers found that 47 percent of dermatologists and dermatology residents believed they did not receive adequate training in diagnosing conditions on black skin. This statistic does not surprise Bordeaux.

“The later diagnosis is really two parts. It’s the doctors, but it’s also the public too,” Bordeaux says. “I think the first thing that has to happen is that a patient has to say, ‘I have a spot and it needs to be looked at.’ I think that in many cases that doesn’t happen or it happens much later within the black community. The second roadblock is when they finally make it to their primary care doctor — the likelihood that they are going to think it’s cancer is lower and then if they make it to the dermatologist I think it’s the same thing.”

Bordeaux explained that though the stage-by-stage differences between white patients and non-white patients is a grey area, he does have a few hypotheses. The first is that non-whites are not getting timely treatment or they’re getting different treatment than whites. He feels this could be due to access to health care, something he hopes to study next as he continues his research. Secondly, it could be an issue related to clinical trials, he says. The third possible explanation is that there may be something genetically different about melanomas in non-whites .

Though melanoma can develop anywhere on the body, people of color often develop it on their hands and feet, white men on their back and white women on their legs.

If caught early, melanoma can often be cured with surgery. In advanced stages, melanoma is treated with chemotherapy, radiation therapy, targeted therapy or immunotherapy.

“For everyone, it’s important to be very aware of your skin,” says Bordeaux. “If you notice a spot that’s growing, changing, bleeding or anything out of the ordinary — raise concern with your dermatologist.”
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