Current Trends in Skin of Color

melanoma specific survival rate for ALM is 81% and 68%, respectively, compared to 89% and 85%, respectively, for overall cutaneous melanomas. Early stage diagnosis for MM is seen in 91% of Caucasians, 74% of Hispanics, and 48% of African Americans.

In an attempt to elucidate the real incidence of MM among Hispanics, a retrospective, cross-sectional analysis of 41,072 cases of MM with known stage and ethnicity reported in Florida from 1990-2004 was done. Malignant melanoma incidence rates increased by 3% per year among non-Hispanic white men, 3.6 % among non-Hispanic white women, 3.4 % among Hispanic women, and 0.9% among white Hispanic men, while remaining stable among black men and women.⁸

The advanced stage upon diagnosis of MM in Hispanics can be related to lack of access to medical services, lack of understanding of their risk to skin cancer, or both. An in-clinic survey about sun exposure and protection was conducted. A total of 100 individuals of African-American, Asian, and Hispanic descent were interviewed about their perception of the effect on sun exposure.⁹ Although 43% of the participants reported sun-burns upon sun exposure, 65% of the participants believed they were not at risk for skin cancer. In addition, they reported recreational sun exposure without sun-protection for themselves and their children. This might explain why in an epidemiologic study of the population of Florida, the incidence of MM was 20% higher in Hispanic male patients living in Florida than that of their male counter parts in catchment areas.¹⁰ Another study looked at the skin cancer awareness in white Hispanics and white non-Hispanics in high school students in Miami, Florida.¹¹ The study found that white Hispanics were more likely to tan deeply, less likely to have heard of or perform self-skin examinations, and 2.5 times more likely to have used tanning beds in the past year as compared to the white non-Hispanics. Also, white Hispanics believed they were less likely to develop skin cancer. Even though Hispanics' lack of self-perception of risk for skin cancer is well documented and erroneous, this population lacks support when it comes to medical care. The US Census Bureau’s 2011 American Community Survey revealed that 30% of Hispanics lack medical insurance compared to 15% of the total US population; making it the largest population without medical insurance in the US.¹² Health care professionals, especially Dermatologists, must inform and educate Hispanics on their risk for developing skin cancer and the need to adapt protective behavior outdoors upon sun exposure.

As a group, Hispanics should not be referred to by the label 'skin of color' because Hispanics are every 'color' and have very diverse genetic backgrounds. In my opinion, Hispanic skin should be identified by sex, country of origin, and shade of skin color: be that white, light beige, beige, medium beige, dark beige, light brown, medium brown, dark brown, light black, medium black, and black. That way, Hispanics are not identified by their 'skin of color' but by the color of their skin.

Maritza Perez MD
Mt. Sinai Icahn School of Medicine
New York, NY

Dr. Perez has no conflicts of interest to declare.