Recognition of Skin Cancer and Sun Protective Behaviors in Skin of Color

September 2013 | Volume 12 | Issue 9 | Original Article | 1029 | Copyright © September 2013

Chikoti M. Wheat MD,a Naissan O. Wesley MD,b and Brooke A. Jackson MDc

aDuke University School of Medicine, Durham NC
bSkin Care and Laser Physicians of Beverly Hills, Los Angeles, CA
cSkin Wellness Center of Chicago, Chicago IL

Sun protective behaviors are not as frequently practiced in skin of color as they are amongst Caucasians.1 Thus providing a reasonable assumption this behavior, or lack thereof, increases the risk of skin cancer in this skin of color populations. The aim of this study was two-fold-- the first was to understand whether patients with skin of color, when categorized by ethnicity or skin type, are able to recognize skin cancer lesions. The second was to examine the correlation between ethnicity and/or skin type and practice of sun protective behaviors. We surveyed 105 respondents presenting for various skin problems in a dermatology office in Chicago, IL. Topics covered in the survey included recognition of skin cancer appearance and choice of sun protective behaviors. We show that there is a tendency for patients to potentially recognize atypical pigmented lesions when they are “dark moles with irregular borders” or “new moles”. In contrast, there is a reduced ability among darkly pigmented skin types IV to VI, to recognize non-melanoma skin cancers. We also show that in addition to ethnicity, skin type within ethnic groups may also play an influential role on the decision to protect or not protect oneself from the sun.

J Drugs Dermatol. 2013;12(9):1029-1032.


That people of color are not at risk for developing skin cancer is a common misconception.2 Unfortunately, the consequences of such a belief are reflected in the increased morbidity and mortality of African-Americans from skin cancer when compared to Caucasians.1,3,4 Unlike fair skin ethnic groups, where basal cell carcinoma is the most common type of skin cancer, dark-skinned ethnic groups are more likely to have squamous cell carcinoma. In addition, dark skinned ethnic groups have squamous cell carcinoma and melanoma occurring on non sun-exposed sites.5
Primary care physicians have increasingly become aware of the importance of educating their patients of color on the basics of “safe sun” measures including sun avoidance, sunscreen use, protective clothing and the recognition of skin cancer lesions.6 Despite these efforts, we have shown that there still remains a large percentage of the population of people of color that are unable to recognize the appearance of certain cancerous lesions. Not only is the lack of self-recognition a key hindrance, but the failure to practice sun protective behaviors additionally continues to remain an obstacle to reducing the incidence of skin cancer in people of color. There has been increased awareness that people of color, particularly African-Americans, are less likely to engage in sun-protective behaviors.1,7,8 Interestingly, we also show that skin type plays as huge a role in influencing one’s personal efforts in knowing about signs of skin cancer and engaging in preventative behaviors.


In order to appreciate whether ethnicity of skin type influences a patient’s ability to recognize skin cancer lesions and their sun protective behaviors, we conducted a questionnaire survey in May 2008 within a Dermatology clinic (private practice) setting in Chicago, IL. The survey was handed out to people of color who were presenting for a variety of reasons including annual skin examinations, follow-up appointments, or new evaluations. Inclusion criteria included above age 16, skin of color, male or female. All participating respondents were included in the analyses. Demographic information obtained included ethnic origin (Black (African-American or non-African American), Hispanic, Asian, and Middle Eastern), age, sex, occupation, where they were raised, and reason for visit. The participants were also asked a variety of open- and close-ended, circle answer questions on topics such as basic understanding of skin cancer, recognition of cancerous skin lesions, outdoor activities and choice of sun protective behaviors. A total of 105 surveys were completed and submitted.


We surveyed a total 95 female and 10 male respondents between the ages of 16 and 79 with a mean age of 40.2 and median age of 40. Total number of respondents included 91 Black (88 African-American and 3 non-American Africans), 9 Hispanics, 4 Asians and 1 Middle Eastern (Table 1). When categorized by Fitzpatrick skin type (as determined by the surveying physician), there were a total of 9 Type III, 29 Type IV, 64 Type V and 3 Type VI skin types (Table 1B). Fifty-one (49%) of the total