For people of color, skin cancer may not be top of mind as a significant health threat. However, while uncommon in darker complexions, skin cancer does occur and can be deadly when diagnosis is delayed.
Delayed diagnosis can result from a false conception that people of color do not get skin cancer, a lack of access to medical care, or both. As we raise awareness, it is equally important to remember that ethnicity does not confer skin type. African Americans, Asians, Hispanics, Middle Easterners, Asian Pacific Islanders, Native Americans, or any other ethnic minority can have Fitzpatrick skin phototypes ≤III and live with the false notion that they are immune to skin cancer, when in reality, they may be at a comparable risk to Caucasians.
By the year 2050, 50% of the US population will consist of minority populations.1 It is essential that we educate both physicians and patients on skin cancer and skin of color so that unnecessary mortality can be prevented. We need to spread the message that this disease does not discriminate.
Skin Cancer and Skin of Color
Differences exist in the epidemiology, clinical presentation, and prognosis of skin cancers in skin-of-color populations (Figure 1).2
Basal cell carcinoma is the most common skin cancer in Caucasians, Hispanics, Chinese Asians, and Japanese Asians, while squamous cell carcinoma is the most common skin cancer in African Americans and Asian Indians.3 Basal cell carcinoma is most likely to occur on the head and neck in people of color because sun exposure is the most common predisposing factor. Squamous cell carcinoma, on the other hand, occurs in sites of chronic inflammation or scarring, and is more likely to metastasize in this clinical setting (Figure 2).4
Melanoma is the third most common type of skin cancer among all racial groups. Obviously the incidence of melanoma is higher in Caucasians than in African Americans, but a recent epidemiological review published by the American Academy of Dermatology showed that the 5-year survival rate for African Americans (78%) was significantly lower than that of whites (92%).5 The high percentage of advanced and thicker melanomas among non-Caucasians highlights the need to raise the awareness about skin cancer in skin of color. Studies also reveal that the incidence of melanoma is increasing in Hispanics of Puerto Rican and Mexican descent.6,7 The role of ultraviolet (UV) light in the development of melanoma in brown skin has not been clearly elucidated. Despite the tendency of melanoma to develop on nonâ€“sun-exposed sites in