SEBORRHEIC DERMATITIS

  • Basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma combined are the most common cancer in the United States (1).

  • Persons of African descent with darker skin types have a lower incidence of skin cancer but present at later stages, with poorer prognosis, and have treatment delays (2, 3) compared to their Caucasian counterparts

  • Although cumulative sun exposure is a known risk factor for skin cancer in patients with fair skin tone, hair and eye color; the exact risk factors for skin cancer in skin of color are under investigation (4). 

  • Sunscreen use and sun-protective behavior are less common in patients of African descent, despite the potential for sunburns and other negative effects from sun exposure (5).

  • Risk factors for skin cancers in patients with darker skin types have not been well studied but include (5)

    • BCC: "UV radiation, albinism, scars, ulcers, exposure to ionizing radiation, arsenic ingestion, oral methoxsalen (psoralen), xeroderma pigmentosum, HIV, and iatrogenic immunosuppression​."

    • SCC: "Chronic scarring processes, inflammatory conditions, HPV, immunosuppression, burn scars, sites of radiation therapy, albinism, epidermodysplasia verruciformis, and chemical carcinogens"

    • Melanoma: "Role of UV exposure unclear

  • Clinical Presentation​ in patients with darker skin types include (3)

    • BCC​: Small pearly bump with rolled borders.  More common to have areas of pigment in the bump

    • SCC: Scaly bumps or patches, some with increased or decreased pigment.  More common on the legs

    • Melanoma: Dark asymmetric macule or patches with irregular borders, more common on the palms, soles, nailbeds

  • Management of skin cancer depends on the type and stage. It includes prevention​ (e.g. regular skin cancer screening, sunscreen, sun-protective behavior), surgical removal, chemotherapy, and radiation.

 

References: 

  1. American Cancer Society. Facts & figures 2018. American Cancer Society; 2018.

  2. Wu, X.C., Eide, M.J., King, J., et al., 2011. Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999–2006. J. Am. Acad. Dermatol. 65 (5 Suppl 1), S26–S37 (Nov).

  3. Boczar D, et. al.  Analysis of Melanoma in African American Patients in the United States.

  4. Anticancer Res. 2019 Nov;39(11):6333-6337. 

  5. Hogue L, Harvey VM. Basal Cell Carcinoma, Squamous Cell Carcinoma, and Cutaneous Melanoma in Skin of Color Patients.  Dermatol Clin. 2019 Oct;37(4):519-526. 

  6. Buchanan Lunsford N, Berktold J, Holman DM, Stein K, Prempeh A, Yerkes A. Skin cancer knowledge, awareness, beliefs and preventive behaviors among black and hispanic men and women.  Prev Med Rep. 2018 Oct 6;12:203-209.