Misconceptions lead to late diagnosis of melanoma in African Americans

With the incidence of skin cancer on the rise, it has never been more important for the public to practice the prevention and detection steps that are key to avoiding melanoma, the most deadly form of skin cancer. Yet in the case of African Americans, detection may be more difficult because studies of African Americans who are diagnosed with melanoma have shown that the condition most often develops on non-sun-exposed areas of the body. This finding along with the misconception that melanoma is not a significant threat for individuals with darker skin, may contribute to the higher mortality rates for this population.

Speaking today at the American Academy of Dermatology’s Melanoma/Skin Cancer Detection and Prevention Month news conference, dermatologist Susan C. Taylor, M.D., assistant clinical professor of dermatology, The College of Physicians and Surgeons, Columbia University in New York, addressed the alarming statistics that support the fact that prevention and detection messages about melanoma are not being heeded by African Americans.

Melanoma is the deadliest form of skin cancer and is one of the few cancers where the cause is known – overexposure to the ultraviolet rays of the sun and artificial light, like those in a tanning bed. It is estimated that 95,880 people in the U.S. will be diagnosed with melanoma in 2004 and approximately 7,910 deaths will be attributed to melanoma this year. At this rate, one person dies of melanoma every hour.

One reason why African Americans are not overly concerned about melanoma, reasoned Dr. Taylor, is that most of the skin cancer warning messages are geared toward fair-skinned individuals with blue eyes and blond or red hair who sunburn easily. Also, the incidence of melanoma in African Americans is much lower than in Caucasians due to the additional melanin, or pigment, in the skin. While this pigment offers some sun protection, dark brown or black skin is not a guarantee against melanoma.

However, once African Americans are diagnosed with melanoma, studies have shown that their long-term survival is significantly lower than that of Caucasians, 58.8 percent compared to 84.8 percent. “Melanoma has a 96 percent cure rate when detected early, yet the mortality rate in African American patients remains high and can be directly linked to the advanced state of the disease at the time of diagnosis,” stated Dr. Taylor. “The question is why are African American patients waiting so long to seek treatment?”

When diagnosed, melanoma in African American patients has often spread to other parts of the body. A recent Washington Cancer Institute study of 649 patients showed that 32.1 percent of African American patients were diagnosed with stage III or stage IV melanoma, as compared to only 12.7 percent of Caucasian patients. Melanoma in these advanced stages is usually fatal. The study was published in the January 2004 issue of the Journal of the American Academy of Dermatology.

“It is unclear if racial differences in melanoma mortality are related to delays in diagnosis and medical treatment, or if it represents inherent differences in the aggressiveness of the disease in the skin of people of color,” said Dr. Taylor.

Another factor that may prevent African Americans from seeking early treatment is that they usually develop melanoma in locations that differ from those described in conventional detection messages. A recent study showed that while 90 percent of Caucasian patients develop melanoma on skin that is regularly sun-exposed, only 33 percent of African-American patients developed the condition in these areas. In African Americans, melanoma most often develops on non-sun-exposed skin, such as the foot, toenails and the mucous membranes of the mouth, nasal passages or genitals.

Another challenge that may delay treatment is that melanoma of the nails, which peaks in incidence between the ages of 50 and 70 in African Americans, often does not conform to the ABCD rule of pigmented lesions – “A” being asymmetry; “B” being border irregularity; “C” being color variations; and “D” being diameter larger than 6 mm.

“The ABCD rule is the best way to determine if a suspicious mole or spot on the body is changing and requires immediate medical attention,” stated Dr. Taylor.

“However, African Americans also should examine their nails for some additional symptoms that can signal a serious condition.” These additional factors are most commonly found on the nails of the thumbs or big toes and may include brown or black bands under the nail, and a spot that extends into the nail folds or the skin that supports the nail.

“It is important for Africans Americans and their physicians to know that melanoma can and does occur in people of color, and a greater effort needs to be made to inform these audiences about this potentially life-threatening condition that can be avoided,” stated Dr. Taylor. “In addition to sun protection, African Americans should perform regular skin self-examinations that include special emphasis on the feet, hands, nails, between the fingers and toes, and on non-sun-exposed areas, and to immediately visit their dermatologist if they notice anything suspicious.”

The American Academy of Dermatology recommends that everyone follow these sun protection guidelines: avoid outdoor activities between 10 a.m. and 4 p.m. when the sun’s rays are the strongest; seek shade whenever possible; wear a broad-spectrum sunscreen with a Sun Protection Factor (SPF) of 15 or higher; wear sun-protective clothing and accessories, such as wide-brimmed hats and sunglasses; and follow the “shadow rule” – if your shadow is shorter than you are, the sun’s damaging rays are at their strongest.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than14,000 dermatologists worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the AAD at 1-888-462-DERM (3376) or http://www.aad.org.