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It's a fairly common myth that African-Americans and other people of color don't get sunburned or get skin cancer. Unfortunately, this is not true. While Caucasians are definitely at higher risk, skin cancer still represents 1 to 2% of all cancers diagnosed in non-Hispanic black people and 4 to 5% in Hispanics. Because of this myth, however, a skin cancer diagnosis tends to come at a later stage, partly because it's harder to see on deeper-toned skin and partly because dark-skinned people are less likely to be screened regularly.
What Causes Skin Cancer?
Most skin cancers are caused by excessive UV exposure from the sun or tanning beds. Because of this, people with higher levels of melanin (the level of dark color in one's skin and hair) have a certain level of protection, but that protection is not enough to prevent skin damage. The following factors strongly affect risk:
Sunburn. More than five sunburns in your life double your risk of skin cancer. While it does take longer for dark-skinned people to burn, it still happens.
Having a family history of skin cancer increases the risk. Your risk of any kind of skin cancer is higher if you have a relative with skin cancer.
Genetics and ethnicity, which decide your skin color, can also play a part in the type of skin cancer you are more likely to develop. The two most common types of non-melanoma skin cancers are basal cell carcinoma and squamous cell carcinoma.
Hispanics, Chinese, Japanese, and Caucasians are most at risk for basal cell carcinoma.
Black people and Asian Indians are more at risk for squamous cell carcinoma.
Melanoma, the most dangerous form of skin cancer, is the third most common among all groups. People with darker skin color, and those of Asian descent, are also more likely to develop acral lentiginous melanoma, found on the palms, soles, and nailbeds, which tends to be faster growing and more likely to spread to the lymph nodes.
How Can You Reduce Your Risk of Skin Cancer?
So, what should people of color do in the hot Virginia and North Carolina sun?
Wear at least SPF 30 sunscreen regularly. Apply to dry skin at least 20 minutes before going outdoors and reapply at least every two hours, more often if you are heavily sweating. As a note, natural skin protection in black people is 13.4, compared to 3.4 in whites, so your natural protection is still lower than what is really needed. Remember that swimming or bathing can increase the effect of the sun. Use water-resistant or sweat-resistant sunscreen. This is effective for at least 40 minutes, so try to limit your swimming time and reapply immediately when you get out of the water.
Stay in the shade when you have the choice. If it's very hot and you are heading into a more exposed area, consider portable shade like an umbrella or parasol. Even simple things like walking on the shaded side of the street can be helpful.
Protect yourself with clothing. Particularly, wear shoes that cover your entire foot rather than sandals. For genetic reasons, nonwhites are at particular risk of skin cancer on their feet. Wear a wide-brimmed hat. Wear pants and long sleeves when possible.
Never use tanning beds or sun lamps. The use of tanning beds is increasing amongst people of color. Many options for tanning are available in today’s marketing, including self-tanning lotion that does not require sun or UV lamp exposure.
How Can You Increase Early Detection of Skin Cancer?
One of the biggest problems for dark-skinned people concerning skin cancer is a tendency for it not to be detected early enough. Here are a couple of tips to increase early detection and improve outcomes.
Do a skin self-exam every month. Look for the following, paying particular attention to the bottoms of your feet, toenails, lower legs, groin, and buttocks (60 to 75% of tumors on very dark-skinned people show up in areas where they have less pigment, such as the palms, soles, or around the nails):
Dark spots, growths, or darker patches that are bleeding or changing. Asians often see a roundish, raised brown, or black growth
Changes to existing moles
Sores that don't heal, heal and return, or are on scars or injuries
Rough or dry patches of skin
Dark lines under or around your nails
Odd marks inside your mouth
See a dermatologist for a checkup every year. Sadly, many general practitioners are not well-educated about skin cancer in darker-skinned people. On the other hand, dermatologists are trained to work on skin of all colors and types. Ask your dermatologist how often you should be checked, as it may be affected by individual skin color, family history, etc.
Are There Other Reasons to Use Sunscreen?
There are other reasons why even very dark-skinned people should use sunscreen. Skin damage from the sun affects all ethnicities. Sun damage can include:
Actinic keratosis forms scaly, rough patches of skin or raised bumps, which can come and go and itch. Up to 10% of actinic keratoses turn into cancer later.
Wrinkles, age spots, and other age-related skin damage. Your skin will most likely look younger if you use sunscreen.
So, the best solution for everyone is to use sunscreen. Look for a type or brand designed for deeper complexions, if possible. The skincare and sunscreen industry has made strides in creating inclusive products for all skin shades, but don't let the fear of looking a little "chalky" stop you from using sunscreen, especially if you're going to the beach. Everyone needs to protect themselves from the sun, no matter the color of their skin.
Virginia Oncology Associates is dedicated to helping you with creating a treatment plan for a skin cancer diagnosis. If you've been recently diagnosed, please contact our cancer centers in the Hampton Roads and Eastern North Carolina areas to learn more about our services and customized treatment options in Norfolk, Virginia Beach, Hampton, Newport News, Williamsburg, Chesapeake, Suffolk, and Elizabeth City, NC.
Originally published November 2019. Updated July 2022.