Advocacy for Skin Cancer Screening

Photo Courtesy of Mayo Clinic

By: Hannah Berman, M.D. Mayo Clinic – Melanoma is a rare but aggressive type of skin cancer It’s responsible for about three quarters of skin cancer related deaths. It most often affects white people, but people with all skin types can be affected by melanoma.

Unfortunately, Black people experience worse outcomes from melanoma, though this disparity has improved. From 1975 to 2014, deaths from melanoma decreased by about 25% in Black men and women. One reason is likely increased advocacy for skin cancer screening. Also, new research has helped us better understand the different subtypes of melanoma.

Black people are more likely than white people to develop melanoma on the palms and soles.  This type of melanoma – called acral lentiginous melanoma – is rare and only accounts for 1% – 1.5% of all melanoma cases in the United States

Multiple factors account for worse melanoma outcomes for Black people, including lower rates of skin cancer screening and dermatology access in Black communities, as well as the more aggressive nature of acral lentiginous melanoma.

Darker skin contains larger cells called melanocytes that produce a material called melanin. Melanin gives skin its color and works like a filter, blocking out and protecting the skin from ultraviolet (UV) radiation.

Generally, melanoma risk is increased with increased UV exposure and decreased sun protection. However, research has shown that acral lentiginous melanoma – the most common type of melanoma in Black people – is less influenced by sunlight than other types of melanomas.

Fitting with this information, individuals with skin of color are more likely to be diagnosed with a melanoma in a non-sun exposed area. Furthermore, the genetic mutations found in these melanomas are different than the mutations that are seen in the types of melanomas more associated with UV light exposure.

Because we now know that acral lentiginous melanomas are different from other melanomas, we should treat them differently. Clinical trials are looking into immunotherapy treatment for metastatic acral lentiginous melanoma.  Immunotherapy works by helping the body’s own immune system target and fight cancer cells. While this is an ongoing area of study, it is encouraging to see active investigation into treatments for this highly aggressive type of melanoma.

There are two things’ individuals can do to protect themselves from skin cancer. First, everyone should engage in skin protection, including using sunscreen when outside or wearing sun-protective clothing (hats, long sleeves, etc.). Second, perform self-skin checks to look for any new or concerning spots or changing moles. We like to look for the “ABCDE of melanoma,” which stands for:

  • Asymmetric shape
  • Border that is irregular/uneven
  • Color that is multicolored or different from other moles
  • Diameter larger than a pencil eraser
  • Evolution or change in shape/size/appearance over time

If a mole is on the palms or soles, some dermatologists also like to use “CUBED,” which is more specific to acral lentiginous melanomas. CUBED stands for:

  • Color
  • Bleeding
  • Uncertain what it is
  • Enlarged or growing
  • Delayed (or slow) healing wounds in or on the spot in question.

While ABCDE and CUBED are imperfect tests, they are good guides for skin self-exams.

Melanoma is a difficult and dangerous disease. Fortunately, progress has been made in treatment options and survival for people with skin of color. However, there is still work to be done and research is ongoing for new treatment options. On the individual level, everyone should feel empowered to protect and examine their own skin.

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