Transcription:
Skin Cancer Concerns for People of Color

Melanie Cole (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine. I'm Melanie Cole and today we're discussing skin cancer prevention and considerations for patients of color.

Joining me is Dr. Andrew Alexis. He's the Vice Chair for Diversity and Inclusion for the Department of Dermatology. And he's a Dermatologist at the Center for Diverse Skin Complexions at Weill Cornell Medicine. Dr. Alexis, it's a pleasure to have you join us again today. Data has shown that people from racial or ethnic minority groups are less likely to receive preventive health care and across the board, they faced a disproportionate health burden. When it comes to skincare and skin cancer, can you talk to us about the unique challenges these communities have faced in terms of healthcare disparities?

Andrew Alexis, M.D., MPH (Guest): Yes, I'd be happy to. So, it turns out that while skin cancer prevalence is lower in individuals with richly pigmented skin, the rates of skin cancer are far from zero. So, they still occur across the board regardless of one's skin type, racial or ethnic background. But there are indeed differences in the prevalence from one population to the other. The thing is, having darkly pigmented skin, skin that's rich in melanin while it offers some natural protection against skin cancer, it certainly doesn't make anyone immune to skin cancers. And so when skin cancers do occur in individuals with richly pigmented skin, they tend to have some differences in their appearance. They tend to have differences in where they appear. And there are differences in the prognosis.

Host: So, then are there risk factors, anything that would alert someone to say, I need to be more careful about this, or I need to check closer?

Dr. Alexis: Yes, as a general rule, and I would provide this advice to anyone of any background, any skin type a new lesion or growth in the skin that is changing in color, size, shape, itches, bleeds, scabs easily be looked at by a dermatologist for, to confirm the diagnosis. Now I would add that it's important to look at places that don't necessarily receive the sun or are not necessarily exposed to the sun on a regular basis, such as the soles of the feet or between the toes or the nail beds themselves having brown, irregular brown streaks in the nail bed can be a warning sign for melanoma. The challenge is that having pigmentation in the nail bed may be perfectly normal in individuals with richly pigmented skin, but it could also be a sign of melanoma. And how to differentiate these is really something that a dermatologist has to do, but some general guidelines are that if the pigmentation within the nail is not uniform, it doesn't have one color, if it varies in color, that would be unusual and would definitely warrant evaluation, or if it's new or changing, if it suddenly appears, this would be something that she'd want to have looked at as soon as possible.

Host: Many times Dr. Alexis, people with richly pigmented skin have moles. Now are these moles a risk to turn into cancer? If they see a change in one of those? I'd love for you to go over what to look for when things change.

Dr. Alexis: Absolutely. Occur quite frequently that something that is a new mole that a patient of mine might notice, it may or may not turn out to be anything of any medical concern. There are certainly are benign growths and moles that occur, but it's difficult to differentiate those without a trained eye. So, potential warning signs that could signal that this is more than just a benign mole would be a mole or growth that is changing in color, shape, size, or is symptomatic.

Host: So, tell us a little bit about what accounts for a gap that when skin cancer is found in patients of color, sometimes it's found late. So, is it not believing that skin cancer is a risk? Is it the healthcare disparities that we mentioned at the beginning? Is it just no knowledge of this? Tell us a little bit about what you've seen in your practice.

Dr. Alexis: That's a great question. Why is there a tendency for skin cancers to present at a later stage and have a worse prognosis in populations of color? This is something that definitely warrants broad based efforts to reduce these gaps. Well, the answer is, as we say, multifactorial. There are multiple potential contributors to these delays in diagnosis. One, being lack of public awareness, general awareness that even folks with very richly pigmented skin can still, are still at risk for skin cancer. Second, is understanding that the way skin cancers might look in the background of darkly pigmented, or richly pigmented skin, may be different than a lot of the images that are seen on publicly available sites and brochures.

One example, basal cell carcinoma is the most common skin cancer in the general population. When it presents in populations with skin of color, almost 50% or more of the time it's pigmented. So, instead of being pink and pearly, as it would occur typically in someone with lighter pigmented skin, in someone with more darkly pigmented skin, this same skin cancer, basal cell carcinoma, may have a brown, look like a brown spot, that scabs easily. It might fall off and come back. And this would be a signal that it's something to get looked at. Another example is squamous cell carcinoma. This is the second most common skin cancer in the general population, but it turns out it's the number one, most common skin cancer in Blacks or African-Americans as well as other populations with what we call type five or type six skin, which is richly pigmented.

A lot of these squamous cell carcinomas that occur in this population might not even be related to sun exposure. They are, a subset of them are related to other conditions such as suppression of the immune system or chronic non-healing wounds or inflammatory processes. For example, there have been cases of squamous cell carcinomas arising from a longstanding ulcer, that is not healed.

And so there are differences in the types skin cancers that we see, and this does contribute to a tendency to be diagnosed at later stages and unfortunately, worse prognosis. The last example that I'll give is melanoma, which is the most serious of the three skin cancers. And whereas in lightly pigmented populations, melanomas are more commonly found in sun exposed areas. In populations of color, the number one site for a melanoma is on the lower extremity, including the foot. And an example of a famous individual who was known to be diagnosed with a melanoma on the foot is the late reggae legend, Bob Marley, who had a melanoma on his big toe. So, I use that example to really inform everyone that anyone is susceptible to melanoma. And when it does occur in a populations of color, the foot or lower extremity is a very important place to look for them.

Host: I didn't know that about Bob Marley. What an interesting piece of information that you gave us today. So, now let's talk about prevention and awareness, Dr. Alexis, I mean, dermatologists try and get teens to use sunblock. And of course they're not interested, but if you appeal to their vanity, the anti-aging or you don't want to look like this wrinkled person. Tell us a little bit about the considerations for people of color and how we can get that awareness out. And that prevention really is the key. And then talk a little bit about sunscreen for us.

Dr. Alexis: Sure. I'd be happy to. When it comes to prevention, there's really a multi-pronged strategy. It includes self exams. Get to know your own skin, examine your skin regularly. And when examining your skin, don't forget to look at your, at the soles of your feet, in between the toes among all the other places, because it's not just the places where the sun shines, so to speak.

Second piece of advice is to get an annual checkup with your physician or your specifically a dermatologist. And third, when it comes to sun protection, all of us are susceptible to the damaging effects of the sun. And so, sunscreen and sun protection is recommended for all. And to get to your point about other benefits beyond skin cancer prevention of sun protection anti-aging. When it comes to all, many of the features, many of the features in the skin, people associate with aging, whether it's discoloration, uneven skin tone, which is a very key manifestation of sun damage in populations of color.

This can be prevented and improved simply through sun protection. So, for populations with skin of color, one of the key incentives to practicing safe sun habits is avoiding hyperpigmentation or uneven skin tone which becomes increasingly common as we age and it's can be prevented and improved by a good sun protective regimen.

Host: So, before we wrap up, give us a brief overview of sun protection. Is the higher number always going to be better? How often do we reapply? Does it expire? These are questions that really work across the board, but give us a little bit of an education on sunscreen.

Dr. Alexis: Sure. What I typically recommend for sun, sunscreen is an SPF of 30 or greater, broad spectrum. The label should say broad spectrum, which means it protects against UVA and UVB. And here's a nuance for populations with skin of color, it turns out that having a tinted sunscreen may be beneficial at reducing the risk of hyperpigmentation.

So, we talked about some of the aesthetic and anti-aging benefits of sun protection. It turns out sunscreens with tint also protect against visible light, which is another important component of the light emitted by the sun. And that visible light can induce hyperpigmentation or uneven skin tone. And we see conditions such as melasma for example, very common facial condition with hyperpigmentation in skin of color. And this can be re, the risk of that can be minimized by using tinted sunscreens that are also UVA and UVB protective.

Host: Aren't you giving us just such great advice here today, wrap it up for us, with your best advice for persons of color, when they're thinking about their skin and protecting it and sunscreen, and most importantly, visiting their dermatologists and checking their skin themselves. So, kind of wrap it up for us in a nice, neat little package about what you feel is the most important information about skin cancer awareness.

Dr. Alexis: Sure be happy to. I think what I'd like everyone to take away from this conversation is that anyone of any background, racial, ethnic groups, skin type, risk of skin cancer while that risk might vary, we are all susceptible. So, ways that we can work towards early detection and hence have far better prognoses is being knowledgeable about our own skin by taking a time on a regular basis to evaluate our skin, including places that don't get the sun. Seeing a dermatologist for a formal skin exam, especially if something is new or changing in color, size, shape, or suddenly becomes symptomatic.

And don't forget the value of sun protection and an easy way to ensure that you're protecting yourself is to find a moisturizer that has sunscreen, SPF or greater and use that daily regardless of the weather and regardless of your plans that day and this way, you know, you're getting daily protection. One other thing I'd like to make clear, if you plan to be outdoors for a prolonged period of time, it's important to reapply your sunscreen and we recommend reapplying it every two hours. You also need to reapply sunscreen after you've done any watersports. If you've gone into the water for swimming, for example, and come out, it's time to reapply.

And the third scenario is after any sort of exercise with intense perspiration, reapplying sunscreen then is also important. In addition to wearing a moisturizer with sunscreen SPF 30 or greater for any scenario where you do plan to be outdoors for a prolonged period, I recommend reapplying your sunscreen every two hours. And you may need an SPF that's higher than 30 for intense and prolonged sun exposure. Beyond sunscreen, wearing a broad brimmed hat and seeking the shade are also very important ways that we can protect our skin from the sun, together with sunscreen.

Host: What great information Dr. Alexis, and you're an awesome guest, as always. So, I hope you'll join us again. Thank you so much. And Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to invite our audience to download subscribe, rate, and review Back to Health on Apple podcasts, Spotify and Google podcast. For more health tips, go to weillcornell.org and search podcasts and parents, don't forget to check out our Kids Health Cast. I'm Melanie Cole. Thanks so much for listening.