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MEDICAL YEAR
IN REVIEW

Skin of Color Dermatology: Exploring Skin Cancer

Disparities in Ethnic Populations

By Marie Vu, Alexandra Montgomery and Tue “Felix” Nguyen

S and Asians. The typical appearance of this cancer in fair skin can vary
kin of color (SOC) dermatology is a subset of dermatology
which treats skin, hair and nail conditions in individuals of
from scaly pink-to-red patches to thickened, crusted plaques or nod-
African American, Asian, Hispanic/Latino, Native Indian or
Pacific Islander descent. With a diverse ethnic population that ules. Like BCC, the appearance of SCC in darker skin is often brown
or black rather than pink due to excess pigmentation. In Caucasians,
continues to grow, demographics in the United States are shifting. SCC usually appears in areas that have been chronically exposed to the
These changes underscore the importance of a thorough understanding sun, like the face and upper body. However, in patients of color, it can
of SOC dermatology, although attention to addressing these needs has often occur in areas without much sun exposure, such as the lower legs
increased in recent years. There are cutaneous diseases that are more or the genital region, and may be more often related to chronic wounds
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prevalent, present differently or are inadequately understood in people or additional underlying disease.
of color. More specifically, skin cancer plays an impactful role when as- Melanoma is the least common type of skin cancer, but is the most
sessing disparities within SOC dermatology due to its increased preva- dangerous due to its ability to spread to other organs. It primarily affects
lence and malignant potential. Caucasians, however, the diagnosis of melanoma in SOC is often as-
The three most common types of skin cancer are basal cell carcinoma sociated with poorer clinical outcomes. Melanomas are often irregularly
(BCC), squamous cell carcinoma (SCC) and melanoma. Each of these shaped and may have different shades of pigmentation within a single
skin cancers have characteristic features that doctors and patients can lesion. The common “warning signs” to detect melanoma include le-
look for, but some of these classic signs are often not present when these sions that exhibit asymmetry, irregular borders, color changes, a diam-
cancers arise in SOC, which can make early detection more difficult eter greater than six millimeters and a spot that has significantly
and can negatively impact prognosis. changed over time. An important difference between the development
Basal cell carcinoma is the most common skin cancer in Caucasians, of melanoma in people of color and in Caucasians is location. While
Asians and Hispanics, and the second most common in African Amer- melanomas most often present on the trunk in Caucasians, melanomas
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icans. In fair skin, this cancer typically looks like a flesh-colored or often develop in unusual locations such as the lower extremities, palms,
“pearly pink” bump, often with raised edges, visible blood vessels and soles, nails and mucosal surfaces in African American, Hispanic and
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commonly with an open sore in the center. In SOC, BCC may lack its Asian populations.
characteristic pink hue and visible blood vessels, and instead may con- Though SOC individuals are less likely to develop skin cancer, there
tain extra melanin, giving the lesion a darker appearance. is increased morbidity and mortality in such populations when compared
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Squamous cell carcinoma is the most common skin cancer in African to Caucasians. An epidemiological review showed a 5-year survival rate
Americans, and the second most common in Caucasians, Hispanics of 70% for SOC patients while Caucasian patients had a significant in-

24 SAN ANTONIO MEDICINE • December 2021