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Go With The Glow! Why Sunscreen For Brown Skin Is An Absolute Must

Three dermatologists explain the causes, risks, and how to prevent skin cancer.

Even with the ease and availability of the internet, you’d be surprised how many people still believe the browner your skin tone, the less you’ll have to worry about getting skin cancer. And, while it is true that POCs (People of Color) are less likely to get the disease, you are, in fact, more likely to die from it.

We know that in white populations, skin cancer represents up to 45% of all new and abnormal tissue growth, and in the Black community, that number is only between 1 to 2%. Yet, the estimated melanoma survival rate for Black patients after five years is 71% versus 93% for white patients.

“Most families do not encourage the use of sunscreen because they have the misconceived idea that skin cancers do not occur in the African American community,” says Lisa Nyanda-Manalo, MD, double board-certified in dermatology and pediatrics of Advanced Dermatology & Cosmetic Surgery. “Most People of Color associate their darker complexion with representing a degree of sun protection; however, they don’t understand that the accumulation of sun exposure over time can still increase their risk of skin cancers”.

Still, while there may be a lack of education in communities of color, the medical community also needs to take some responsibility. "Dermatologists aren't offered adequate training to recognize skin cancer in darker skin types, and historically, the Black community hasn't gone for routine skin cancer monitoring, so the volume needed to adequately see a variety of different skin manifestations is significantly reduced," says Dr. Nyanda-Manalo. Furthermore, dermatology and other medical textbooks do not have enough representations of darker tones, which can lead to missed or delayed diagnosis and poor outcomes.

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In fact, a 2018 study found that less than 5% of images included in general medicine texts were that of dark skin tones. And while technology has advanced in the dermatological field, we haven’t moved the needle regarding providing diverse examples in photography.

"Skin cancer has certain characteristics, and dermatologists, in general, are trained to identify those characteristics," says Caroline Robinson MD, FAAD, CEO and founder ToneDermatology. "However, we're falling short in making sure that the breadth of that education includes the nuances that can present on People of Color".

To that end, Dr. Robinson has partnered with Vaseline to help create a resource to access images that can help to identify skin conditions through an online search at SeeMySkin.com. "It's a resource for patients, students studying the skin, and dermatologists because there aren't a lot of databases of images right now," she says. In addition to finding images of medium to dark skin tones on conditions such as psoriasis, skin cancer, eczema, hives, and rashes, it offers a directory of culturally sensitive doctors.

Here's how to access and use website

Types of Skin Cancer

Basal cell carcinoma: Also known as BCC, this disease is a slow-growing skin cancer that can develop on the head or neck and may be mistaken for a pimple, scar, or sore.

Squamous cell cancer: This disease tends to grow slowly but deep, which can damage nerves and blood vessels. "Squamous cell cancer seems to be more common in Black patients, and it can manifest in different ways," says Dr. Robinson. "Although it is sun-induced in white patients, in Black patients, it can develop in scars—and Black people are prone to scarring."

Melanoma: This type of skin cancer can be found on any part of the body and is more likely to spread from the skin to other parts of the body. "We do have a risk of basal cell carcinoma and melanoma, particularly acral lentiginous (found on palms and soles, and subungual melanoma (found under nails), which is what took Bob Marley's life," says Dr. Robinson.

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Signs and Symptoms of Skin Cancer

Before self-diagnosing every brown spot or mole on your body, consider some of the true signs and symptoms that may indicate skin cancer.

"The first signs of skin cancer could be associated with a painful or bleeding lesion that is recurring and non-healing," says Dr. Nyanda. "In addition, moles change, and we utilize the ABCDE's to evaluate such changes," she says.

Once a month, you can perform a self-skin check on your own for the early detection of skin cancer. Here’s what you should be looking for in your exam:

Asymmetry: An indication that the shape of the lesion or mole isn't uniform.

Border: The borders of the lesion are uneven or aren't well defined.

Color: Lesions will likely have an unusual color and are often more than one color or shade.

Diameter: The growth is larger than 6mm (¼ inch), which is about the size of a pencil eraser's diameter.

Evolving: You can see changes in the mole, such as its size, shape, or color.

It is also important to note that skin cancer may present differently depending on skin tone. "In the case of basal cell carcinoma, it can appear as a pink bump on lighter skin, but it often [looks] brown, purple, or black on patients of color," says Dr. Robinson. "Melanoma can be a little more pigmented, but most melanomas have pigment, regardless of the skin tone," she says.

Dr. Robinson also notes that squamous cell cancer can be a little challenging to spot as it can look like an ulcer or like an area that doesn't heal. "My rule of thumb is if you have a spot that isn't healing or have a bump that looks like an acne bump, a dark bump, that's there for more than a month, especially if it's getting larger, you should get it checked," she says.

Risk Factors

While monthly self-skin checks are necessary, Dr. Nyanda encourages “establishing annual skin cancer evaluation examinations with a dermatologist.” This can help to spot issues early and also for you to discuss the any risk factors such as:

Moles: Although they don’t always mean that you have skin cancer, if you have more than the average amount, which is about 40 to 50, you should get checked.

Family history of skin cancer: If you have a close family member, such as a mother, father, or sister who had melanoma, know that you are at an increased risk.

UV light exposure: Sources of ultraviolet radiation are the sun, tanning beds, and sun lamps. “If you have had multiple blistering sunburns, that can create significant skin damage and put you at higher risk,” says Dr. Robinson. “And while everyone experiences peeling, unlike lighter skin types which show visible damage such as redness, darker skin tones tend to manifest physical symptoms such as heat sensitivity and itchiness,” says Kim Nichols, MD, FAAD. Board-Certified Dermatologist and Cosmetic Surgeon and founding director of NicholsMD of Greenwich.

Protecting Yourself

The solution is simple and yet complicated all at once. To reduce your chances of skin cancer, just limit your exposure to UV radiation. This means avoiding sun exposure from 10 a.m. to 4 p.m. when the sun is at its strongest. You should also wear sunglasses that have 100 percent ultraviolet B (UVB) and ultraviolet A (UVA) protection. Whenever outdoors and simply cannot avoid direct sunlight, you should opt for wide-brimmed hats and clothing with Ultraviolet Protection Factor (UPF) to reduce your risk.

“Although melanin is believed to offer a sun protection factor of about SPF 4, meaning melanin absorbs 50% to 75% of UVR naturally, skin cells are still not totally immune to all radiation, and damage is possible,” says Dr. Nichols. “Everyone, regardless of skin type, should use SPF 30 or higher and re-apply every 2 hours,” says Dr. Nyanda. And don’t forget to use lip balm with SPF.

“For my patients of color who are particularly prone to hyperpigmentation, I tend to recommend mineral sunscreens,” says Dr. Robinson. “There is a growing body of evidence suggesting these sunscreens provide a little more protection against visible light, which has been shown to worsen hyperpigmentation in darker skin individuals,” she says.

Editor’s note: If you have any questions or need further information on skin cancer and risk factors please speak with a healthcare professional.

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