Detecting Skin Cancer in Skin of Color

Skin cancer can affect any patient of any age or skin color. The risk of skin cancer is increased for people in certain populations (eg, those with fair skin, increased UV exposure, immunosuppression, chemical exposures, genetic syndromes), however, this does not mean skin cancer does not occur in people with darker skin colors.

Recognizing skin cancers in skin of color is crucial. Individuals with darker skin (such as Hispanic and African American individuals) are historically less likely to be screened for skin cancer; an example of racial disparity in medicine and an opportunity for all dermatologists to improve our detection skills. Below, we will review special cases of skin cancer and highlight images in skin of color. Although skin cancers have common presentations, even uncommon presentations should remain suspect. Certain warning signs exist, such as new lesions, asymmetric, growing or enlarging lesions, irregular borders, bleeding or symptomatic, irregular colors, irregular dermoscopy findings, or abnormal history.

Basal Cell Carcinoma

The most common skin cancer.

Subtypes include superficialnodularpigmented, and infiltrative.

Erythema may be subtle.

Squamous Cell Carcinoma

squamous cell carcinoma on the ankle

A keratinocyte carcinoma.

Risk factors include UV exposure, non-healing wounds, scars, medications, and HPV.

Skin conditions that can result in squamous cell carcinoma include chronic nonhealing wounds or chronic scarring conditions such as lichen sclerosus and systemic lupus erythematosus.

 

Melanoma

Subtypes include nodular, superficial spreading, lentigo maligna, and acral lentiginous melanoma.

Acral lentiginous melanoma is of particular concern in darker skin types. This can be missed due to its location in acral regions (ie, palms and soles), so it’s prudent for the physician to examine feet during skin screenings.

Cutaneous T-Cell Lymphoma

Skin lymphoma is technically in its own category of malignancy as it is not originating from keratinocytes. It has a different pathogenesis than the cancers listed above and has different risk factors.

Skin lymphomas can technically occur in any skin type.

Mycosis fungoides is the most common form of CTCL.

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