Skin cancer prevention: Understanding African skin
Skin cancer prevention involves lifestyle changes and an understanding of one’s own skin. Though skin cancer is prevalent in all skin types, it manifests differently in different skin tones. African skin, for example, is more likely to develop squamous cell carcinomas. Unfortunately, skin cancer in darker skin has often reached a late stage by the time it gets diagnosed, as the symptoms of skin cancer are more difficult to recognise. Not only is skin cancer harder to see on darker skin, but people of this skin tone often lack awareness of their potential susceptibility. Even health care providers sometimes lack knowledge on the subject, so are unable to educate their clients and warn them of the risk. As a result of this, people of darker skin tones have a higher mortality rate than light-skinned people. Awareness of the risk of skin cancer and the early detection thereof is key in the treatment of this disease, so regular self-checks are essential for people of darker skin tones.
Dark skin tones and skin cancer susceptibility
Dark skin tones do have an advantage when it comes to sun exposure. The darker the skin, the more melanin (pigment) it contains, which, to a certain extent, protects the skin from sunburn and skin cancer. But only to a certain extent. Though darker skins are less likely to develop skin cancer, they are still at risk. The risk comes in with the length of time the skin is in the sun as well as underlying conditions, including genetic predisposition. In patients with genetic conditions like Xeroderma Pigmentosus and Albinism, ultraviolet light plays a huge role in skin cancer aetiology. People with these conditions are often plagued by aggressive skin cancers in sun-exposed areas of the body.
Unlike fair skins, which can only tolerate short intervals of sunlight exposure before showing signs of skin damage, darker skins can generally endure the sun for longer periods. Therefore, it is important for all people, regardless of skin tone, to apply sunblock with a high SPF, especially at times of extended sunlight exposure.
Types of skin cancer in darker skin tones
Squamous cell carcinoma
Squamous cell carcinomas (SCCs) possibly have both UV light and aetiological influences as these tend to occur in areas of the body that are not exposed to sunlight (e.g. legs, anogenital area). Squamous cell carcinomas are also possibly linked to chronic scarring (post-burn scars) and areas of chronic inflammation.
Basal cell carcinoma
Basal cell carcinomas (BCCs) in darker skin are typically associated with ultraviolet light exposure. Therefore, it is common to find these carcinomas in areas exposed to the sun.
Melanomas in dark-skinned individuals often develop in acral sites and areas hidden away from sunlight exposure. Acral lentiginous melanoma is the most common type of melanoma found in dark skins, often developing on the feet, palms of the hands, and under the nails.
Lymphomas and sarcomas
Mycosis Fungoides is a type of cutaneous or skin lymphoma, caused by uncontrolled growth of the T-cell lymphocytes in the skin. Mycosis Fungoides can be similar in appearance to eczema or other scaling and itching disorders. A high index of suspicion is required when inspecting the body for this skin cancer. Any rash that mimics chronic eczema or any rash that is poorly responsive to treatment must be referred to a dermatologist urgently.
Dermatofibrosarcoma Protuberans is a very rare type of skin cancer, initially developing in the deep layers of the skin (dermis), and subsequently spreading to the surrounding fat and muscle structures. Dermatofibrosarcoma Protuberans can be similar in appearance to a keloid.
Kaposi’s Sarcoma is an abnormal growth of the cells lining lymphatic vessels, caused by a Herpes virus. Kaposi’s Sarcoma often appears as a round, raised nodule that looks purplish in colour, and commonly affects the legs, thighs, face, nose and throat. Kaposi’s Sarcoma can also be associated with limb swelling, and is commonly seen in patients with immunosuppressing illnesses like HIV.
Skin cancer prevention: Recognising the signs
Self-checks are an integral part of skin cancer prevention. In darker skin, skin cancer typically develops in areas with less pigment, like the palms of the hands and soles of the feet, and areas generally shielded from sunlight, like the lower extremities. So it’s important for people of darker skin to frequently check these areas and maintain a high index of suspicion while doing so.
When checking the skin for signs of skin cancer, one should ensure the following areas of the body are thoroughly inspected:
6. Upper back
7. Lower Back
8. Legs and genitals
Dark skin tones and skin cancer prevention
Although it is more difficult to identify skin cancer in darker skin (due to the blending of colours), it is not impossible. Common signs of skin cancer in people of dark skin tones include sores that won’t heal on the soles of the feet, on the hands, or inside the mouth, and dark spots on the lower portions of the body that are changing in appearance. Dark lines around and under the toenails and fingernails are also common signs of skin cancer in darker skin, though, at first glance, these are often not noticeable. So to reiterate, it is imperative that people of darker skin tones perform their checks meticulously and frequently in these areas of susceptibility.
Skin cancer prevention: Are you doing your checks?
If you’d like an expert skin analysis and more tips for skin cancer prevention, send a message to our practice and we’ll be in touch.