Darker skin not immune to melanoma

The authors of a new study are urging physicians to counsel dark- and light-skinned patients on the need for protection from the sun and to perform skin checks on all patients.

Although blacks and Hispanics are less likely than whites to be diagnosed with melanoma, it is not unheard of, according to a study in the December 2009 Archives of Dermatology (link). And the diagnosis frequently is made at a more advanced -- and less curable -- stage among minority patients than it is for whites, said senior author Robert Kirsner, MD, PhD, professor and vice chair of dermatology at the University of Miami Miller School of Medicine in Florida.

"We looked at three different 5-year periods, and while whites' diagnoses improved, blacks' and Hispanics' did not," Dr. Kirsner said.

Melanoma is among the top 10 new cancer diagnoses for men and women in the nation, the researchers said. Melanoma incidence has increased 2.4% annually in the last decade.

For their study, researchers analyzed information in the Florida Cancer Data System, a statewide, population-based cancer registry. They looked at three 5-year periods: from 1990 to 1994, 1995 to 1999, and 2000 to 2004.

Of 41,072 cases of melanoma diagnosed from 1990 to 2004, 39,670 were in whites, 1,148 in Hispanics and 254 in blacks. During that period, 18% of Hispanics and 26% of blacks had disease that spread to other parts of their bodies compared with 12% of white patients.

Research and public education efforts have focused on melanoma prevention among whites because of the high risk of developing the dangerous skin cancer, and those efforts appear to be working, according to the study.

Survival rates among whites increased from 68% in the early 1970s to 92% in recent years. But such improvements have not occurred among other racial and ethnic groups.

Although the tumors could differ biologically in minority populations and be more aggressive -- a possibility being studied -- the researchers believe that survival differences are more likely a public health issue.

"There is a lack of knowledge about blacks and Hispanics at risk, so these populations don't use primary prevention, like being 'sun smart,' " Dr. Kirsner said. Also, suspicious lesions may be ignored by patients and physicians, he added, with physicians thinking, "The likelihood of this being anything bad is remote."

He urged clinicians to be alert to possible melanomas in unusual locations, such as on the bottom of feet or palms of hands of minority patients.

"The results of our study should motivate the expansion of melanoma awareness and screening campaigns to the minority communities, which can ultimately alleviate the disparities in melanoma outcome in these populations," researchers wrote.

An editorial on the study in the same issue of Dermatology said, "It is important for physicians, researchers and the general public to realize that disparities are not inevitable. All population groups deserve equal access, equal care and an equal opportunity to enjoy good health."