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Original Article

Features of Skin Cancer in Black Individuals: A Single-Institution Retrospective Cohort Study

Author Affiliation(s)

Abstract

Background: Minimal knowledge exists regarding skin cancers in Black individuals, which may adversely affect patient care.


Objectives: To describe clinical features and risk factors of skin cancers in Black individuals.  


Methods: Retrospective study of Black individuals diagnosed with skin cancer between January 2000 and January 2020 at our institution.


Results: 38,589 patients were diagnosed with skin cancer, of which 165 were Black.  One-hundred-thirteen of these Black individuals were diagnosed with melanoma, 35 with squamous cell carcinoma (SCC), and 17 with basal cell carcinoma (BCC). Most melanomas (80.0%, n=90) were of the acral subtype; 75% (6 of 8 cases with dermoscopic images) displayed a parallel ridge pattern (PRP). The surrounding uninvolved background skin was visible in 7 cases, all demonstrating a PRP. This disappeared adjacent to most of the melanoma lesions (n=4, 57.1%) – creating a peripheral hypopigmented “halo”. The nonmelanoma skin cancers were pigmented and had similar dermoscopic features as reported in predominantly white populations. Most SCCs (n=5, 71.4%) had a hypopigmented “halo” and most BCCs (n=10, 55.6%) had an accentuated reticular network adjacent to the lesions. Most (80.0%, n=28) SCC patients had a chronic inflammatory condition. Two BCC patients (16.7%) had Gorlin syndrome.


Conclusions: Skin cancers are pigmented in Black individuals. In both ALMs and SCCs, we noted a peripheral rim of hypopigmentation between the lesions and the surrounding uninvolved background skin, while BCCs had accentuation of the background pigmentation adjacent to the lesions. Most acral melanomas displayed a PRP, which was also seen in surrounding uninvolved background skin.  

Keywords : skin cancer, basal cell carcinoma, squamous cell carcinoma, melanoma, skin of color, ethnic skin, dermoscopy

References

1. Gordon R. Skin cancer: an overview of epidemiology and risk factors. Semin Oncol Nurs 2013; 29(3):160-169. 2. Gloster HM Jr, Neal K. Skin cancer in skin of color. J Am Acad Dermatol 2006; 55(5):741-764. 3. Buster KJ, Stevens EI, Eelmets CA. Dermatologic health disparities. Dermatol Clin 2012; 30(1):53-viii. 4. Lawson CN, Hollinger J, Sethi S, et al. Updates in the understanding and treatments of skin and hair disorders in women of color. Int J Womens Dermatol 2017; 3(1 Suppl):S12-S37. 5. Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis 2007; 80(5):387-394. 6. Hogue L, Harvey VM. Basal Cell Carcinoma, Squamous Cell Carcinoma, and Cutaneous Melanoma in Skin of Color Patients. Dermatol Clin 2019; 37(4):519-526. 7. Ezenwa E, Stein JA, Krueger L. Dermoscopic features of neoplasms in skin of color: A review. Int J Women Dermatol 2021. 8. Kato J, Horimoto K, Sato S, Minowa T, Uhara H. Dermoscopy of Melanoma and Non-melanoma Skin Cancers. Front Med (Lausanne) 2019; 6:180. 9. dermoscopedia contributors – Ash Marghoob, Natalia Jaimes. Basal cell carcinoma. dermoscopedia. June 8, 2019, 11:10 UTC. Available at: https://dermoscopedia.org/w/index.php?title=Basal_cell_carcinoma&oldid=16531. Accessed January 25, 2021. 10. dermoscopedia contributors - Florentina Dimitriou, Theresa Deinlein, Iris Zalaudek. Squamous cell carcinoma. dermoscopedia. November 27, 2020, 17:18 UTC. Available at: https://dermoscopedia.org/w/index.php?title=Squamous_cell_carcinoma&oldid=17536. Accessed January 25, 2021. 11. dermoscopedia contributors – Luc Thomas, Amelie Boespflug. SCC. dermoscopedia. September 19, 2018, 10:32 UTC. Available at: https://dermoscopedia.org/w/index.php?title=SCC&oldid=13642. Accessed January 12, 2021 12. Lallas A, Kyrgidis A, Koga H, et al. The BRAAFF checklist: a new dermoscopic algorithm for diagnosing acral melanoma. Br J Dermatol 2015; 173(4):1041-1049. 13. Starace M, Alessandrini A, Brandi N, Piraccini BM. Use of Nail Dermoscopy in the Management of Melanonychia: Review. Dermatol Pract Concept 2019; 9(1):38-43. 14. Elder DE, Bastian BC, Cree IA, et al. The 2018 World Health Organization Classification of Cutaneous, Mucosal, and Uveal Melanoma: Detailed Analysis of 9 Distinct Subtypes Defined by Their Evolutionary Pathway. Arch Pathol Lab Med 2020; 144(4):500-522. 15. Manuel JI. Racial/Ethnic and Gender Disparities in Health Care Use and Access. Health Serv Res 2018; 53(3):1407-1429. 16. Halder RM, Bridgeman-Shah S. Skin cancer in African Americans. Cancer 1995; 75(2 Suppl):667-673. 17. Agbai ON, Buster K, Sanchez M, et al. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol 2014; 70(4):748-762. 18. Cormier JN, Xing Y, Ding M, et al. Ethnic differences among patients with cutaneous melanoma. Arch Intern Med 2006; 166(17):1907-1914. 19. Mahendraraj K, Sidhu K, Lau CSM, et al. Malignant Melanoma in African-Americans: A Population-Based Clinical Outcomes Study Involving 1106 African-American Patients from the Surveillance, Epidemiology, and End Result (SEER) Database (1988-2011). Medicine (Baltimore) 2017; 96(15):e6258. 20. Lopes FCPS, Sleiman MG, Sebastian K, et al. UV Exposure and the Risk of Cutaneous Melanoma in Skin of Color: A Systematic Review. JAMA Dermatol 2021; 157(2):213–219. 21. Whiteman DC, Pavan WJ, Bastian BC. The melanomas: a synthesis of epidemiological, clinical, histopathological, genetic, and biological aspects, supporting distinct subtypes, causal pathways, and cells of origin. Pigment Cell Melanoma Res 2011; 24(5):879-897. 22. Hayward N, Wilmott J, Waddell N, et al. Whole-genome landscapes of major melanoma subtypes. Nature 2017; 545(7653):175-180. 23. Coleman WP 3rd, Gately LE 3rd, Krementz AB, et al. Nevi, lentigines, and melanomas in blacks. Arch Dermatol 1980; 116(5):548-551. 24. Lewis MG. Malignant melanoma in Uganda. (The relationship between pigmentation and malignant melanoma on the soles of the feet). Br J Cancer 1967; 21(3):483-495. 25. Palicka GA, Rhodes AR. Acral Melanocytic Nevi: Prevalence and Distribution of Gross Morphologic Features in White and Black Adults. Arch Dermatol 2010; 146(10):1085–1094. 26. Phan A, Dalle S, Touzet S, et al. Dermoscopic features of acral lentiginous melanoma in a large series of 110 cases in a white population. Br J Dermatol 2010; 162(4):765-771. 27. Phan A, Dalle S, Marcilly M, et al. Benign Dermoscopic Parallel Ridge Pattern Variants. Arch Dermatol 2011; 147(5):634. 28. Saida T, Miyazaki A, Oguchi S, et al. Significance of Dermoscopic Patterns in Detecting Malignant Melanoma on Acral Volar Skin: Results of a Multicenter Study in Japan. Arch Dermatol 2004; 140(10):1233–1238. 29. Ishihara Y, Saida T, Miyazaki A, et al. Early acral melanoma in situ: correlation between the parallel ridge pattern on dermoscopy and microscopic features. Am J Dermatopathol 2006; 28(1):21-27. 30. Ruben BS. Pigmented lesions of the nail unit: clinical and histopathologic features. Semin Cutan Med Surg 2010; 29(3):148-158. 31. Bradford PT. Skin cancer in skin of color. Dermatol Nurs 2009; 21(4):170-178. 32. Alam M, Ratner D. Cutaneous squamous-cell carcinoma. N Engl J Med 2001; 344(13):975-983. 33. Morais PM, Schettini APM, Rocha JA, Silva Júnior RCD. Pigmented squamous cell carcinoma: case report and importance of differential diagnosis. An Bras Dermatol 2018; 93(1):96-98. 34. Gupta R, Gordon SL, Council ML, Hurst EA. Clinical Characteristics of Basal Cell Carcinoma in African Americans: A 10-Year Retrospective Review at a Single Academic Institution. Dermatol Surg 2019; 45(5):660-665. 35. Beckenstein MS, Windle BH. Basal cell carcinoma in black patients: the need to include it in the differential diagnosis. Ann Plast Surg 1995; 35(5):546-548. 36. Nouri K. Skin cancer. New York, NY, USA: McGraw-Hill Medical; 2008. 37. Kelati A, Aqil N, Baybay H, Gallouj S, Mernissi FZ. Beyond classic dermoscopic patterns of dermatofibromas: a prospective research study. J Med Case Rep 2017; 11(1):266.

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