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Skin cancer: No one is immune

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Dr. Mona Gohara, a skin cancer expert at Yale New Haven Hospital, says people of color need to know three important facts:

• No one is immune to skin cancer.

• Ethnicity does not give any protection against skin cancer; melanin does.

• Everyone is vulnerable; everyone should use sunscreen every day.

No one is immune.

Skin cancer rates among whites in the U.S. are higher than they are for people of color, including Native Americans and Alaska Natives, African Americans, Hispanics and Asian Indians. For example, the Centers for Disease Control finds melanoma (the deadliest form of skin cancer) occurs in whites at a rate of 25.5 people per 100,000. In Native Americans and Alaska Natives, it occurs at a rate of 4.6 people per 100,000.

But that’s not the whole story.

The CDC reports that in 2005, the most recent statistics are available for, “50,589 whites, 1,122 Hispanics, 261 African Americans, 159 Asian/Pacific Islanders, and 95 American Indians/Alaska Natives in the United States were diagnosed with melanomas of the skin.”

More than 21 percent of AI/AN with the disease died of it, compared with 8,146, or 16 percent, of whites. This can be a little misleading. The 20 Native Americans who died in 2005 were not all from the group of 95 that was diagnosed in 2005. But these numbers do make the point: A significantly higher percentage of AI/AN than whites diagnosed with melanoma die of the disease.

Ethnicity does not give any protection against skin cancer; melanin does.

Melanin is a compound that exists in human skin and a few other organs. In the skin, melanin is a pigment that determines skin color. On one end of the spectrum, an albino, a person with little or no melanin, has extremely light skin, while on the other hand a person with lots of melanin has very dark skin. Melanin offers some protection from the UV radiation in sunlight that causes cancer, which is why darker-skinned people have a lower rate of skin cancer than lighter-skinned people.

The degree of protection the melanin in a person’s skin offers is dependent on how much melanin there is. A light-skinned Native American has just as much risk for skin cancer as a white person does.

So, the statistics cited change. The rate of the disease will be about the same for whites and for light-skinned Native Americans. Whether the morbidity rate changes is not known. Morbidity depends on factors other than skin tone, and ethnicity and related socioeconomic factors – in terms of Native Americans’ access to health care compared with whites’ access – could be among them. There is not much research that treats AI/ANs as a separate group. Some of what is thought to be true about Native Americans and skin cancer is not proven; it is extrapolated from what we know about other groups, such as blacks and Hispanics.

Everyone is vulnerable; everyone should use sunscreen, every day.

And people without access to regular medical care are more vulnerable than others, whether you are talking about skin cancer, other cancers, or myriad diseases such as atherosclerosis, stomach ulcers, complications of common diseases such as the flu, or diabetes. The increased morbidity among AI/ANs with melanoma is directly attributable to late diagnosis and treatment because of irregular (or no) health screenings and the fact that neither doctors nor patients are looking for the symptoms of the disease.

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Gohara gives many suggestions for protecting oneself and one’s family from skin cancer.

Basal cell carcinoma is the most common type of skin cancer, and it’s directly linked to exposure to sunlight. “The correlation between UV light and basal cell carcinoma in darker skin types explains the relatively high incidence of this malignancy among darker-skinned populations living in summer climates, such as Hispanics residing in New Mexico and Arizona,” reads an excerpt from the Skin Cancer Foundation’s Web site. And of course, light-skinned people, Native or not, in those climates are even more susceptible.

This is where sunscreen comes in; everyone – every day.

Squamous cell carcinoma is directly linked to sun exposure in light-skinned people. For people with darker skin, the main correlation appears to be with other kinds of damage to the skin – scarring, chronic inflammation, such as discoid lupus, burn scars and skin ulcerations that do not heal. Skin cancer that develops in relation to these factors seems to be more aggressive than those caused by sunlight.

Melanoma is the deadliest form of skin cancer, and the least is known about how and why it develops. In people of color, melanoma is most likely to appear in the mouth, the palms of the hands, the soles of the feet or under the nails. According to the Skin Cancer Foundation, “Other reported risk factors for melanoma in minority populations include: albinism, burn scars, radiation therapy, trauma, immunosuppression, and preexisting moles (especially on the palms/soles and mouth.)” People who are solid organ transplant recipients and those with HIV are also at higher risk for skin cancer because their immune systems are compromised.

For these types of skin cancer, Gohara recommends people seek out free skin cancer screenings, such as those offered through the Skin Cancer Foundation, the American Academy of Dermatology, hospitals and clinics around the country, companies that manufacture skin care products such as Aveeno and Olay, and tribal, local and county health departments.

She also urges people to complete a monthly self-check for skin cancer. Look for lesions or ulcers that are oozing, crusting over, or not healing, and for moles. She suggests following the ABCDE regime to check moles:

• A – Asymmetry. Look for asymmetric moles (moles that are not the same on either side).

• B – Borders. Look for irregular or jagged borders.

• C – Color. Look for moles that are different colors or that change color.

• D – Diameter. Look to see if the mole is larger than a pencil eraser.

• E – Evolving. Look to see if the mole has changed in any way since the last time you checked.

If you see any of these symptoms, see a doctor; now. And be sure to check your kids, who can get all three types of skin cancer.