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SUMMARY
The incidence and prevalence of nonmelanoma skin cancer (NMSC) in non-White people are likely to continue to increase because of environmental changes and prolonged life expectancy.
Atypical clinical presentations of NMSC in non-White people is one of the key factors for worse outcomes and higher morbidity and mortality.
Raising public awareness for skin cancer prevention strategies for all people, regardless of their ethnic background or socioeconomic status, is important for timely diagnosis and treatment.
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DON’T FORGET
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CLINICAL PEARLS
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PATIENT EDUCATION POINTS
Increased awareness of the importance of self-skin examinations would significantly reduce the rate of delayed diagnosis and advanced stage at presentation.
Sun avoidance during the high-intensity hours of 10:00 a.m. to 4:00 p.m. and the use of daily broad-spectrum sunblock of at least sun protection factor 30 should be encouraged in patients of all skin colors.
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KEY PHRASES AND ABBREVIATIONS
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Non-White people, also called people of color, are individuals of Asian, Hispanic/Latino, African, Pacific Island descent, and mixtures thereof.
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Nonmelanoma skin cancers (NMSC) include keratinocyte carcinoma (KC), basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). Other less common types of NMSC are Merkel cell carcinoma (MCC), microcystic adnexal carcinoma (MAC), dermatofibrosarcoma protuberans (DFSP), Kaposi sarcoma (KS), and cutaneous lymphoma (CL).
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The color of skin in humans is primarily determined by the presence of melanin. Dark skin has larger melanocytes that produce more melanin, which protects the deeper layers of the skin from the harmful effects of the sun.1 Human skin is repeatedly exposed to ultraviolet (UV) radiation, which influences the function and survival of many cell types and is regarded as the main causative factor of skin cancer.2 Ionizing radiation, pollutants, chemicals, and occupational exposures are also linked to skin cancer.3 The superior photoprotection in non-White people is related to the packaging and distribution of melanosomes, which are distributed individually in keratinocytes rather than in aggregates. It is estimated that the epidermis of dark skin has an intrinsic sun-protection factor (SPF) of 13.4, whereas light skin has an SPF of 3.3.1,4 The increased melanin and more dispersed melanosomes appear to absorb and deflect UV light more efficiently, conferring significant photoprotection to skin.5 A higher amount of epidermal melanin in non-White people filters at least twice as much UV radiation as the epidermis of White people.6,7 This is the reason that White people are the primary victims of skin cancer8,9 and the incidence of skin cancer is lower in non-White people.2
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Although some non-White ...