WS Chronicle

By David Winship 

May is Skin Cancer Awareness Month and the American Academy of Dermatologists is shining the spotlight on the most common cancer in the United States – skin cancer.  

Melanoma, a type of skin cancer, is often called the “most serious skin cancer” because it can spread from the skin to other parts of the body. It’s estimated that every day about 9,500 people in the United States are diagnosed with this cancer. 

Many of These Skin Cancers Could be Prevented 

Prevention is a matter of protection, detection and treatment.  

Black people are less likely to develop melanoma than non-Hispanic white people due to the protection that melanin, the body’s natural skin pigment, provides from damaging ultraviolet rays. However, Black people who do develop the cancer have a much lower five-year survival rate.  

Detection of skin cancer is very important in the melaninated population – those with African heritage – because the appearance of skin cancer is not readily apparent and not often recognized. While those with darker skin have less occurrence of melanoma, it often is not recognized early, and it often goes untreated. Several factors lead to this. The appearance of the cancerous lesion may be obscured, because the discoloration caused by cancer is not as noticeable. 

There may be less attention from dermatologists. Additionally, the health care coverage for specialists may be unaffordable.  

According to Loren Krueger, MD, an assistant professor of dermatology at Emory University School of Medicine in Atlanta, Georgia, “We have a unique responsibility to understand how skin color and ethnicity play into diagnosis.” 

Part of the issue is that melanoma in Black patients often presents as a melanoma (ALM), which is found on the palms, soles of the feet, or beneath the nails, as opposed to parts of the skin that are more exposed to sunlight, as is more commonly seen in lighter skin tones, Krueger says. 

What are the warning signs? 

Attention to the warning signs of melanoma is made easier by an easy-to-remember memory aid. The ABCDE guideline highlight the changes on the skin. All of these are visual indicators that the skin lesion needs to be examined by a dermatologist. 

The signs they point to are as: 

*Asymmetry: Watch for an irregular, or asymmetric, shape in a discolored patch on the skin; 

*Border: Check if the border of the discoloration is hard to distinguish and has irregular edges; 

*Color: See if there are multiple colors on a mole; 

*Diameter: Measure to see if the diameter of the mole is about a quarter-inch, or bigger than a pencil eraser; 

*Evolution: Observe if there is an increase in size, or if there is a change in shape or color.  

How can UV exposure be prevented? 

There are preventive measures which can be taken to minimize the risk of skin cancers. Removing these risk factors can be done by changing lifestyle, fashion style, and minimizing exposure to harmful Ultraviolet (UV) rays of the sun. Protecting your skin from UV radiation is the simplest way to reduce the risk of skin cancer. 

Another memory aid to consider in melanoma prevention involves the 5 Ss: SLIP, SLOP, SLAP, SEEK, AND SLIDE.  

*SLIP into clothing which is UV resistant. Consider the clothing’s style, fabric, color and UPF rating. Any fabric rated above UPF15 provides good protection against UV radiation. Shirts with collars or high necks and sleeves protect the exposed skin. 

*Pants or longer shorts and skirts below the knees provide protection for the lower part of the body. Clothing that is loose rather than tight across the skin is better.  

*SLOP: Apply sunscreen. Sunscreen reduces the amount of UV radiation reaching your skin by providing a barrier to absorb or filter UV rays away from your skin. The best sunscreen is one that you will use. Choose sunscreen that is SPF50 or higher, broad-spectrum and water-resistant. Apply sunscreen 20-30 minutes before going out into the sun to allow it time to seep into the skin; otherwise, the effect is negligible. 

*SLAP: #Bring Back the Brim! Whether fedora, Panama, cowboy or safari, hats are cool and we’re seeing more musicians wearing them, such as Keb’Mo, Dom Flemons, Willie Nelson, and LL Cool J. Putting a brimmed hat on your head, one that shades the whole face, including the ears, is a sun-smart hat that is a simple, effective way to protect your face, head, neck and ears from UV radiation. Wear a wide-brimmed hat to protect the face, neck and ears. The ears are particularly vulnerable for men, who often have shorter hair which does not cover the tops of the ears. Caps, with the bill in front, may provide some shade for the face, but the ears are left exposed. The ears, temples, lips and nose are among the most common parts of the body for skin cancers to develop. UV radiation can also cause permanent damage to your eyes and a sun smart hat can reduce the amount of UV radiation reaching your eyes by 50%.  

*SEEK: Looking for shade is a good way to block the UV rays and is one of the easiest ways to protect against UV radiation. Good-quality shade can reduce UV exposure by up to 75%. Shade can be natural or built.  

*SLIDE: Sliding some sunglasses on will protect your eyes from UV radiation. Sunglasses don’t have to be expensive to be effective, but some cheaper fashion sunglasses don’t provide sun protection. Some sunglasses are marked with an Eye Protection Factor (EPF). An EPF of 9 or 10 provides excellent protection, blocking almost all UV radiation. UV radiation can cause short-term eye problems, such as excessive blinking, swelling and difficulty looking at strong light. Over time, exposure to UV can cause serious or permanent eye damage, including cataracts, keratopathy or corneal cloudiness, and melanomas of the eyelids or around the eyes. 

Regular Skin Checks by a Dermatologist 

As a dermatologist practicing in Detroit, Michigan, a city where the population is more than 80% people of color, Meena Moossavi, MD, has seen how health inequities have disproportionately harmed her patients. At times, her patients of color have come to her with late-stage skin cancer that she believes may have been better treated if it had been detected earlier. 

Because of a lack of awareness of the risks of skin cancer among Black people and clinicians’ lack of experience diagnosing skin conditions in people with darker skin, melanoma for Black patients can go untreated far longer than when it’s identified for white patients, Moossavi explains, “The patients have to understand they are at risk so they can come to the doctor. The providers need to know what to look for so they can diagnose as soon as possible.” 

Free Skin Care Check on May 9 

Dermatologists at Atrium Health Wake Forest Baptist will offer free skin cancer screenings to the public on Thursday, May 9, from 5:30-7:30 p.m. at Dermatology – Country Club, located at 4618 Country Club Road, in Winston-Salem.  

No insurance or appointment is required, and anyone can receive either a spot check or a more thorough screening for skin cancer.  

In a press release about the event, Dr. Lindsay Strowd, dermatologist at Atrium Health Wake Forest Baptist and associate professor and interim chair of dermatology at Wake Forest University School of Medicine, said, “This is a great opportunity, especially if you have never had a skin screening or if it’s been some time since your last exam. In past screenings we have identified many skin cancers, along with abnormal moles and pre-cancerous spots.  

“This is a great way to make sure your skin is healthy and give you piece of mind before heading into summer.”