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dear doctor

Does Dark Skin Protect Against Skin Cancer?

Not at all, but education and sunscreen do!

Photo credit: Getty Images

Q: I’ve heard that people like me with darker skin don’t need to use sunscreen because it’s naturally protected from the sun. Does that mean I have no risk of skin cancer and I can skip sunscreen?

Sincerely,

"Lovely Melanin"

Dear Lovely Melanin:

I’m so glad you asked because this is 100 percent false. I work in Queens and Long Island where we have a very diverse population and I treat skin cancer in every race. Not infrequently, people with skin of color believe that they are not at risk for developing skin cancer because often skin care ads and images of skin cancer feature light skin.

Melanin is essentially a chemical shield in the skin to protect against DNA damage from ultraviolet sun rays. The more melanin you have, the more your skin is protected from ultraviolet light. For example, light skin has a sun protective factor, or SPF, of about 3, whereas very dark skin has an intrinsic SPF of about 13. However, these values are not sufficient. Even lots of melanin doesn’t block all of the sun's damaging rays. Any skin type can get sunburned. People with dark skin, however, tend to think that sunburns and skin cancer risks don’t apply to them. In fact, one survey found that African-Americans who have gotten sunburned still tended to not use sunscreen in the future. Any sunburn, however, indicates the presence of DNA damage due to ultraviolet light.  Every sunburn increases your risk for both non-melanoma and melanoma skin cancer.

There are three common types of skin cancerbasal cell carcinoma is the most common skin cancer in the United States in all populations except African-Americans. Squamous cell carcinoma and melanoma are found in all skin types and have the potential to be fatal.

When people with dark skin, such as African-Americans, develop melanoma, they tend to occur in areas that are not often exposed to the sun such as mucosal sites, like the inside of the mouth, or on the hands, feet or nails.  Most people don’t examine the bottom of their feet or the insides of their mouths, which is one reason why people with darker skin may be diagnosed with more advanced melanoma. Melanoma in these sites are due to causes other than ultraviolet radiation and may in part have a genetic component.

How do you look for signs of skin cancer? We recommend performing a self-skin check from head to toe once per month. Look at the bottoms of your feet, your legs, groin, even your buttocks. Look at your head (not forgetting the scalp), neck, and hands, including your palms. Look for dark lines on or around your fingernails. Have someone help you examine hard-to-see places, or use a mirror to do it yourself. Unusual lesions may be asymmetric or multicolored. Look for lesions that are bleeding, growing, irregularly shaped, or changing in any way. Sores that don’t seem to be healing, or that have healed and returned, could also be signs of skin cancer.

The bottom line: People of all skin colors are at risk for developing skin cancer. Perform monthly skin checks and have a dermatologist do a head-to-toe skin exam every year if you have a history of sunburns.

The good news is that prevention and early diagnosis helps! Keep an eye out for unusual skin changes and use sunscreen and sun protective clothing every day. When selecting a sunscreen, choose one with an SPF of at least 30—it blocks 97 percent of the sun’s damaging rays.  Sunscreen ingredients matter: You want a sunscreen in which at least one ingredient is a physical blocker, specifically zinc oxide or titanium dioxide, in order to provide immediate and broad-spectrum coverage. Sunscreens with chemical blockers such as avobenzone are effective, but can take 15 to 20 minutes to become active after application, which will leave your skin unprotected for a period of time if you are already out in the sun.

Since no sunscreen will provide 100 percent protection, remember to wear sun protective clothing such as sunglasses and hats! It’s also a good idea to minimize time outside during peak UV hours, usually between 10am and 4pm.

“When you see skin care ads or images of skin cancer, it's usually on light skin. So darker skinned people don't realize that they, too, are at risk.”
Dr. Victoria Sharon, Dermatologist
Dr. Victoria Sharon, Dermatologist | Photo credit: Donna Alberico/The Well

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Published May 22nd, 2018