The Pink Elephant Lady
An Aggressive Form of Skin Cancer that Affects People of Color
Reggae musician Bob Marley died in 1981 at age 36 from acral lentiginous melanoma (ALM), an aggressive form of skin cancer that disproportionately affects people of color. His cancer was initially thought to have been a soccer bruise under his toenail. Although people of color are less likely to get skin cancer, they are more likely to die from it. Many people of color have the misconception that they are immune to skin cancer, but skin cancer can occur in all populations regardless of skin color.
Studies show that people of color receive little or no education from their doctors concerning the risks and prevention of the disease. Lack of awareness, diagnosis at a more advanced stage, and socioeconomic barriers that hinder access to care contribute to the fact that the 5-year skin cancer survival rate for the non-white population is 70%, but 92% for whites.
Skin cancer can be more difficult to detect in blacks, Asians, Filipinos, Indonesians and native Hawaiians because 60 to 75 percent of tumors arise on areas of the less pigmented skin that are not usually exposed to the sun, like soles of the feet. ALM more commonly occurs on the feet than on the hands, and appears on non-hair bearing areas of the body and in mucous membranes (like the mouth). Lesions or dark spots can go unnoticed or misdiagnosed as warts, fungus or dark nail.
The higher amount of epidermal melanin in people of color filters at least twice as much UV radiation as the epidermis of whites. Although UV light, along with heredity, plays a role in melanoma in whites, the primary risk factor for melanoma in people of color is undetermined. Determined risk factors for melanoma in people of color include albinism, burn scars, radiation therapy, trauma, a suppressed immune system, and preexisting moles.
“It’s true that the vast majority of melanomas occur in fair-skinned people, but it’s important to know that dark-skinned people can get skin cancer, too,’’ says Maral Skelsey, a surgeon and skin cancer specialist who heads the Georgetown University Medical Center’s dermatologic surgery center. “Your physician shouldn’t dismiss you just because you are black if you have any new or changing skin lesions on your body, especially nail changes,’’ Skelsey says. “If somebody has a wide, dark streak under a nail or on the edge of the skin where it meets the nail, it is very important to have it evaluated, especially if it is something that persists and is wide and solitary.’’
According to the Skin of Color Society, any suspicious, changing, or new mole or freckle anywhere on your skin should be evaluated by your dermatologist, and any pigmented lesion that looks different than the majority of one’s moles and freckles (i.e., an ‘ugly duckling’) should be evaluated. However, because many melanomas on dark skin are found on poorly visible areas, you should do a monthly self-skin examination. It can be helpful to have a spouse or partner assist in examining hard to see and/or hard to reach areas of the body.
An easy way to remember the signs of melanoma is by the ABCDEs:
A ‐ Asymmetry. Pigmented lesions should look the same on both sides when folded in half.
B ‐ Border irregularity. The borders should be smooth and regular–usually round or oval in shape.
C ‐ Color variation. The lack of uniform and even color.
D ‐ Diameter. Size of greater than 6mm or about the size of a pencil eraser.
E ‐ Evolving. Any change (including size, shape, color) in an existing mole or skin lesion
Because there is a higher incidence of melanoma in a fingernail or toenail in people of color (subungual melanoma), the “alphabet of nail melanoma” is a useful guide for self-examinations:
A – Age range 20-90 years
African-American, Native American, or Asian
B – Band of Brown or Black pigment in nail OR
Breadth of >3mm OR
Border that is irregular/blurred
C – Change in size or growth rate of nail band OR
lack of Change in irregular nail despite treatment
D – Digit involved (nail melanoma is most common in the thumb>big toe>index finger)
Pigmented band on a single Digit is more suspicious
Dominant hand involvement is more common
E – Extension of brown or black pigment to the side or base of the nail
F – Family or personal history of melanoma or irregular moles
Side note: Please, please, please DO NOT self-treat skin cancer with frankincense oil! This is a DANGEROUS myth being perpetrated by irresponsible essential oil peddlers, most commonly the MLM (multi-level marketing) companies. If you have a suspicious skin growth, see a licensed health care professional, not an 'independent consultant'. For more information about the frankincense oil and cancer myth, click here: http://tisserandinstitute.org/frankincense-oil-and-cancer-in-perspective/
Skin of Color Society: http://skinofcolorsociety.org/dermatology-education/melanoma/
The Washington Post: https://www.washingtonpost.com/national/health-science/many-blacks-are-unaware-of-a-skin-cancerthat-primarily-affects-dark-skinned-people/2014/08/04/14164ada-e68a-11e3-afc6-a1dd9407abcf_story.html?noredirect=on&utm_term=.d1a657b7ff9f
American Academy of Dermatology: https://www.aad.org/public/diseases/skin-cancer/skin-cancer-in-people-of-color
National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454668/