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One Woman’s Story Highlights the Hidden Skin Cancer Risks for People of Color

7/13/2015

Yahoo! Health

By Grace Gold
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While Caucasians are more likely to be diagnosed with skin cancer, only 16 percent of cases involve advanced-stage cancer. In comparison, 52 percent of African-Americans and 26 percent of Hispanic patients are diagnosed with late stage cases. (Photo: Getty Images/Brand X Pictures)

When Jacqueline Smith discovered an almond-sized lump on her bikini line, the concerned college senior went to her campus health center to find out what it could be.

There, she was told not to worry — it was simply an inflamed hair follicle. But Jacqueline couldn’t shake the feeling that the firm, unmoving lump was something more serious. After graduation, she headed back home to Hackensack, New Jersey, and saw her family’s primary care physician for a second opinion. He referred her to a surgical oncologist, who biopsied the site and had dire news: Jacqueline had skin cancer, a stage IIIC melanoma that had metastasized and was just a whisper shy of slipping into stage IV cancer.

A shocking diagnosis for anyone to handle, Jacqueline was especially incredulous: she was a young African American woman with no family history of skin cancer, and had never engaged in behaviors like tanning that studies show correlate with a higher risk. “I was totally shocked by the diagnosis – my first thought was, ‘Melanoma is the deadly skin cancer’ – I never had a reason for it to be on my radar, and never thought I had to prevent it,” Jacqueline tells Yahoo Health. ”I had always heard melanoma was a risk for fair-skinned, middle-aged Caucasian women.”

Jacqueline, who’s now working as the regional assistant for New York Senator Kirsten Gillibrand, had the cancerous lymph nodes removed when she was just 21 years old. Young age and otherwise good health appeared to be on her side when subsequent scans showed no evidence of cancer, and doctors declared her clear to go on with life. Jacqueline excitedly began her first semester of a PhD program in sociology.

Then it happened again six years later, when she was still only 27 years old: another lump emerged in the same area of her bikini line. Jacqueline visited the gynecologist at her university’s health center, who said it was just an inflamed lymph node. “If it doesn’t bother you, don’t bother it,” advised the physician.
This time, Jacqueline wasted no time in seeking a second opinion. A needle biopsy confirmed the dreaded: stage III melanoma had returned. “Even though it was my second diagnosis, I was shocked all over again. My doctor told me, ‘It will be a miracle if you survive another five years,’” shares Jacqueline.

The Hidden Skin Cancer Risks for People of Color

Perhaps even more surprising is that Jacqueline’s case isn’t an anomaly. While Caucasians are more likely to be diagnosed with skin cancer, only 16 percent of cases involve advanced-stage cancer. In comparison, 52 percent of African-Americans and 26 percent of Hispanic patients are diagnosed with late stage cases, according to the Skin Cancer Foundation.

The initial site of Jacqueline’s melanoma has never been determined. People of color are more likely to be diagnosed with melanoma in unusual areas like the between the toes, under the nails, behind the ears, on the palms of hands and soles of feet, inside the lips, and between the buttock cheeks. Melanoma can even develop in the eyes, in the lungs, in the gastrointestinal tract, and in the membrane known as the meninges that covers the brain and spinal cord.
“While we know UV light plays a role in melanomas found on Caucasian skin, the primary risk factors for melanoma in people with skin of color has yet to be determined,” New York dermatologist Whitney Bowe, MD, tells Yahoo Health. “That’s why patients with darker skin may get melanomas in areas that we don’t commonly associate with sun exposure.”

This time around for Jacqueline, driving the cancer back into remission was grueling. She had all of her pelvic lymph nodes removed, and underwent Interferon drug treatment and radiation over the course of a year that had her coping with painful open wound burns. While she finally did achieve remission, Jacqueline was left with lymphedema in one leg, a permanent severe swelling that is caused by lymphatic system blockage. “I keep the lymphedema in perspective – I have two legs that still work and I have my health, yet it’s difficult being young and having so many restrictions. Once upon a time, just being able to choose my shoes was something I took for granted – now, I can’t fit into most regular shoes,” she explains.

Lymphedema, which Jacqueline cites as her greatest survivor challenge, is a risk associated with lymph node removal after melanoma and breast cancer surgeries. “The risk of developing lymphedema is dependent upon the number of lymph nodes removed – so if melanoma is diagnosed early, there may be no lymph node dissection at all, and therefore no risk of lymphedema, says Deborah Lindquist, MD, an oncologist with Arizona Oncology, a practice in The US Oncology Network. Lindquist adds that a drug to treat the chronic condition is currently in clinical trials, and may be available to the public in the near future.
According to the Skin Cancer Foundation, Hispanics account for the highest amount of new skin cancer cases among people of color. “Melanoma incidence is increasing rapidly in Latinos, who are outpacing African-Americans likely due to more tanning bed usage,” explains New Jersey dermatologist Jeanine B. Downie, MD.

Experts recommend wearing sunscreen with an SPF of 30 or higher as the best way to prevent skin cancer and melanoma in people of any color. Jacqueline now follows the advice religiously; she always has sunscreen in her bag (favorites include sprays by Neutrogena like CoolDry Sport Sunscreen Spray and Ultra Sheer Body Mist), as she finds the spray formulas absorb without the chalkiness of other more traditional formulas. “Please don’t think you don’t need sunscreen because your skin color is natural protectant from the sun – anyone with skin is at risk for developing melanoma,” she warns.

Most importantly, experts say to get familiar with your skin, so that you notice any changes to new or existing spots and moles. Melanoma is virtually always curable if detected early. “If the mole is multi-colored, very dark, growing rapidly in size, painful, or stands out as totally different from your other moles, have a dermatologist check it out,” says Downie.

Have an annual skin checkup with your dermatologist to assess new and old spots, and if you’ve previously had pre-cancerous or cancerous lesions, you should go even more regularly, every six months. When visiting other doctors like your ophthalmologist and gynecologist, have them check for any unusual signs that you can’t see – as well as your hair stylist, whom experts say is often your very first line of defense against skin cancer on the scalp.

In fact, New York hair stylist Roman Kusayev of the Roman K Salon recently detected a melanoma on a regular Latina client’s scalp while applying hair color. “I noticed a suspicious slightly red spot on her scalp that clearly wasn’t a wound or scab. I didn’t want to scare her, but I knew I had the responsibility to bring it to her attention,” Kusayev tells Yahoo Health.

The client soon made an appointment with her dermatologist, who diagnosed the lesion as skin cancer. Fortunately, the early detection made for routine removal. Hairstyles like tightly parted ponytails and tight braids can leave the scalp vulnerable to the sun’s UV rays. Experts recommend wearing a hat or brushing hair back when out in the sun so as not to harshly part and expose swaths of scalp to UV rays.

If you do see something pop up that gives you a funny feeling, Jacqueline says to always trust your instinct. “It’s important to be your own health advocate. I didn’t stop harassing doctors until I definitively found out what was wrong and that is what saved my life.”

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