Brykyta Shelton found herself standing at the checkout counter of a major retailer, feeling uncomfortable when a woman in front of her stared at her sandal-clad feet.
Shelton has been on medication for months because her doctor said it was toenail fungus, but one nail still looks nasty.
After Sheldon completed her purchase, the woman pulled her aside and said that while she was not a doctor, she thought Sheldon was dealing with something more serious than fungus.
“She was like: ‘I know I’m just a random stranger, but please let someone else check,'” said Shelton, who lives in suburban Washington, D.C., Maryland
Sheldon, 42, accepted the advice.
Initial lab work did not give a definitive diagnosis, but her new doctor said he was sure she had acral melanoma, a type of skin cancer. Additional tests proved him right. Although rare, it is the most common subtype of melanoma in blacks like Shelton. It’s the disease that killed reggae star Bob Marley at age 36, and it’s most common on skin that’s less exposed to the sun, such as the hands, soles and under nails. Researchers don’t know what causes acral melanoma or how to prevent it. It is often overlooked or misdiagnosed during skin exams.
In general, skin cancer is often missed or misdiagnosed in black patients.
Historically, black people and people with skin cancer with dark skin have been excluded from efforts to fight skin cancer. Long ignored by sunscreen makers and a medical community that lags behind in diversity and cultural competence – acknowledging the traditions, beliefs and values of patients – many are not told sunscreen safety or how to check their skin for damage or cancer signs.
To be sure, dark-skinned people are less likely to develop skin cancer. The incidence of melanoma in whites is more than 20 times that of African Americans, and the overall lifetime risk for whites is 1 in 38 compared with 1 in 1,000 for blacks. Melanin does provide some protection against sun damage, so those with high levels of melanin — those with darker skin — are better protected than those with fairer skin.
But overall, black patients are more likely to be diagnosed with various forms of skin cancer at more advanced stages, says Dr. Janiene Luke, Skin Color Association is a non-profit organization dedicated to educating physicians and the public about skin health.
5 According to the Centers for Disease Control and Prevention, the annual melanoma survival rate for non-Hispanic blacks is 66 percent, compared to 90 percent for non-Hispanic whites. The American Cancer Society says that in the United States, 1 in 3 black men or women diagnosed with melanoma succumbs to the disease, compared with at least 1 in non-Hispanic whites.
Given the known variability in results, Dr. Valerie Harvey, president of the Society of Color, said two areas of research are needed: studying educational programs to see if awareness might lead to earlier diagnosis and improved survival; and To identify risk factors in dark-skinned patients, especially those that lead to the development of melanoma in places with less sun exposure.
Increasing cultural competence and diversity in dermatology only improves diagnosis and outcomes. According to the latest data, less than 3 percent of dermatologists nationwide are black. Orthopedics is the only medical specialty with a smaller share, said Dr. Michelle Henry, clinical lecturer in dermatology at Weill Cornell Medicine.
Dermatology has traditionally been one of the most competitive specialties in the medical field. In addition to rigorous academic requirements, admission to a dermatology program depends on connections and extensive networks with mentors, which can be expensive. This has traditionally created barriers for black medical students wanting to pursue dermatology, Henry said.
“There are a lot of barriers that make it difficult for a lot of students of color to do the things they need to do in such a super unique and small space,” she said.
Recent initiatives to help students overcome these barriers are starting to pay off,” says Diversity, Equity, and Inclusion in the Department of Dermatology at the University of Pennsylvania and founder of the Society for Color. The American Academy of Dermatology’s initiatives include A comprehensive review of residency applications, mentoring, and programs to increase interest in high school students and prepare them for college and medical school.
Medical app company VisualDX is working to reduce A catalog of images of various diseases, Differences in Medicine via Project Impact. Skin cancer may look different on lighter skin than darker skin, and since doctors may only be trained to describe white skin, As a result, there is an increased chance of misdiagnosis in people with dark skin.
Jorge Martínez, senior vice president and partner at C+R Research, a market research firm in Chicago- Bonilla said the medical community’s failure to provide adequate skin care for people with darker skin reflects the lack of sunscreen that meets the needs of patients, especially black people.
“What’s done is , it drives the arrival of black entrepreneurs, launching their own solutions and their own products from day to day,” Martínez-Bonilla said. “Not only because of the lack of availability, but because these people know their needs best. “
Katonya Breaux is one of those entrepreneurs. When she noticed moles on her face and neck in her 30s and 40s, she was growing up in an older family She wasn’t excited when she saw a similar mole on a member. She thought it was just part of aging. But her dermatologist said it was a sunburn.
“I was really shocked . I was like: ‘But I’m black,'” she said, adding that she had no experience with sunscreen growing up. “It was so foreign to me. I believe we just don’t need it. “
After struggling to find a sunscreen that didn’t leave a residue or feel like it didn’t burn her skin, she teamed up with a chemist who helped her create a tinted mineral sunscreen. At first, she only intended to use it for personal use, but eventually she launched Unsun Cosmetics. The Los Angeles-based company educates skin care and sells products designed for dark-skinned consumers.
Shontay Lundy also struggled to find a sunscreen that wouldn’t “leave a blue, purple or whatever color” – the color on my skin.” Until, she says, “I didn’t realize it didn’t exist.”
So in 2016, she developed products that leave no residue, culminating in the Black Girl Sunscreen.
Education is the cornerstone of her company’s advertising, Lundy said. “Our mission is to equip people of all ages and skin tones with the right sun protection products to take their skin health seriously and protect themselves from sun damage.”
Shelton, by chance at store checkout Encountering her line that led to her cancer diagnosis, she says she has become an evangelist for skin self-exams and sunscreen, and is now known as the “Sunscreen Lady” at her local pool. The skin cancer she developed may not have been caused by sun exposure, but it raised her awareness of skin damage and other types of skin cancer.
She has been cancer free since doctors successfully removed the tumor on her toe, which she underwent chemotherapy and radiation therapy. But the experience was painful.
“It’s life-changing,” she said.
She said she has still returned to an active and fulfilling life. She said she will be forever grateful to the stranger who pulled her aside that day, and the doctor who didn’t trust the first batch of labs back, choosing instead to trust his gut and start treatment immediately.
Tips to avoid skin cancer for all skin tones
• Avoid direct sunlight, especially at 10am Keep baby out of full sun between 4pm.
• Use a broad-spectrum sunscreen with SPF 30 or higher daily. Reapply every two hours or after swimming or activity/sweating.
• Do not leave sunscreen in the car as temperature fluctuations can cause it to break down and become less effective.
• Wear clothing that covers arms and legs.
• Wear a wide-brimmed hat to protect the face, ears and neck.
• Wear UV-blocking sunglasses.
• Avoid indoor tanning beds.
• Check the skin from head to toe monthly. Look for dark spots or plaques, or growths that are growing, bleeding, or changing; sores that heal slowly or that heal and return; patches of skin that feel rough and dry; and dark lines under or around fingernails or toenails. Be diligent about checking the nail beds, palms, soles, head, calves, groin, and other places that don’t get enough sunlight. If you have any concerns, please contact your doctor.
• See a board-certified dermatologist at least once a year for a full body exam.
Source: Skin Cancer Foundation, American Academy of Dermatology, Dr. Janiene Luke, Dr. Michelle Henry, Katonya Breaux
[Update: This article Revised on Aug. 11 at 12:30 PM ET, 2022, to alleviate possible confusion about survival rates for black people diagnosed with melanoma. ]