Dark-skinned patients still at risk for skin ca.(Clinical Rounds)

NEW ORLEANS -- Melanoma and other skin cancers in blacks and Hispanics are likely to be discovered at a more advanced stage and are associated with significantly poorer survival rates, researchers said at the annual meeting of the American Academy of Dermatology.

Blacks and Hispanics--and their primary care physicians--may believe that darker skin protects against these cancers, said Susan Taylor, M.D. As a result, these patients don't perform frequent skin self-exams, aren't taught the warning signs of skin cancers, and don't see pigmented lesions as a concern.

These problems, coupled with the fact that skin cancers often occur in atypical or sun-protected areas, contribute to their poorer prognosis.

Physicians "must develop a high index of suspicion for melanoma in the black population and fully evaluate any suspected lesion," said Dr. Taylor, who is the director of the Skin of Color Center at St. Luke's-Roosevelt Hospital Center, New York.

Additionally, she said, health care providers should tell dark-skinned patients that they are at risk for melanoma, must wear sunscreen, and should perform monthly self-exams of their skin.

Malignant melanoma is about 10 times more common in whites than in blacks. Dark skin transmits only about 7.4% of ultraviolet B and 17.5% of ultraviolet A, while white skin transmits more than 55% of UVB and 29% of UVA, said Rebat Halder, M.D., of Howard University, Washington.

"As a result of this additional filtering, black skin has a natural SPF of about 13.4," he added.