Why Sunscreen Is Not the One-Size-Fits-All Answer for Skin Cancer
A common misconception is that the melanin in Black people’s skin prevents them from getting skin cancer (Skin Cancer). While the risk of getting melanoma is lower for people with darker skin, they have the highest mortality rate once it develops. As a result, a sunscreen campaign to reduce the risk has become the standard public health message in the past few years. However, biased messaging from dermatologists, media, skincare companies and influencers has led to a spread of misinformation that emphasizes the racial disparities in dermatology because sunscreen is highly effective in preventing melanoma, but for white people.
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Melanoma is one of the deadliest skin cancers in the U.S., and exposure to ultraviolet radiation from the sun is known to increase its risk (Cancer.org). It is more than 20 times more prevalent in white people than Black people (American Cancer Society). Yet the five-year survival rate for melanoma is 67% for Black people and 92% for white people (American Cancer Society). Also, people of color, specifically Asian, Hispanic, and Black, are more commonly diagnosed with acral lentiginous melanoma (ALM), which has a lower survival rate. Unlike superficial spreading melanoma (SSM), commonly diagnosed amongst Caucasians, ALM occurs on the palms of the hands, soles of the feet, or under the nails (CDC, Canadian Cancer Society). Because people of color are more likely to be diagnosed later, causing a racial disparity in survival rates.
Public messaging advises people to follow the ABCDE (asymmetry, border, color, diameter, evolving) rule when self-screening for skin cancer in areas exposed to the sun. But not all melanomas present this way. Even squamous cell carcinoma (SCC), a non-melanoma skin cancer most common in people of color, can be found in non-sun exposed spots, despite typically appearing on the faces of white people (Asian Pacific Journal of Cancer Prevention).
Since ALM is present in areas that don’t get sun exposure, sunscreen recommendations are largely ineffective for preventing skin cancer for Black and Brown people. One of the most extensive studies on UV radiation and melanoma found “no connection” in the risk of incidence in Black people. But sunscreen is still prescribed as a preventative solution for all (The Conversation).
Blanket messaging and one-fits-all solutions fail to protect those already disproportionately at a disadvantage and potentially cause a delay in people of color seeking lifesaving treatment.
Medical textbooks disproportionately use light skin tones in diagrams, even for conditions common in populations of color. Doctors are largely trained to spot a type of skin cancer as “pink, pearly growth that may or may not be crusted” on a white person, and not a “brown, slightly translucent lesion” on a Black or Brown person (Social Science & Medicine, Skin Cancer Foundation).
The systemic bias in healthcare that structures research, public messaging, diagnosis, and treatment around white people is deadly because Black and Brown people are told that this information relates to them too and are diagnosed and treated based on it. This was the case of reggae musician Bob Marley, who died of ALM after it spread from his toenail to his brain. He initially thought the lesion was a bruise (Skin Cancer).
Due to the lack of research in finding a link between melanoma and the rate of incidence in Black people, prevention is awareness and education. Despite melanoma having a high mortality rate, early detection can prevent a death sentence. The American Academy of Dermatology Association gives a self-exam breakdown, including what to look for and where to check with pictures.
People like dermatologist Adewole Adamson have been debunking the idea that sunscreen prevents skin cancers on all skin types. This means calling for education beyond sun-awareness, inclusive research and clinician training, and less invasive ALM treatments (Mother Jones). However, many in the field have been hesitant to stray from sunscreen messaging since it took years to get the public on board and is still considered to be vital.
The centering of sun protection in the skin cancer prevention messaging places the blame on Black and Brown people for their melanoma diagnoses. “Making that link makes patients feel like they are the reason they got melanoma,” Adamson said. “It’s almost like victim-blaming.”
Until the racial disparities in dermatology and healthcare overall are eliminated, Black and Brown people’s deaths will be mislabeled as a product of their failures and not another example of how the system is set up to disregard their lives.
• A common misconception is that Black people cannot get skin cancer highlights racial disparities in dermatology.
• A lack of people of color in dermatology, from clinical trials to medical professions, leads to fatal disparities.
• Melanoma is one of the deadliest skin cancers in the U.S., but early detection can prevent a death sentence.