Importance of including Skin of Color

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 Editor: Richard Usatine

Author(s): Rachel Manci, Richard Usatine
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Importance of Dermoscopy in Skin of Color[edit]

Individuals with skin of color (SOC) are defined by the Skin of Color Society as those individuals of Hispanic/Latino, Asian, African, Native American, Pacific Island descent, and mixtures thereof. All too often skin cancers are detected late in persons of skin of color due to many factors including health inequity, poverty, lack of access to education and healthcare. Another factor is that skin cancer is less common in darker-skinned persons and the lack of worry that a skin growth is cancer may lead to delays in diagnosis. Even the preventive messages about sun and skin cancer are more directed to lighter skinned persons.

Please visit these sub-chapters on SOC after completing this section below[edit]

Many studies have demonstrated that melanomas in persons of skin of color are diagnosed at more advanced stages and have a worse prognosis than melanomas in non-Hispanic whites. [1][2][3][4][5]

Dermoscopy has been proven to increase the sensitivity and specificity of cancer detection especially in light skinned individuals. Unfortunately, many of the studies have included very few persons with darker skin types (skin of color). The most comprehensive article on skin cancer in skin of color does not even have the words dermoscopy or dermatoscope in the article. [6] However, nevi, lentigines, and melanomas in skin of color have been analyzed as far back as the 1970’s prior to dermoscopy. [7]

In one prospective study of dermoscopic nevus patterns in skin of color, Lallas, et al. analyzed 300 nevi from persons with skin type V and VI. [8] The majority of nevi in skin type V revealed a reticular pattern with dark brown color, whereas persons with skin type VI possessed more nevi showing a structureless pattern with black, blue and grey colors. [8] In another similar prospective study, Tuma et al. reported that nevi in patients with skin types V and VI had a color distribution pattern with a tendency for central hyperpigmentation. [9]

Dermoscopic patterns in acral melanocytic lesions in the United States in skin of color was analyzed by Madankumar, et al. [10] They confirmed that melanocytic lesions of the palms and soles are common in skin of color. However, there were no melanomas found in over 1000 patients, so they were unable to make any conclusions about the predictive value of various dermoscopic patterns for diagnosing acral melanoma in skin of color. [10]

De Giorgi, et al. utilized dermoscopy to analyze 100 pigmented cutaneous lesions in non-white patients. [11] This analysis included Clark nevi, seborrheic keratoses, blue nevi, dermatofibromas, and melanomas. [11] They determined that the use of dermoscopy in nonwhite populations remains the same as in white populations, since single dermoscopic features such as a pigmented network, streaks, globules, blue-white veil, and milia-like cysts were easily identified during dermoscopic exam. [11] Therefore, more research promoting the use of dermoscopy in skin of color patients will be useful in making this practice more commonplace in this population.

Fortunately, more attention is being paid to the issue of skin of color in general as increasing attention is being paid to the systemic racism in the US and around the world. This is a time to collaborate to put together what we know about dermoscopy in skin of color and to begin doing research to advance our knowledge of this area.

Simultaneously, the dermatology world is beginning to look at how to be more inclusive of doctors of skin of color. [12][13][14][15][16] This can break down some barriers to healthcare for people of color.

Of course, our goal in Dermoscopedia is to see that all dermatologists and other health-care providers caring for people’s skin are competent and confident dermoscopists with the full spectrum of human skin.

On the Spot Video: Dermoscopy of Skin of Color[edit]


Dermoscopy of Skin of Color by Richard Usatine, MD

On the Spot Video: Dermoscopy of Brown Skin[edit]


Dermoscopy in Brown Skin by Blanca Carlos, MD

References:[edit]

  1. Wu et al.: Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006. J Am Acad Dermatol 2011;65:S26-37. PMID: 22018064. DOI.
  2. Cormier et al.: Ethnic differences among patients with cutaneous melanoma. Arch Intern Med 2006;166:1907-14. PMID: 17000949. DOI.
  3. Cress & Holly: Incidence of cutaneous melanoma among non-Hispanic whites, Hispanics, Asians, and blacks: an analysis of california cancer registry data, 1988-93. Cancer Causes Control 1997;8:246-52. PMID: 9134249. DOI.
  4. Hu et al.: Advanced presentation of melanoma in African Americans: the Miami-Dade County experience. J Am Acad Dermatol 2004;51:1031-2. PMID: 15583613. DOI.
  5. Hu et al.: Comparison of stage at diagnosis of melanoma among Hispanic, black, and white patients in Miami-Dade County, Florida. Arch Dermatol 2006;142:704-8. PMID: 16785372. DOI.
  6. Gloster & Neal: Skin cancer in skin of color. J Am Acad Dermatol 2006;55:741-60; quiz 761-4. PMID: 17052479. DOI.
  7. Coleman et al.: Nevi, lentigines, and melanomas in blacks. Arch Dermatol 1980;116:548-51. PMID: 7377786.
  8. 8.08.1 Lallas et al.: Dermoscopic nevus patterns in skin of colour: a prospective, cross-sectional, morphological study in individuals with skin type V and VI. J Eur Acad Dermatol Venereol 2014;28:1469-74. PMID: 24237599. DOI.
  9. Tuma et al.: Dermoscopy of black skin: A cross-sectional study of clinical and dermoscopic features of melanocytic lesions in individuals with type V/VI skin compared to those with type I/II skin. J Am Acad Dermatol 2015;73:114-9. PMID: 25982540. DOI.
  10. 10.010.1 Madankumar et al.: Acral melanocytic lesions in the United States: Prevalence, awareness, and dermoscopic patterns in skin-of-color and non-Hispanic white patients. J Am Acad Dermatol 2016;74:724-30.e1. PMID: 26803347. DOI.
  11. 11.011.111.2 de Giorgi et al.: Dermoscopy in black people. Br J Dermatol 2006;155:695-9. PMID: 16965417. DOI.
  12. Van Voorhees & Enos: Diversity in Dermatology Residency Programs. J Investig Dermatol Symp Proc 2017;18:S46-S49. PMID: 28941493. DOI.
  13. Pritchett et al.: Diversity in dermatology: Roadmap for improvement. J Am Acad Dermatol 2018;79:337-341. PMID: 29653209. DOI.
  14. Granstein et al.: Diversity in Dermatology-A Call for Action. JAMA Dermatol 2017;153:499-500. PMID: 28423151. DOI.
  15. Pandya et al.: Increasing racial and ethnic diversity in dermatology: A call to action. J Am Acad Dermatol 2016;74:584-7. PMID: 26774427. DOI.
  16. Bray et al.: Publication rates on the topic of racial and ethnic diversity in dermatology versus other specialties. Dermatol Online J 2020;26:. PMID: 32609444.