Brykyta Shelton found herself standing in a checkout line at a large retailer, uncomfortably aware that a woman in front of her was staring at her sandaled feet.
Shelton had been taking medication for months for what her doctor said was toenail fungus, but one nail still looked gross.
After Shelton completed her purchase, the woman pulled her aside and told her that while she wasn’t a doctor, she thought Shelton was dealing with something more serious than a fungus.
“She’s like, ‘I know I’m just a random stranger, but please have someone else check it out,'” said Shelton, who lives in a Washington, DC suburb of Maryland.
Shelton, now 42, followed the advice.
Initial lab work did not give a clear diagnosis, but her new doctor said he was certain she had acral lentiginous melanoma, a form of skin cancer. Additional tests proved him right. Although rare, it is the most common subtype of melanoma in black people, such as Shelton. is the disease that Murdered reggae star Bob Marley at age 36, and is most often found on skin less exposed to the sun, such as the hands, soles of the feet, and under fingernails. Researchers don’t understand what causes acral lentiginous melanoma and don’t know how to prevent it. It is often missed in skin checks or misdiagnosed.
Skin cancer, in general, is often missed or misdiagnosed in black patients.
Historically, blacks and dark-skinned people have been left out of efforts to combat skin cancer. Long neglected by sunscreen manufacturers and a medical community lagging behind in diversity and cultural competence (the recognition of a patient’s heritage, beliefs, and values), many have not been educated about sun safety or how to check their skin for signs of damage or cancer. .
Without a doubt, skin cancer rates are lower for people with darker skin tones. Melanoma is more than 20 times more common in white people as well as in African Americans, with an overall lifetime risk of 1 in 38 for white people compared to 1 in 1,000 for black people. Melanin provides some protection against sun damage, so people with more, people with darker skin, are better protected than people with lighter skin.
But in general, black patients are more likely to be diagnosed with various forms of skin cancer at more advanced stages and have a higher death rate, he said. dr janine lucaswith the skin of color societya nonprofit organization that works to educate physicians and the public about skin health.
The five-year melanoma survival rate among non-Hispanic black people is 66%, compared to 90% for non-Hispanic white people, according to a report from the Centers for Disease Control and Prevention. And 1 in 3 black men or women diagnosed with melanoma in the US die from the disease, compared to at least 1 in 7 non-Hispanic whites. says the American Cancer Society.
Given the known disparities in results, Dr. Valerie Harvey, president of the Skin of Color Society, said two areas of research are needed: studying educational initiatives to see if awareness could lead to earlier diagnosis and better survival; and determine the risk factors in patients with dark skin, especially the factors that lead to the appearance of melanoma in places less exposed to the sun.
Improving cultural competence and diversity within dermatology is just one step in improving diagnosis and outcomes. According to the most recent data, less than 3% of dermatologists nationwide are black. Orthopedics is the only medical specialty with a smaller share.
Dermatology has traditionally been one of the most competitive specialties in medicine, said Dr. michelle henrya clinical instructor of dermatology at Medicine Weill Cornell. In addition to stringent academic requirements, admission to dermatology programs also depends on connecting with mentors and a wide network of contacts, which can be costly. And that, Henry said, has traditionally created barriers for black medical students who want to pursue dermatology.
“There are so many obstacles that make it difficult for a lot of students of color to do the things that they need to do in such a super exclusive and small space,” she said.
Recent initiatives to help students overcome those barriers are starting to work, said Dr. susan taylor, vice president of diversity, equity and inclusion in the department of dermatology at the University of Pennsylvania and founder of the Skin of Color Society. initiatives of the American Academy of Dermatology they include holistic reviews of residency applications, mentorships, and programs to increase interest among high school students and prepare them for college and medical school.
medical applications company VisualDX is working to reduce disparities in medicine through Project Impact creating a catalog of images that reflect various diseases in different skin colors. Skin cancers may look different on lighter skin than on darker skin, and because clinicians may have been trained only with representations of fair skin, the chance of misdiagnosis in people with dark skin increases.
Change has also come to the sunscreen industry.
Jorge Martinez BonillaSenior Vice President and Partner at Chicago Market Research Firm C&R ResearchHe said that the failures within the medical community to provide adequate skin care for people with dark skin reflects the unavailability of sunscreens to meet the needs of patients, especially for blacks.
“What he has done is that he has pushed black entrepreneurs, from one day to the next, to find their own solutions and their own products,” Martínez-Bonilla said. “Not only because of the lack of availability, but because they are the people who know their needs best.”
katonya breaux He is one of those entrepreneurs. She was not thrilled when she, in her 30s and 40s, noticed moles growing on her face and neck, similar to those she had seen on older members of her family when she was a child. She guessed it was just part of aging. But her dermatologist said it was sun damage.
“I was literally in shock. I was like, ‘But I’m black,'” she said, adding that she had no experience with sunscreen growing up. “It was so weird to me. I thought we just didn’t need it.”
After struggling to find a sunscreen that didn’t leave a residue or feel like it burned her skin, she worked with a chemist who helped her create a mineral-based tinted sunscreen. At first, she intended it just for her personal use, but she finally released unsun cosmetics. The Los Angeles-based company educates skin care and sells products designed for consumers with dark skin.
shontay lundy I also struggled to find a sunscreen that wouldn’t “leave a blue, purple, or other color cast on my skin.” Until, she said, “I realized it didn’t exist.”
So, in 2016, he developed products that left no residue, finally launching Black Girl Sunscreen.
Education is critical to advertising your company, Lundy said. “Our mission is to equip people of all ages and skin tones with the right sun protection products to take their skin’s health seriously and protect themselves from sun damage.”
Shelton, whose chance encounter in a store checkout line led to her cancer diagnosis, said she has become an evangelist for self-monitoring of skin and sunscreen, and is now known at her local pool as “the sunscreen lady” The type of skin cancer she had may not have been due to sun exposure, but it increased her awareness of skin damage and other types of skin cancer.
He has been cancer-free since the doctor successfully removed the tumor in his toe and underwent chemotherapy and radiation. But the experience was traumatic.
“It’s life changing,” he said.
Still, he said, he has returned to a full and active life. She said that she will always be grateful to the stranger who pushed her away that day, as well as the doctor that she did not believe in the first set of labs she threw out, and chose to trust her instincts to begin treatment immediately. .
Tips to avoid skin cancer for all skin tones
• Avoid direct sun, especially between 10 am and 4 pm Keep babies out of the sun completely.
• Use a broad-spectrum sunscreen with an SPF of 30 or higher every day. Reapply every two hours or after swimming or activity/sweating.
• Don’t leave sunscreen in the car, because temperature fluctuations can cause it to break down and become less effective.
• Wear clothing that covers arms and legs.
• Wear a hat with a wide brim to protect your face, ears, and neck.
• Wear sunglasses that block UV rays.
• Avoid indoor tanning beds.
• Examine your skin from head to toe every month. Look for dark spots or patches, or growths that are growing, bleeding, or changing; sores that are slow to heal, or heal and come back; skin patches that feel rough and dry; and dark lines under or around the fingernails or toenails. Be diligent about checking your nail beds, palms of your hands, soles of your feet, head, lower legs, groin, and other places that get little sun. Contact a doctor if you have any concerns.
• See a board certified dermatologist at least once a year for a full body exam.
Sources: Skin Cancer Foundation, American Academy of Dermatology, Dr. Janien Lucas, Dr. Michelle HenryKatonya Breaux