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Friday, 8 March 2024

Skin cancer vs skin colour – More melanin may mean more protection, but risks remain

As summer wanes, South Africans are advised to always exercise caution when out and about. Skin cancer ranks as one of the most common cancers in South Africa, but what does that mean for a country with such a diverse array of skin colours? 

According to Functional Head: Oncology Management Dr Jenni Noble at the AfroCentric Group, skin cancer is a medical condition often associated with fair-skinned individuals, but due to our sunny climate, it poses a threat to people of all skin tones in the country.

“As an African nation, we need to acknowledge the role of melanin in skin cancer,” says Noble. “Melanin (the pigment responsible for skin colour) does provide a level of protection against overexposure to harmful ultraviolet or UV rays, which are a primary cause of skin cancer.”

This is why, Noble says, fair-skinned people are more likely to develop a wider array of skin cancer types than any other group - because they possess less melanin in their skin.

According to an American study published in the Journal of Dermatology for Physician Assistants (JDPA) in 2021, there exists a stark contrast in skin cancer rates, with 25.6 in every 100,000 White people developing melanoma from 2013 to 2017, compared to 1 in 100,000 Black people.

Noble warns “While melanin levels play a significant role in offering protection against UV damage, we know the prevalence of skin cancer is not solely dependent on skin colour. But more protection adds different levels of risk.”

Noble says a crucial aspect of skin cancer treatment (like most cancers) is a timely diagnosis. According to The Skin Cancer Foundation, darker-skinned patients are more likely to be diagnosed with melanoma at a late stage than fair skinned patients.

According to Dr Bianca Tod, Dermatologist and senior lecturer at Stellenbosch University, the data shows that more melanin may even mean more risk. "In many well-resourced countries, with populations with predominantly light skin colours, melanoma mortality has been decreasing in the last decade. However, this trend is not being observed in less well-resourced countries or in populations with predominantly dark skin colours.”

Dr Tod says the risk of sun-related skin cancer may be lower in people with constitutionally darker skin colours; however, it is not zero. “We see (presumably) sun-related skin cancers relatively frequently in people with light brown skin colours. This is an area of dermatology that urgently requires more research.” 

Noble emphasises the critical role of early diagnosis in skin cancer treatment, echoing global concerns. “In South Africa, this urgency takes on a sharper edge due to stark socio-economic disparities. The Skin Cancer Foundation's statistics, while alarming, don't fully capture the complexities at play here,” says Noble.

Many misconceptions persist that skin cancer only affects lighter skin tones, leading to delayed recognition of symptoms and hesitation to seek medical attention in darker-skinned communities.

Dr Tod advises that “Public education campaigns in local languages and tailored to cultural contexts are crucial to dispel myths and encourage proactive self-checks.”

The diagnostic challenge posed by darker skin tones cannot be understated. “Melanoma often presents differently on melanin-rich skin, with subtle variations in pigmentation or texture that can be missed by untrained eyes,” says Noble.

While levels of care and access to medications can differ widely between public and private healthcare environments, she emphasises early detection and intervention is a critical activity that needs to be elevated at all levels.

“Skin cancer is a pervasive concern that transcends racial boundaries. Understanding the risks, debunking myths, and promoting awareness are crucial steps toward reducing the impact of this disease in South Africa. Regular screenings, regardless of skin tone, can contribute to early detection and improved outcomes,” concludes Noble.

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