Skin Cancer: Equal-Opportunity Health Threat
According to current estimates, more than 1 million cases of skin cancer will be diagnosed in the United States this year. While historically those most at risk for developing skin cancer are fair-skinned individuals with blonde or red hair, light eyes, and generally older populations, dermatologists advise that those who do not fit this profile are not immune. In fact, some dermatologists are reporting an increased incidence of skin cancer in younger women and people with skin of color – with the latter group often facing a bleaker outcome due to delayed diagnosis.
At the recent 67th Annual Meeting of the American Academy of Dermatology (Academy), research presented by dermatologist Jason K. Rivers, MD, FRCPC, FAAD, clinical professor of dermatology at the University of British Columbia in Vancouver, found a higher than expected incidence of basal cell carcinoma in a small population of women under age 40. In other research unveiled at this meeting, dermatologist Robert S. Kirsner, MD, PhD, FAAD, vice chairman and Stiefel professor in the department of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine, reported the incidence of melanoma (the deadliest form of skin cancer) among Hispanics and African-Americans in Florida is higher than the national average.
Increasing Incidence of Basal Cell Carcinoma in Young Women
In order to determine the demographic and tumor characteristic changes of patients diagnosed with basal cell carcinoma and squamous cell carcinoma, Dr. Rivers conducted a retrospective chart review on 885 of his patients with diagnosed non-melanoma skin cancers from 1993 to 2005 in his Vancouver dermatology practice.
Of the 885 patient charts that were reviewed, 1,177 non-melanoma skin cancers were identified. While basal cell carcinomas and squamous cell carcinomas generally were diagnosed in the older age group of patients (60+ years of age), Dr. Rivers noticed a surprising trend of a slight increase in basal cell carcinomas in patients under age 40 (20-39 years of age).
In his practice, Dr. Rivers noted that approximately five to 10 women under age 40 were diagnosed with basal cell carcinoma per year between 1995 and 2003 – a notable observation since this type of skin cancer generally affects older people. In fact, women in all age groups developed an increasing number of basal cell carcinomas over the decade studied, whereas the rate of this particular skin cancer in men remained stable.
“Although the actual number of young women diagnosed with basal cell carcinoma was relatively low, it is disturbing that we noticed a consistent increase in these numbers given that this type of non-melanoma skin cancer is a result of intermittent damage from ultraviolet radiation early in life,” explained Dr. Rivers. “This means that young people are getting enough ultraviolet exposure at a very young age to cause the development of skin cancers that normally do not occur until later in life or generally in people over age 40.”
Since Vancouver is a low sunlight area, Dr. Rivers speculated that the young women diagnosed with basal cell carcinoma in his practice could be getting more ultraviolet (UV) radiation from tanning beds, which studies show is also linked to an increased risk in melanoma.
“I think these findings of an increased incidence of basal cell carcinomas in younger people is representative of what you would find across North America if a large-scale study was conducted,” said Dr. Rivers. “We probably would notice even higher rates in areas where year-round sun exposure is more prevalent, such as the southern parts of the United States.”
Dr. Rivers added that it is important for young people to be vigilant about practicing proper sun protection and limiting their sun exposure, whether to natural or artificial sunlight. This advice is especially important for people diagnosed with skin cancer, as non-melanoma skin cancer increases a person’s risk for developing future skin cancers, including melanoma.
Increasing Rates of Melanoma in People of Color
According to estimates from the American Cancer Society, one American dies of melanoma almost every hour (every 62 minutes). While melanoma can strike anyone, Caucasians are more likely to be diagnosed with melanoma than other races. However, new research suggests that melanoma rates among Hispanics and African-Americans may be increasing in certain populations.
In a study comparing state and national melanoma incidence trends, Dr. Kirsner examined data from the Florida Cancer Data System (FCDS) and the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program that compiles cancer statistics from geographic areas across the country – representing 26 percent of the U.S. population. A retrospective trend analysis comparing age-adjusted, race/ethnic- and gender-specific invasive cutaneous melanoma incidence rates in Florida versus the general U.S. population were computed for the years 1992-2004.
When melanoma rates in Hispanic males were compared, the incidence of melanoma among this group was elevated in Florida. Specifically, Dr. Kirsner reported that the incidence of melanoma among male Hispanic patients residing in Florida was 20 percent higher than that of their counterparts in the SEER program. In the African-American population, black female patients in Florida had a 60 percent higher incidence of melanoma than that of black female patients reported in the SEER program – representing a significant difference in melanoma rates.
“Numerous studies also show that because of the perceived low risk of melanoma in Hispanics and African-Americans in the U.S., these patients are diagnosed later when melanoma is more advanced and much more likely to spread. As a result, they have poorer outcomes than Caucasians,” said Dr. Kirsner. “We hope that earlier diagnosis of melanoma in black and Hispanic patients at a more favorable or treatable stage will ultimately improve melanoma survival rates in minority populations. Clearly, it is important for people of all races and ethnicities to protect their skin from ultraviolet light and to make an appointment to see a dermatologist at the first sign of a suspicious mole.”
To educate the Hispanic population, the Academy is working with the National Alliance for Hispanic Health on its skin cancer public education initiative.