A surprising number of Hispanics are being diagnosed
– who were thought to be low risk
A deadly skin cancer is on the rise in California and the
disease has made leaps among Hispanic men, surprising researchers
who have generally seen low rates in the Latino population.
The news is particularly important to South Valley and San
Benito County, which has a large population of men working in the
construction trades and in agriculture, in which sun exposure plays
a key role.
A surprising number of Hispanics are being diagnosed – who were thought to be low risk
A deadly skin cancer is on the rise in California and the disease has made leaps among Hispanic men, surprising researchers who have generally seen low rates in the Latino population.
The news is particularly important to South Valley and San Benito County, which has a large population of men working in the construction trades and in agriculture, in which sun exposure plays a key role.
Like many cancers, melanoma is treatable when caught early.
“We want to educate dermatologists, teach dermatologists not to look at the person in front of them and say, ‘He is Latino, I don’t have to worry about melanoma,'” said Myles Cockburn, an assistant professor at the Keck School of Medicine at the University of Southern California. “It’s too late to do primary protection if you’ve already got melanoma and that’s where early detection comes in.”
The best way to detect melanoma is through self skin examinations and yearly examinations by a doctor. Melanoma can be tricky to distinguish from benign skin marks such as moles, birthmarks and aging spots, but there are resources available to help people identify possible problem spots.
“It’s important to teach people what is normal and what isn’t,” said Steven Swengel, a former chief of dermatology for Kaiser Permanente and the current chief of the Mohs Micrographic Surgery department in San Jose. “It’s difficult for people to diagnose their own lesions.”
Swengel suggested people have a spouse or a housemate help them with monthly self-exams. Patients can ask for a brochure on skin examinations at their doctor’s office or they can view tips online at the Skin Cancer Foundation Web site.
“Benign lesions are known by the company they keep,” Swengel said. “If one is new, but you have 25 just like it, it’s probably fine. But if you suddenly say ‘Wow that has really changed and that’s just not like anything else on my body,’ that’s when you need to be concerned.”
Melanoma is the most common form of skin cancer and is also the most fatal, according to the Skin Cancer Foundation, and it is being diagnosed in people at increasingly younger ages.
Dermatologists and skin-cancer experts list five characteristics that can point to malignant melanoma. They include asymmetry (uneven shape), border, color, diameter and evolution. Melanoma spots tend to be asymmetrical with uneven borders or scalloped or notched edges. While normal moles or skin spots are a single shade of brown, melanoma has varied shades of brown, tan and black at early stages and can progress to red, white and blue coloring. Early melanomas generally grow larger than moles to about a quarter inch or more in diameter, though they can be smaller.
“The last one is e for evolution. If something is changing it needs to be watched,” Swengel said. “Most good moles are pretty much there by the time you are 25.”
Swengel suggested people talk to their doctors about their family and medical history to decide if they are at high risk for melanoma.
“In the Asian population they tend to have more melanomas … between the toes and fingers, so they need to look in those areas,” Swengel said.
Others who need to be concerned are those with a family history of melanoma and those with dysplastic nevus syndrome, a disorder that causes people to have a large number of moles which often shows up in “pink, pasty-white Caucasian groups,” Swengel said.
A study published in the online journal “Cancer” Jan. 28 found that rates of melanoma increased from 1988 to 2001. The cancer develops in melanocytes, or skin cells that produce pigment in the skin, and has generally been found in lower rates among populations with darker skin tones.
Cockburn led research that analyzed data from the California Cancer Registry over 14 years. The statewide registry system is one of the most reliable in the country, according to Cockburn, and because of California’s diverse population it allowed a unique opportunity to look at rates of melanoma in different ethnic groups.
“Essentially we were looking at contrasting rates for other ethnicities,” Cockburn said. “It’s kind of a question of extremes. African Americans had the lowest rate of it and Latinos, which have a variety of skin colors also had a low rate.”
The finding that alarmed Cockburn and his fellow researchers is that the rate of melanoma among Hispanic men increased by 7 percent a year from 1996 to 2001.
The increase for Hispanic women remained lower than 1 percent per year over the same period. The rate for non-Hispanic whites increased by 3 percent.
The other finding that concerned Cockburn is that more of the tumors diagnosed in Hispanic men were thick, or 1.5 milimeters deep.
While 24 percent of non-Hispanic white men had thick lesions, 35 percent of the tumors among Hispanic men were thick.
“It’s an oversimplification, but a thicker tumor generally has been around longer and it’s more likely to have spread to other organs,” Cockburn said. “Someone with a thin tumor has a 90 percent chance of survival while someone with a thick lesion only has 40 percent.”
When a thin lesion is found, doctors often treat it by cutting out the lesion and surrounding tissue. But the risk with thicker melanomas is that they often have spread to other parts of the body, including the lymphatic system, Swengel said.
“Once a melanoma reaches a certain diameter, it can get into the lymphatic system and that’s harder to treat,” Swengel said. “It’s not that it is definitely lethal, but the risk is definitely greater.”
Swengel cited occupations such as construction workers, landscapers and field workers as risk factors for some in the Hispanic community, as well as a lack of health coverage.
“It is increasing, I think, based on occupation and based on population count,” Swengel said. “And hopefully people are getting more access to health care, but most probably don’t have health insurance.”
Cultural factors can also play a role in delaying diagnosis.
“Men in the Hispanic community tend to be more stoic,” Swengel said. “They have to be on a death bed before they go to a doctor.”
Both Swengel and Cockburn recommend that people avoid sun exposure by wearing sunscreen, protective clothing and avoiding sun exposure at the highest point of the day. Swengel recommended parents teach children sun safety early on. Reports from Australia are finding that early sunburns, from infancy or the toddler years, can lead to a predisposition for melanoma later on, Swengel said.
“Sun exposure is accumulative no matter were you are coming from,” Swengel said.
For more information on the ABCD’s of melanoma and self-exams, visit the Skin Cancer Foundation at www.skincancer.org.
