81 years ago today, Bob Marley, the Jamaican musician and outspoken social advocate, was born. While many know his accomplishments in music, culture, and society, less know that his untimely passing at the young age of 36 was due to skin cancer. Marley was diagnosed with acral lentiginous melanoma—a rare, aggressive form of skin cancer—found underneath his right toe nail at the age of 32. Assuming the dark spot was a soccer injury, he did not get it examined until it reached a later, ultimately fatal, stage.
While skin cancer in Black communities is fairly rare (representing one to two percent of all cancers in Black people), it still exists. Not only that, but survival rates for those who have been diagnosed is disproportionately lower than their white counterparts. This is, in many cases, a result of later stage detection.
In honor of Marley’s heavenly birthday, ESSENCE speaks to Dr. Kim Nichols, a Connecticut-based board certified dermatologist and spokesperson for The Skin Cancer Foundation, to understand how skin cancer shows up in Black people and what to look out for.
ESSENCE: If most skin cancers can be linked to sun exposure, and most diagnoses for people of color are found in areas that typically receive low sun exposure, how do these skin cancers develop?
Dr. Kim Nichols: Scientifically, they’re researching in terms of how this comes about exactly, but there seems to be some sort of genetic predisposition in this group. The statistics show that the number one area that melanoma is found in people of color is the palm of the hand or the plantar surface of the feet, so there’s got to be a genetic basis to it.
What does research around melanoma look like for people of color?
Nichols: One of the barriers to research is scientists having such a small base population [of eligible people of color] to even study for this research. Unfortunately, when melanoma is found in people of color it is often found at a later stage, so scientists are not able to study the progression of it over time as they are in cases of those with lighter skin types.
Seeing that detection of the disease for people of color comes much later, are there early signs that people can and should look out for?
Nichols: It is important to pay attention to moles or lesions that may progress, change, enlarge, or become irregular over time. There is a system we call the ABCDEs of checking your own moles. A is for asymmetry, B is for border, C is for color, D is for diameter (specifically if the mole is smaller and grows to be larger than six millimeters; that is something to watch out for), and E is for evolution. If there is a change or irregularity to any of these markers, that is something to bring up to your dermatologist. When people of color are doing self checks, education is so important because they have to know to also look at areas that don’t get sun exposure such as their palms or soles of their feet.
Additionally, later detection for people of color tends to happen for a few reasons. Primarily, the lower rate of diagnoses as well as the location of diagnoses leads people of color to not check as frequently or in the less sun-exposed areas such as the aforementioned. Secondarily, as people of color tend to develop benign skin tags or seborrheic keratosis as they age, they may not always think to monitor those changes as closely.
As the old adage goes, most people of color [and Black people in particular] think they are immune to skin cancer or don’t need to wear sunscreen.
Do you have recommendations for how often people should be doing skin exams?
Nichols: I’d recommend, as early as 18 years old, doing self skin checks once a month. With knowing your body and knowing what moles you have, a month is a good amount of time to see changes. That’s super important. Then, see a dermatologist before the age of 40, every two years for a full body exam, and then once a year after the age of 40.
We understand that people of color with melanoma have an average five-year survival rate. Once someone is diagnosed with skin cancer, what does life look like from that point?
Nichols: Thankfully a five year survival rate for melanoma is relatively high compared to some other cancers, still, survival for people of color is around 70% compared to the 94% rate of people with lighter skin types. Both fairly good, but still a large difference. This is again, because detection for people of color tends to happen at a later, more invasive stage. Earlier detection is vital so that we hopefully start catching these at an earlier stage, which then will, of course, result in a higher than five year mortality rate.
Diagnosis usually occurs after a dermatologist sees a lesion or mole and recommends a biopsy, which is the act of taking a small portion and testing it. If it comes back as melanoma then they determine the stage and how deep it is. The next intervention is full excision, or surgical removal of the entire lesion plus a large border. They then check to see if there has been any spread to the lymph nodes. Depending on that, for some people if it’s caught early enough, surgery can be the cure. In later stages or deeper melanomas, chemotherapy or other interventions could be needed.
What are risks to look out for when it comes to your susceptibility of being diagnosed with melanoma?
Nichols: Seeing that we are dealing with such a small population in terms of skin of color melanoma patients, we do believe there is some sort of genetic predisposition. That said, looking at family history of melanoma is very important and could lead to more diligent skin checks. And of course, skin of color still requires sun protection and awareness of safety from sun exposure.
More information on types of skin cancer, risk factors, and a quiz to understand the disease better can be found on skincancer.org.