People of color at risk for more deadly skin cancer
When Tereska James would tell friends that her sister Tanya had been diagnosed with stage four melanoma, an extremely aggressive skin cancer, the responses were almost always the same:
African-Americans don't get skin cancer.
"It was like, 'Wrong answer. Yes, we do,' " James said. "I have friends who are very health conscious. They eat right. They exercise. But they don’t use SPF. That was a wake-up call."
Though people of color have a lower risk of developing skin cancer than Caucasians, skin cancer in minority communities is more deadly and often found in areas not typically exposed to sun.
It didn't take long for Tanya's cancer to become fatal; after a two-month battle, she died Dec. 2 at age 44.
It's possible to develop cancer in the three types of cells in the epidermis, or top layer of skin. Squamous cells are flat and shed as new ones form. Basal cells line the deepest layer of the epidermis.
Melanocytes are the pigment-making cells of the skin that make melanin, which gives the skin a tan or brown color.
If caught early, melanoma, which develops from melanocytes, is curable. But it’s still the most aggressive skin cancer and more likely to spread to other parts of the body. It is 20 times more common in Caucasians than in African-Americans, according to the American Cancer Society.
Melanoma can be found in the skin cells in the back of the eyeball or as a black streak under the finger, explained Dr. Julie MacRae, a plastic surgeon with Christiana Cosmetic Surgery Consultants. Left untreated, it can spread to the lymph nodes, blood vessels and other organs.
Chemotherapy with the drug interferon can prolong survival for a year or two, but it is hard on the body.
"At this time right now, we don’t have really good treatment for the dissemination or spread of melanoma," she said.
Early on, there are often no symptoms of the disease, so yearly skin checks are imperative, MacRae said. Dilated eye exams are also helpful in detecting spots on the back of the eyeball.
Skin cancer in people of color is more commonly diagnosed in places such as the legs or bottom of the feet compared with the more typical spots on the face or upper body, explained Dr. Ellen Pritchett, a dermatologist with the Detroit-based Henry Ford Hospital.
Skin cancer prevention helps avoid treatment
The skin cancer spots are easy to overlook as well, Pritchett added.
"There's a lack of awareness," she said.
Acral lentiginous melanoma is the most common and deadly form of melanoma diagnosed in African-Americans, according to an analysis of skin cancer and protection in people of color published by the American Academy of Dermatology in 2014, with a five-year survival rate of less than 50 percent.
Typically, dark brown to black patches of acral lentiginous melanoma are found on the hands and feet, added Dr. Herbert Allen, chair of the department of dermatology at Drexel’s College of Medicine.
However, since the patches look similar to tinea nigra, a fungal infection also found on the palms of the hands and soles of the feet, it is often misdiagnosed.
"It kind of sneaks up on you," Allen said.
In rare cases, the melanoma can metastasize or spread, without doctors ever knowing where the primary cancerous spot occurred.
That's what happened to Tereska James' sister Tanya Haman.
At first Tanya Haman thought she just had bad allergies.
Then by Labor Day 2015, doctors told Haman, of Townsend, she had a viral infection and that she should take it easy.
Tuesday, after the holiday, Haman was still weak, but she wanted to go to work, mother Joan Mitchell-Williams recalled. But her daughter couldn't even put her car in reverse; her entire right side was numb so she couldn't move.
The pair sped to Christiana Hospital, where doctors did a series of tests.
"The doctor comes back an hour later with tears in his eyes," Mitchell-Williams said.
He told them that Haman's brain was bleeding in three places. A week later a biopsy revealed that Haman had melanoma, and that it had spread to her brain. Doctors checked her body all over, but they could not find a questionable mole or cancerous lesion.
"I was still in disbelief ... of all the cancers," Mitchell-Williams said.
She had 14 rounds of chemotherapy and radiation, but it didn't help her heal.
Throughout her treatment Haman expressed that she still wanted to go on the family's planned cruise to the eastern Caribbean over the Thanksgiving holiday with 34 family members, Mitchell-Williams said. So, they went as planned.
"She was having a wonderful time. She looked so beautiful," she said. But it turned out to be her last outing. She died eight days later on Dec. 2.
Living with skin cancer after life of tanning
The American Cancer Society estimates that there will be 76,380 new melanoma cases diagnosed in 2016. About 10,130 people are expected to die of melanoma in that same year.
Delaware ranked fourth-highest in the U.S. for incidence of melanoma, but due to low incidence rates, state data can measure skin cancer rates only in Caucasians specifically. Between 2007 and 2011, 1,320 Caucasians were diagnosed with melanoma, and there were 34 melanoma cases recorded as "other."
"When you talk to people of color, most people don’t think they can get skin cancer because of the melanin," James said. "You do hear melanin is natural protection from sun. ... I don’t need to worry about protection."
James is hoping to erase some of those misconceptions with the new Delaware-based foundation Brown Skin Too, which launched on Tanya's birthday in early February.
"If we can use this platform to change behavior and start the conversation, I think we have accomplished a lot," James said.
"You need to be educated and really in tune with your body."
Added her mom, "Your body is your best doctor."
Jen Rini can be reached at (302) 324-2386 or jrini@delawareonline.com. Follow @JenRini on Twitter.
Brown Skin Too Foundation
Launch event and benefit: Melanin Bright, Shine the Light will be held May 14 at the Clarion Hotel, 1612 N. Du Pont Highway, New Castle