Skin Cancer in Skin of Color

Porcia T. Bradford


Dermatology Nursing. 2009;21(4):170-77; 206. 

In This Article

Basal Cell Cancer

Basal cell cancer (BCC) is the most common type of skin cancer in Caucasians, Hispanics, and Asians (Rubin, Chen, & Ratner, 2005) (see Table 1). Hispanics are six times more likely to be diagnosed with BCC than squamous cell cancer (SCC) and are more likely to be diagnosed with multiple BCCs compared to a solitary SCC (Byrd-Miles, Toombs, & Peck, 2007). In contrast, BCC represents the second most common skin cancer in Black s (Gloster & Neal, 2006; Halder & Bridgeman-Shah, 1995). The majority of BCCs in a clinical series at Howard University in Washington, DC, from 1960–1986 occurred in light-complexioned, as opposed to darker, Blacks (Halder & Bang, 1988). Thus, the frequency of BCC appears to be directly correlated with the degree of pigmentation in the skin, being most common in fair Caucasians and least common in African blacks.

UVR exposure is the most common etiologic factor for BCC in all racial groups (Gallagher et al., 1995) (see Table 1). Other possible risk factors for BCC include scars (Mora & Burris, 1981), ulcers (Abreo & Sanusi, 1991), chronic infections, immunosuppression (Maloney, Comber, Conlon, & Murphy, 2006), previous radiation treatment (Walther, Grossman, & Troy, 1981), and both physical and thermal trauma (Ewing, 1971; Gloster & Neal, 2006). Genetic disorders, such as albinism (Asquo, Agweye, Ugare, & Ebughe, 2007), xeroderma pigmentosum (Giannotti, Vanzi, Difonzo, & Pimpinelli, 2003), and nevoid BCC syndrome (Kimonis et al., 1997) are also risk factors for BCC.

The clinical features of BCC are similar in Blacks, Asians, Hispanics, and Caucasians. Most patients with BCC are elderly and present with asymptomatic, translucent, solitary nodules with central ulceration (Rubin et al., 2005) (see Table 1). Telangiectasias and a pearly, rolled border in dark skin or in a pigmented tumor may be difficult to discern. Interestingly, when BCC does occur in skin of color, pigmentation is present in more than 50% of the tumors (Bigler, Feldman, Hall, & Padilla, 1996; Gloster & Neal, 2006) (see Table 1). In contrast, only 5% of B CCs in Caucasians are pigmented. When pigmented BCC presents in skin of color, there are often incorrect diagnoses, such as seborrheic keratoses, malignant melanoma, or nevus sebaceous (Halder & Bridgeman-Shah, 1995). BCCs in Asians have been reported clinically to appear brown to glossy black and have the so-called "black pearly" appearance (Kikuchi, Shimizu, & Nishikawa, 1996). Lesions can occur as nodules, plaques, papules, ulcers, or in more advanced cases, indurated or pedunculated masses.

The anatomic distribution of BCC tends to be similar in Caucasians and people of color (see Table 1). In a review of BCCs in Washington, DC, Halder and Bang (1988) showed that 89% of BCCs in people of color occurred on the head and neck regions. This is also true in Caucasians (Rubin et al., 2005).

Metastatic BCC is rare in all races, with rates ranging from 0.0028% to 0.55% (Rubin et al., 2005). However, risk factors for metastasis include a tumor diameter greater than 2 cm, location on the central part of the face or ears, longstanding duration, and incomplete excision. The prognosis for metastatic disease is poor, with mean survival ranging from 8 months to 3.6 years (Rubin et al., 2005). Treatment for BCC includes Mohs' micrographic surgery, cryosurgery, and electrodessication and curettage.


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