Melanoma is a potentially deadly form of skin cancer linked to overexposure to ultraviolet (UV) rays from the sun. Sunscreen can block UV rays and therefore reduce the risk of sun burns, which ultimately reduces the risk of developing melanoma. Thus, the promotion of sunscreen as an effective melanoma prevention strategy is a reasonable public health message.
While this may be true for light-skinned people, such as individuals of European descent, this is not the case for darker skinned people, or individuals of African descent.
The public health messages promoted by many clinicians and public health groups regarding sunscreen recommendations for dark skin people is incongruent with the available evidence. Media messaging exacerbate the problem with headline after headline warning that black people can also develop melanoma and that blacks are not immune. To be sure, blacks can get melanoma, but the risk is very low. In the same way, men can develop breast cancer, however, we do not promote mammography as a strategy to fight breast cancer in men.
This message is important to me as a black, board certified dermatologist and health services researcher at Dell Medical School at the University of Texas at Austin, where I am director of the pigmented lesion clinic. In this capacity I take care of patients at high risk for melanoma.
Melanoma in black people is not associated with UV exposure
In blacks, melanoma usually develops in parts of the body that get less sun exposure, such as the palms of the hands and soles of the feet. These cancers are called “acral melanomas,” and sunscreen will do nothing to reduce the risk of these cancers.
When was the last time you had a sunburn on the palms or soles? Even among whites, there is no relationship between sun exposure and the risk of acral melanomas. Famously, Bob Marley died from an acral melanoma on his great toe, but sunscreen would not have helped.
The research on the association of UV radiation and melanoma among blacks is lacking. Most studies assessing the relationship exclude patients of darker skin types. In the largest study of this question to date, no connection was found between UV index or latitude and melanoma among black people.
Racial disparities in melanoma outcomes are not related to UV exposure
Many dermatologists often point out that black patients tend to show up to the doctor with later stage melanoma, which is true. However, this is an issue of access and awareness and has nothing to do with sunscreen application. Black people should be aware of growths on their skin and seek medical attention if they have any changing, bleeding, painful, or otherwise concerning spots, particularly on the hands and feet.