It’s a Myth That Sunscreen Prevents Melanoma Skin Cancer in People of Color – A Dermatologist Explains

Skin cancer that can be fatal, melanoma, affects people of all racial and ethnic backgrounds. The risk factor most closely associated with developing melanoma is exposure to ultraviolet, or UV, radiation from the sun. In actuality, melanoma risk has been shown to be inversely correlated with sunburn risk.

Sunscreen's ability to filter UV rays and hence lower the incidence of sunburns may ultimately lower the chance of acquiring melanoma. So, it makes sense to advocate for sunscreen as a melanoma preventive approach in public health campaigns.

For those with lighter skin tones, such as those of European ancestry, this may be true, but not for those with darker skin tones, such as those of African or Asian ancestry.

The existing scientific data does not support the public health messaging about sunscreen recommendations for persons with dark skin that are being spread by many doctors and public health organizations. The issue is made worse by media messaging that repeatedly warns that black people are not immune to melanoma and that they can potentially acquire it.

They can get melanoma, to be sure, but the likelihood is exceedingly low. While males can also acquire breast cancer, we do not advocate mammography as a method of preventing it in men.

As a dermatologist with a black board certification and a health services researcher at Dell Medical School at the University of Texas at Austin, where I also serve as the clinic's director for pigmented lesions, this message is significant to me. I care for people who are at a high risk of developing melanoma in this role.

Black people's melanoma and UV exposure are not linked

Melanoma is 30 times more frequent in white Americans than in black Americans.

Melanoma frequently appears on the palms of the hands and soles of the feet in black individuals because these areas of the body are rarely exposed to sunlight. Sunscreen will not lower the risk of these "acral melanomas," as these malignancies are known.

When was the last time your soles or palms got burned by the sun? There is no correlation between sun exposure and the development of acral melanomas, not even among white people. Sunscreen would not have prevented Bob Marley's death from an acral melanoma on his big toe.

In a systematic review we completed two years ago, my study team examined all of the available medical literature on UV exposure and melanoma in persons of color. People of African, Asian, Pacific Islander, Indigenous, and Hispanic origin are included in this. 11 of the 13 studies that satisfied our inclusion criteria did not find any connection between UV exposure and melanoma.

One of the two studies that found a relationship found a connection between UV exposure and melanoma in black men. However, the identical study also looked at UV exposure with melanoma in other populations, including black women, white men and women, and Hispanic men and women. The researchers observed no correlation between UV exposure and melanoma in these other populations. Given that white individuals are the population in whom the relationship between UV exposure and melanoma has been repeatedly proven, this is an unexpected outcome. The reliability of the study's findings is thus called into doubt.

Based on latitude within the nation, the other study indicating a connection between UV and melanoma involved Hispanic males in Chile. A significant limitation of this study is the presence of a sizable community of Chileans of Croatian heritage, who would not be considered people of color, in the city with the highest incidence of melanomas.

The lack of melanin concentration measurements in these investigations makes it impossible to determine if potentially lighter-skinned persons of color may be more susceptible to UV-associated melanoma. However, there is no proof that UV exposure causes melanoma, not even in light-skinned East Asian people.

The basic result is that several studies into the relationship between UV exposure and melanoma in persons of color have produced scant or no evidence of a correlation.

There are no links between racial differences in melanoma outcomes and UV exposure.

It is true, as many dermatologists frequently note, that black individuals frequently present with later-stage melanoma when they see the doctor. However, this is not a matter of using sunscreen or getting enough protection from the sun; rather, it is a matter of access and knowledge. Black individuals, especially those with hands and feet, should be mindful of any growths on their skin and seek medical assistance if they have any changing, bleeding, or otherwise troubling places.

However, it makes little sense to believe that daily sunscreen use on a consistent basis will lessen an already highly rare incidence.

Given the natural sun-protective effect of greater melanin in darker skin, UV radiation does harm dark skin and can cause DNA damage; however, the damage is seven to eight times lower than the damage done to white skin.

To be clear, consistent use of sunscreen may aid in minimizing other UV impacts, such as sunburns, wrinkles, photoaging, and freckling, all of which are advantageous. However, the ordinary black person's low risk of melanoma is not expected to be significantly decreased by sunscreen use.

Why have we never heard of a melanoma outbreak in sub-Saharan Africa, an area with heavy sun, lots of black people, and little sunscreen, if sunscreen were crucial in the prevention of melanoma in individuals with dark skin?

Sunscreen usage may lower the incidence of melanoma in specific subpopulations of black individuals, such as those with illnesses that cause UV sensitivity, those with albinism - a condition in which people generate little to no melanin - or those with impaired immune systems. Any significant risk reduction from the use of sunscreen is unlikely if you don't fit into one of these groups.

Public health messaging that is generic falls short.

Many dermatological and skin cancer-focused groups, including a number to which I belong, advocate using sunscreen to lower the risk of melanoma in black patients. However, there is no evidence to back up this message. There is no research showing sunscreen lowers the risk of skin cancer in black individuals. Period.

Two new studies on sunscreen absorption published in the Journal of the American Medical Association have increased the urgency of the issue of frequent sunscreen usage among black individuals. This study demonstrated that when used at their highest levels, some chemical sunscreen components can enter the bloodstream in large concentrations with unknown effects on human health.

The research' findings that majority of the participants were black—the group least likely to get any appreciable health advantages from sunscreen—while being exposed to possibly dangerous chemical concentrations—surprised me the most.

Without pushing public health messaging that are based on fear and lack of proof, dermatologists and public health advocates can enhance how we inform patients and the general public about melanoma prevention. It is important to let black people know that although their chance of having melanoma is minimal.

A doctor should be consulted by anybody with dark skin who develops a new, changing, or symptomatic mole, especially if the mole is on the palms or soles. The risk factors for melanoma in black or dark-skinned persons are unknown, although they most definitely do not include UV radiation.

Adewole S. Adamson, assistant professor of internal medicine in the division of dermatology at the University of Texas at Austin, authored the article.

This article was first published in The Conversation.