A problem under the sun – Rise of skin cancer in Hispanics, blacks concerns dermatologists

Bahar F. Firoz, M.D., M.P.H.
Board-certified dermatologist Bahar F. Firoz, M.D., M.P.H.

SAN ANTONIO (May 28, 2010) — People with fair skin, blue eyes and red hair are still at the highest risk for skin cancer, but doctors say the number of darker-skinned patients with skin lesions has risen dramatically, both under the hot Texas sun and nationally.

Bahar F. Firoz, M.D., M.P.H., of The University of Texas Health Science Center at San Antonio, says melanoma is increasing among Hispanic women in particular. “Among Hispanic women of all ages in Texas, melanoma incidence increased 4.8 percent every year from 2002 to 2006. That is a very high rate,” Dr. Firoz said. “In Hispanic women over 50, this incidence is a whopping 10.8 percent. Overall, the incidence of melanoma is increasing in darker-skinned patients.”

Dr. Firoz, assistant professor of dermatology and cutaneous surgery in the Health Science Center School of Medicine, sees patients through UT Medicine San Antonio, an academic physician practice based in the Medical Arts and Research Center (MARC). Dr. Firoz is one of more than 250 School of Medicine faculty doctors who screen and treat patients at the MARC. She is board certified in dermatology with a specialty in Mohs surgery.

Mohs surgery, performed at the MARC building as an outpatient procedure, is a technique in which skin cancer is removed with its surrounding margins. While the patient waits, the tumor specimen is processed as a frozen section. The Mohs surgeon analyzes the tissue under the microscope to determine if any tumor cells are left behind. The tissue is sectioned en-face, Dr. Firoz said, which means all the tissue around the tumor, 360 degrees, is analyzed. This enables precise removal of the entire tumor, but preserves as much normal tissue as possible.

Mohs surgery, named for its inventor, can last one hour to several hours depending on the type, size and depth of the cancer, Dr. Firoz said.

Dangerous if left alone
Skin cancer is the most commonly diagnosed cancer in the U.S., according to the American Cancer Society. The most common types are melanoma, basal cell carcinoma and squamous cell carcinoma. “Melanoma can have the worst prognosis depending on its depth,” Dr. Firoz said. “Deep melanomas can metastasize and lead to death.”

Melanomas can spread to the surrounding skin, lymph nodes, the lungs, the liver, soft tissue and the brain.

Texas has seen an “epidemic of melanoma the last few years,” Dr. Firoz said. Because sun exposure and sunburns have been linked to higher rates of skin cancer, the rate of melanoma increase in Texas Hispanics may be related to the Texas sun, she said.

Troubling trend
Nationally among all ethnicities of all ages, the incidence of melanoma is rising 2.2 percent per year, according to data gathered from 2002 to 2006. In black and Hispanic patients under age 50, the increase in incidence is 4.5 percent a year.

“People of color need to be aware that they still have a risk for skin cancer, and that skin cancer is on the rise, especially in Texas,” Dr. Firoz said. “Patients should be checked at least once a year for skin cancer.”

Time equals tumor
Because darker-skinned patients do not expect to have skin cancer, this often leads to a delay in diagnosis and treatment, leading to more advanced tumors in these populations.

Hispanics are also at high risk for developing non-melanoma skin cancers (basal cell and squamous cell carcinomas among them). These are actually much more common than melanomas, Dr. Firoz said.

Dr. Firoz recently treated a San Antonio patient who is a transplant survivor. Because of anti-rejection medications that suppress the immune system, organ transplant recipients are up to 65 times more likely to get squamous cell carcinoma, 10 times more likely to contract basal cell carcinoma and four times more likely to develop melanoma than the general population.

The patient was successfully treated with Mohs surgery at the MARC. UT Medicine San Antonio offers Mohs surgery and many other dermatology services at this state-of-the-art building.

UT Medicine San Antonio is the clinical practice of the School of Medicine at the UT Health Science Center at San Antonio. With more than 700 doctors – all faculty from the School of Medicine – UT Medicine is the largest medical practice in Central and South Texas, with expertise in more than 60 different branches of medicine. Primary care doctors and specialists see patients in private practice at UT Medicine’s clinical home, the Medical Arts & Research Center (MARC), located in the South Texas Medical Center at 8300 Floyd Curl Drive, San Antonio 78229. Most major health plans are accepted, and there are clinics and physicians at several local and regional hospitals, including CHRISTUS Santa Rosa, University Hospital and Baptist Medical Center. Call (210) 450-9000 to schedule an appointment, or visit the Web site at www.UTMedicine.org for a complete listing of clinics and phone numbers.

Tips to Avoid Sunburn

  • Wear sunscreen with an SPF of at least 45
  • Reapply sunscreen every two to three hours
  • Don’t miss ears, nose, lips, hands or feet
  • Wear a 3-inch-wide brim hat, especially if you have thin hair
  • Wear a long-sleeve SPF swim shirt (lightweight and breathes but protects); these are available at sporting goods stores or online

Know the ABCDE of Skin Cancers

  • A – asymmetry (normal moles or freckles are symmetrical)
  • B – border (ragged or undefined edges)
  • C – color (different hues in the same spot or mole; also lightening or darkening)
  • D – diameter (if larger than the size of a pencil eraser, have it examined)
  • E – evolution (has it changed within the last three months?)

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