According to Dr Shyamalar Gunatheesan
By Yasmin Jeffery •
It was only in the last few years that I learned sunscreen is important for people of colour, too: the Australian Cancer Council recommends everyone wear sunscreen everyday on days when the UV Index is forecast to be above three.
It’s also only recently that I’ve learned people with “dark” skin (dermatologists tend to define this as “type four” and above on the Fitzpatrick scale) like me can develop skin cancer, even if it happens to us a lot less often than it does to people with light skin.
It was around the same time I learned research from the US has suggested that when people with dark skin are diagnosed with melanoma, they’re more likely to be at a later stage of the disease.
Dermatologist Shyamalar Gunatheesan puts this down to three things.
She says the first is that it’s common for people with darker skin to dismiss the possibility they could develop skin cancers, like I did, because of our skin’s tendency to burn less and because of the way we’re taught about skin cancer.
Dr Gunatheesan says the second is that it can be common for practitioners to do the same.
And the third is that skin cancers in people with dark skin often develop in areas that aren’t often – or ever – exposed to the sun, and that we don’t routinely look at.
This means changes go unnoticed for longer than they might have if they’d occurred somewhere more visible.
This happens, Dr Gunatheesan says, because “not all skin cancer is sun-related”.
This isn’t always the case, of course.
Dr Gunatheesan says we don’t yet know exactly what causes acral lentiginous melanomas.
“We haven’t mapped out all the genes of non-sun-related melanoma. The messaging is ‘we don’t know, it’s not all sun-related’,” she explains.
It’s likely most people will be familiar with this advice. Where does the message diverge for people with dark skin?
“The biggest message for people with darker skin types is that it’s not just the typical sun-exposed areas for us,” Dr Gunatheesan says.
She recommends a monthly skin check using a mirror, looking at places including your bum, groin, hairline, nails, the soles of your feet and the palms of your hands, and the backs of your ears and neck.
For the harder to reach spots, she suggests asking a partner or friend for help.
“You can also ask your hairdresser to help check your scalp,” Dr Gunatheesan says.
With your nails, she explains you should be looking out for streaks of darker pigmentation.
“People with darker skin do get melanomas that present as little streaks and you’ll want to see a dermatologist if that happens. They can be benign, but if they change and extend wider out to your skin away from your nail, that would be a warning sign,” she says.
“And if you get a non-healing spot on any part of your body, if you get a flaky lesion that doesn’t go away – these are also all little clues. If you have an ulcer that isn’t healing, see a practitioner.”
Basically, the overwhelming message is to get things checked if anything out of the ordinary or concerning crops up, on all parts of your body.
“Low-risk does not mean no risk,” says Heather Walker, the chair of Cancer Council’s National Skin Cancer Committee.
“Get to know your skin and what’s normal for you … if you notice anything new, unusual or changing, go to the GP.”
“People with white skin don’t tend to feel strange about going to their GP and asking to see a dermatologist for a skin check. Part of it is about empowering people with darker skin to look at their skin and then interact with their GP and dermatologist,” Dr Gunatheesan continues.
“We should all be vigilant.”
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