People with skin of color have a lower incidence of melanoma compared with fair-skinned populations, primarily due to the increased degree of ultraviolet (UV) protection offered by higher concentrations of melanin in the skin. A recent systematic review in JAMA Dermatology suggests that many studies do not support standard melanoma prevention recommendations for people with skin of color, especially in regard to the promotion of UV protection in this population.
The review included 13 peer-reviewed studies published from the origin of the study database (PubMed, Cochrane, and Web of Science) to June 2020. These studies were ecological studies (n=7), cohort studies (n=5), and a case-control study (n=1) and evaluated the correlation between UV exposure and the risk for cutaneous melanoma in people with skin of color. All of the studies included in this review were considered moderate to low quality as assessed by Oxford Centre for Evidence-Based Medicine criteria.
The racial/ethnic identifies of participants with skin of color in these studies included anything other than non-Hispanic White or those with Fitzpatrick skin types IV through VI or ability to tan and rarely or never get burned. The measures of UV exposure were the UV index, latitude, irradiance, history of sunburn, and history of phototherapy.
Although the researchers did not conduct a meta-analysis of the data, they did identify more than 7700 melanomas in people with skin of color in all the reviewed studies. There was no association between UV exposure and melanoma in people with skin of color in 11 out of the 13 studies. Only 1 study demonstrated a small positive relationship between UV exposure and melanoma risk in Black men, and 1 study demonstrated a weak correlation between UV and melanoma risk in Hispanic men.
Limitations of this review study were the potential misclassification of race and/or ethnicity in the included studies as well as the inconsistent quantification of UV exposure across studies.
Although this review suggests that “the promotion of UV protection for melanoma prevention in skin of color should be tempered,” the researchers note that “photoprotection may be associated with benefits in other UV-associated disorders, such as photoaging, melasma, and postinflammatory hyperpigmentation” in these patients.
Lopes FCPS, Sleiman MG, Sebastian K, Bogucka R, Jacobs EA, Adamson AS. UV exposure and the risk of cutaneous melanoma in skin of color: A systematic review. Published online December 16, 2020. JAMA Dermatol. doi:10.1001/jamadermatol.2020.4616