Can You Make the Diagnosis?
An 80-year-old Hispanic man presents for evaluation of a lesion affecting the right side of his face.
An 80-year-old Hispanic man presents for evaluation of a lesion affecting the right side of his face. The lesion has been slowly increasing in size during the last 2 to 3 years. He is currently receiving medications to control adult-onset diabetes and hypertension. The patient quit smoking several years ago. Physical examination reveals a hyperpigmented plaque with a slightly indurated base.
By Stephen Schleicher, MD
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Nonmelanoma skin cancers (NMSCs), including basal cell carcinomas and squamous cell carcinomas, are the most common malignant tumors in the United States and have been estimated to affect more than 2 million Americans annually.1 Although Hispanics have lower skin cancer rates than non-Hispanic whites,2 the true incidence of NMSCs is difficult to calculate, as these neoplasms are not routinely reported to most tumor registries. Between 1992 and 2008, melanoma cases in Hispanics in the United States rose by 19%,3 but stabilized between 2008 and 2012.4 People of Hispanic descent encompass a broad range of skin types from very dark type VI skin to very light type I skin. All these skin types are at risk for skin cancer.
As in whites, the most common form of skin cancer in Hispanics is NMSC, usually found on the face and neck. Interestingly, the majority of these cancers in Hispanics occur on the right side, as opposed to the left side in whites.5 Visual recognition of the classic clinical presentation of basal cell carcinoma, the pearly telangiectatic papule, is more challenging in darker skin types. Further, a significant percentage of basal cell carcinomas in the Hispanic population are pigmented.6 Delayed diagnosis may also result from socioeconomic factors such as limited access to care7 and lack of awareness; Hispanics perform self-skin examinations at a lower rate than whites.8 As many NMSCs are related to sun exposure, public education endeavors stressing the need for sun protection should include ethnic populations.9
- Asgari MM, Moffet HH, Ray T, et al. Trends in basal cell carcinoma incidence and identification of high-risk subgroups, 1998-2012. JAMA Dermatol. 2015;151(9):976-981.
- Harris RB, Griffith K, Moon TE. Trends in the incidence of nonmelanoma skin cancers in southeastern Arizona, 1985-1996. J Am Acad Dermatol. 2001;45(4):528-536.
- Coups EJ, Stapleton JL, Hudson SV, et al. Linguistic acculturation and skin cancer-related behaviors among Hispanics in the Southern and Western United States. JAMA Dermatol. 2013;149(6):679-686.
- Garnett E, Townsend J, Steele B, Watson M. Characteristics, rates, and trends of melanoma incidence among Hispanics in the USA. Cancer Causes Control. 2016;27(5):647-659.
- McLeod MP, Ferris KM, Choudhary S, el al. Contralateral distribution of nonmelanoma skin cancer between older Hispanic/Latino and non-Hispanic/non-Latino individuals. Brit J Dermatol. 2013:65-73.
- Bigler C, Feldman J, Hall E, Padilla RS. Pigmented basal cell carcinoma in Hispanics. J Am Acad Dermatol. 1996;34:751-752
- Rouhani P, Arheart KL, Kirsner RS. Differences in melanoma outcomes among Hispanic Medicare enrollees. J Am Acad Dermatol. 2010;62(5):768-776.
- Amber KT, Bloom R, Abyaneh MY, et al. Patient factors and their association with nonmelanoma skin cancer morbidity and the performance of self-skin exams: A cross-sectional study. J Clin Aesthet Dermatol. 2016;9(9):16-22.
- Agbai ON, Buster K, Sanchez M, et al. Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748-762.