We have long associated skin cancer with white people, particularly fair skinned whites. However, as the numbers of diagnosed skin cancers are growing among people of color, science is quickly re-evaluating prevention and identification methods and undertaking new research to find out why skin cancer appears to be growing exponentially among people of color. (As one example, a study published in the September, 2010 Puerto Rico Health Sciences Journal asserts that skin cancer among Puerto Ricans has grown 305 percent since 1974. The study was released today.)
One very commonly used method of evaluating skin cancer risk is the Fitzpatrick’s Skin Type Classification Scale. This scale which classifies skin into four types has long been considered a fundamental tool for dermatologists to measure risk levels of patients for skin cancers.
A recent study, however, questions the validity of this scale when applied to people of color. Published in Ethnicity & Disease, “Measuring Skin Cancer Risk In African Americans: Is the Fitzpatrick Skin Type Classification Scale Culturally Sensitive?” concludes that the Fitzpatrick scale “excludes the majority of Blacks, yields data that overestimates Black population prevalence of type IV skin, and excludes the Blacks who are least likely to use sunscreen.”
According to this study, a major reason why the Fitzpatrick scale is inadequate for measuring skin cancer risks for people of color is its “European cultural terms ’suntan’ and ’sunburn.’” These words do not reflect what happens to dark skin that is harmed by the sun – darkening, itching, flaking and irritation. The Fitzpatrick scale, in short, provides little or no mechanism for describing what happens when the skin of people of color is sun damaged. This in turn limits the ability of the medical profession to assess sun sensitivity and skin cancer risk.
Not surprisingly, the study found that “most Blacks did not categorize their skin into the Fitzpatrick skin types.” Its authors recommend “healthcare providers might use culturally-neutral words, e.g., the skin gets darker, itches, hurts, to enhance this aspect of skin cancer assessment for African Americans and other brown-skinned ethnic groups in the United States and elsewhere.”
The consequence of this important study and others should raise awareness about assessing skin cancer risks among people of color and perhaps prod the development of more inclusive tools.
At SunAWARE we believe the Fitzpatrick scale has important usages for evaluating skin cancer risks in European population groups and in that context it should not be discarded. However, this study makes clear its limitations in describing risk for people of color and we hope that modifications to it will be made very shortly, particularly in view of escalating skin cancer numbers among this group.
We will continue to watch for changes to this scale.
Be Safe. Be SunAWARE.
