Derm Dx: Growing hyperpigmented lesion on an elderly Hispanic male - Clinical Advisor

Derm Dx: Growing hyperpigmented lesion on an elderly Hispanic male

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An 80-year-old Hispanic male presents for evaluation of a lesion on the right side of his face. The lesion has been slowly increasing in size over the last 2 to 3 years. He is currently on medications to control adult-onset diabetes and hypertension. The patient quit smoking several years ago. Physical examination revealed a hyperpigmented plaque with a slightly indurated base.

Nonmelanoma skin cancers (NMSCs), including basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), are the most common malignant tumors in the United States and have been estimated to affect more than 2 million Americans annually.1 While Hispanics have lower...

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Nonmelanoma skin cancers (NMSCs), including basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), are the most common malignant tumors in the United States and have been estimated to affect more than 2 million Americans annually.1 While Hispanics have lower rates of skin cancer 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.

The incidence of melanoma is increasing; from 1992 to 2008, cases of melanoma in the Hispanic population in the United States rose by 19%.3 Hispanic individuals have a broad range of skin types, from very dark type VI skin to very light type I skin, and all of these skin types are at risk for skin cancer.

As in non-Hispanic white individuals, the most common form of skin cancer in Hispanic persons is NMSC, and lesions are usually found on the face and neck. Interestingly, the majority of these cancers in the Hispanic population occur on the right side, as opposed to the left side in the non-Hispanic white population.4 The classic clinical presentation of BCC is a pearly telangectatic papule, but a significant percentage of BCCs in the Hispanic population are pigmented.5

In addition to the potential for difficulty in visual recognition of these lesions in this population, delayed diagnosis may result from lack of awareness or limited access to care. As the majority of NMSCs are related to sun exposure, public education endeavors stressing the need for sun protection should include people of color.6

Aroob Moin, DPM, is a podiatry-dermatology fellow at St. Luke’s University Hospital in Bethlehem, Pennsylvania.

Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.

References

  1. Asgari MM, Moffet HH, Ray GT, Quesenberry CP. Trends in basal cell carcinoma incidence and identification of high-risk subgroups, 1998-2012. JAMA Dermatol. 2015;151(9):976-981.
  2. 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.
  3. 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.
  4. McLeod MP, Ferris KM, Choudhary S, et al. Contralateral distribution of nonmelanoma skin cancer between older Hispanic/Latino and non-Hispanic/non-Latino individuals. Br J Dermatol. 2013;168(1):65-73.
  5. Bigler C, Feldman J, Hall E, Padilla RS. Pigmented basal cell carcinoma in Hispanics. J Am Acad Dermatol. 1996;34(5 Pt 1):751-752.
  6. 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.
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