En español | For years, Yvonne Basil didn't think much of that little dark mark on her right baby toe. Even when it began to change and grow under the nail, she wasn't worried. After all, it didn't hurt and it wasn't sore. Nevertheless, when Basil, 54, had some use-it-or-lose-it funds in her flexible spending account, she decided to have it checked out by a doctor. “I thought I'd use my flex spending account to see a dermatologist because I didn't want to leave any money on the table,” she says.
Basil made an appointment with Seemal R. Desai, M.D., a dermatologist in Plano, Texas,and past president of the Skin of Color Society. Almost as soon as the examination began, the look on the doctor's face told her this was serious. “Dr. Desai looked like he'd seen a ghost,” Basil recalls. “Right away he said, ‘that's melanoma.’ “
As a Black woman who spent little time in the sun, Basil never believed skin cancer was a concern for people like her. Indeed, basal cell carcinoma, squamous cell carcinoma and melanoma, the three main kinds of skin cancer, are far more prevalent in whites. But, as Basil would learn, people of color are also at risk.
While most skin cancers are linked to excessive exposure to ultraviolet (UV) rays, Basil had acral lentiginous melanoma (ALM), which is believed to be caused by a genetic mutation and is not associated with excess sun exposure. ALM accounts for just 2 to 3 percent of all melanomas but is the most common form of melanoma affecting Black people. Typically found in the palms of the hands, soles of the feet or under nail beds, ALM is also more aggressive because it too often goes unnoticed and is diagnosed at a later stage.
With any type of skin cancer, people of color tend to fare worse than the rest of the population. According to the Skin Cancer Foundation, the average five-year melanoma survival rate is only 67 percent in Black people versus 92 percent in whites. “We know that 52 percent of Black patients, and 26 percent of Hispanics, present with an advanced stage of melanoma compared to only 16 percent of white people — just because of lack of awareness and [lower] perceived risk,” says Shani Francis, M.D., a dermatologist based in Manteca, California.
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Reggae superstar Bob Marley is perhaps the most famous case of ALM. He succumbed to a four-year battle with the disease that started in his big toe and was initially believed to be a soccer injury.
Basil first noticed the black spot on her toe around 2010, but basically ignored it for the next five years. She was dumbstruck to learn it was cancer and required an amputation. “I noticed a dark grayish, irregular spot on Yvonne's toe and recognized the danger,” Desai recalls. “Knowing that melanoma is more aggressive when it happens in patients of color, I wanted to take a biopsy right away."
Following the biopsy, an oncologist confirmed Desai's melanoma diagnosis and agreed that the toe needed to be removed. Fortunately, Basil's cancer was considered melanoma in situ at stage 0. “I caught it before it went deeper but on that part of the body it basically means removing the toe. We try to cut out [the melanoma] with margins, which must be a half centimeter around the spot. That's essentially the whole toe,” Desai says.
About a week after seeing Desai for the first time, Basil was in surgery. In addition to amputating the toe, the surgeon went in through her groin, the location of the nearest lymph node for melanoma on the foot, to conduct a sentinel lymph node biopsy (SLNB). This procedure is performed to remove and check the closest draining or sentinel lymph node for melanoma cells. Because Basil's SLNB did not find cancer cells there, she did not need radiation or chemotherapy.
Following the surgery, Basil wore a walkable boot for several weeks and focused on learning to walk and balance herself with one less toe. She and her family also took time to learn as much as possible about melanoma. “I learned that it's so important to really pay attention to your skin and use sunscreen. If I see a little spot or mole on my arm or anything, I start checking to see if it's growing or changing.” Basil also tells anyone who listens that it's a myth that Black people don't get skin cancer. She realizes how lucky she is to have been diagnosed at an early stage. “I tell everybody that Dr. Desai saved my life. I have nine toes and am glad of every one of them.”
Melba Newsome is an award-winning health and science writer whose work has appeared in Health Affairs, Scientific American, O and Newsweek.