On the Saturday before Labor Day 2015, 44-year-old Tanya Haman was feeling lethargic, with a headache she couldn’t seem to shake. When the divorced single mom checked in to an urgent care clinic near her tiny hometown of Townsend, Delaware, doctors gave her a routine exam, then told her she had a viral infection that simply needed to run its course. She was advised to go home, rest, and drink plenty of fluids.



On Tuesday, Haman got into her Honda and tried to force herself to go to work, but she couldn’t even make it out of the driveway. The gearshift wouldn’t go into reverse. Assuming there was a problem with the car, she called to her mother, who was inside the house, for help. “Mom came out, and the car was fine,” says Haman’s older sister, Tereska James, now 48. “My sister was not. She couldn’t shift the gears because she’d lost all feeling in her right side.”

Haman’s mom rushed her to the ER, where doctors ran a number of tests that ultimately revealed the devastating news: Haman was in the final stage of melanoma, the deadliest form of skin cancer. The disease had spread to her brain, meaning the doting mother of an 8-year-old boy who loved Scandal and Red Lobster wouldn’t have long to live—three to six months, possibly less. After hearing the diagnosis, James couldn’t stop thinking, But black people don’t get skin cancer.

In fact, black and brown people can and do get all types of skin cancer—not only melanoma but also the more common squamous and basal cell carcinomas—and though they’re less susceptible than white people, they’re significantly more likely to die from it.

Women of color may assume dark skin is a form of natural SPF, but it's not enough.

About two months after her diagnosis, Haman fell unconscious during a family cruise to the Caribbean to celebrate her son’s birthday; eight days later, she died.

Melanoma is the second-most common form of cancer in females ages 15 to 29, and is increasing faster than in men the same age.

Haman is part of an alarming trend: The five-year survival rate for African Americans with melanoma is 74 percent, compared with 93 percent for whites. Scientists can’t definitively say why this gap exists, but some studies offer a clue: Like Haman, many people of color may not be aware they’re in danger until it’s too late.

According to a 2016 database review of nearly 97,000 melanoma patients published in the Journal of the American Academy of Dermatology, nearly half of black and a third of Hispanic patients are diagnosed in late stages, while just 24 percent of white patients are. “When caught later, melanoma is far more difficult to successfully treat,” says study coauthor Jeremy Bordeaux, MD, an associate professor of dermatology at Case Western Reserve School of Medicine and director of the melanoma program at University Hospitals Cleveland Medical Center.

One possible explanation for these late-stage diagnoses is that black people are disproportionately more likely to get melanomas in inconspicuous places like the palms, the soles of the feet, and under the nails, a form of the disease called acral lentiginous melanoma that may be related to genetic mutations unique to people of color. Spots or lesions could be easily overlooked, and because these areas aren’t typically exposed to the sun, healthcare providers who detect an irregularity might not initially think of skin cancer.

Black people are more likely to die from skin cancer.

“Right now it’s unclear whether melanoma is more deadly in people of color because there’s a biological difference, or if African Americans are getting different or less timely treatment than other patients,” Bordeaux says. “More research needs to be conducted so patients and doctors can be better educated on the risks and signs.”

Another contributing factor is that women of color may assume dark skin is a form of natural SPF, so they’re less likely to have regular screenings or wear sun protection.

Only 15 percent of blacks and 36 percent of Hispanics frequently use sunscreen on their face, according to a study in the Journal of the American Academy of Dermatology.

It’s true that melanin, a pigment found in higher concentrations in dark skin, does offer some protection—but not nearly enough, says Miami dermatologist Heather Woolery-Lloyd, MD, director of ethnic skincare at the University of Miami’s Department of Dermatology and Cutaneous Surgery, who sees a diversity of women in her practice.

“Studies suggest that black skin may have a built-in SPF of up to around 10. The American Academy of Dermatology recommends everyone wear a sunscreen with an SPF of at least 30 daily. Skin color alone won’t cut it.”



It doesn’t exactly help that most sunscreen ads and mainstream messages about skin cancer protection feature Caucasians, according to Neelam Vashi, MD, director of the Boston University Center for Ethnic Skin, who conducts research on what motivates people of color to use SPF. “Representation matters,” she says. “If consumers don’t see themselves reflected, it’s harder to get them to change their behavior.”

65% of African American women said they’ve never used sunscreen.

In her most recent study, conducted primarily with Hispanic subjects, Vashi found that printouts about skin cancer that included photos of patients who looked like them were much more effective at prompting sunscreen use than spoken warnings. But, she stresses, experts need to figure out why, after saying they’ll use sunscreen, many people of color still don’t.

Yet another big reason why black and Hispanic women may not be using SPF regularly? Plenty of darker-skinned consumers have traditionally found sunscreen shopping to be an exercise in frustration. Mineral versions containing zinc oxide or titanium dioxide, which many dermatologists consider the gold standard in sun protection, can go on thick and white, leaving behind an ashy cast—and no one wants that.

“These products clearly weren’t created with black women in mind,” says Nigerian-born Chinelo Chidozie, who cofounded Bolden, a skincare line developed specifically for people of color, with her sister-in-law, Ndidi Obidoa. They launched their brand in 2012 after a trip to Florida, where the only sunscreen they could find left them with a look Obidoa describes as Casper the Friendly Ghost.



“The best sun protection is the kind you use regularly, but if you don’t like a product, you’re not going to put it on your skin,” Chidozie says. Sunscreens that rely on chemical filters like avobenzone and oxybenzone fare better, but their sometimes-greasy feel can be a huge turnoff for women of all skin tones. “We try to make it easy to fall in love with our product. It contains chemical filters, but it’s also moisturizing without leaving your face shiny or sticky.”

The cosmetics industry’s recent advances with innovative textures—tinted creams, clear SPF sticks, non-greasy whipped and gel formulas—could be game changers ushering in a new generation of sunscreens. Inspired by consumer feedback, the sunscreen brand Supergoop! recently introduced a completely transparent solid SPF. “We ended up changing manufacturing plants three times so we could create a clear, oil-based solid to address customers’ issues and make the product more convenient and easy to reapply,” says founder Holly Thaggard.

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Mainstream brands are also offering novel formulas that are friendlier to dark skin. Drugstore mainstays like Neutrogena and Olay have come out with fast-absorbing SPF moisturizers in newer lightweight textures. Shiseido, a department store brand, has reformulated its liquid sun care to have an invisible dry-down and launched a new clear UV protection stick.



Last summer the skincare brand La Roche-Posay introduced a revolutionary way to track sun exposure: a wearable sensor called My UV Patch that connects to a phone app. Now the technology has improved with UV Sense. Small enough to be worn on a fingernail, the battery-free sensor is activated by UV rays and tells you when to be extra mindful.

It’s a start, says Woolery-Lloyd. After talking with hundreds of women while developing Specific Beauty, a skincare line for multiethnic women, she realized that women of color are grateful when they feel they’re being paid attention to in a genuine way. “This population has huge unmet needs,” she says, “and can’t be a side thought anymore. It’s too important; we’re talking about people’s lives here.”

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Fortunately, Woolery-Lloyd and other dermatologists we spoke with are beginning to observe an attitude shift within their diverse patient populations, possibly because of increasing product options. “The question I always start off asking a first-time patient is,‘Do you wear sunscreen?’” says dermatologist Elizabeth Hale, MD, senior vice president of the Skin Cancer Foundation. “In the past, about 90 percent of my darker-skinned patients would say no.” Today she estimates that more than half of her new patients use a daily moisturizer that has SPF, with younger women the most likely to do so.

James, too, is doing her part to make sure the trend continues. Losing her sister, and the questions left behind, inspired her to start the Brown Skin Too Foundation, which promotes melanoma awareness among people of color.

The Delaware-based organization partners with a local skin clinic and hosts wellness events at churches and beaches, offering mole checks and advising on proper sunscreen use. With plans to take these programs to Maryland, New Jersey, Pennsylvania, and eventually nationwide over the next few years, James feels obligated to show that skin cancer doesn’t discriminate.

“My goal is to fill this education and awareness gap so that no mother, sister, daughter, family member, or friend has to experience this kind of loss,” James says. “There needs to be more awareness within the medical community, in particular among primary care physicians, so they treat skin of color with as much time and attention as they do other higher-risk skin.

No one should die from melanoma. Here's how to prevent it:

1. Apply one ounce of an SPF 30 or higher sunscreen (enough to fill a shot glass, or a golfball–size amount) to all exposed areas of the skin 15 to 30 minutes before going outside.

2. Reapply sunscreen every two hours or immediately after swimming or heavily sweating (post-run, for instance).

3. Do a skin self-exam every month, paying attention to moles with any of the ABCDE characteristics: Asymmetry, irregular Border, varied Color, Diameter longer than six millimeters, or spots that appear to be Evolving.

4. See a dermatologist once a year for a full-body examination. Uninsured? Visit aad.org for a list of free SPOTme skin cancer screenings in your state.

5. Women of color should watch out for sores that won’t heal; patches of rough and dry skin; dark lines underneath or around a fingernail or a toenail; and spots on the hands, soles of the feet, lower legs, groin, buttocks, scalp, inside of the mouth, and lips.

6. Wear sun-protective clothing and a wide-brimmed hat if you’ll be outdoors for more than two hours; avoid the sun as much as possible between 10 a.m. and 2 p.m.

This story originally appeared in the June 2018 issue of O.

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