Skin cancers in skin types IV–VI: Does the Fitzpatrick scale give a false sense of security?

Abstract

The Fitzpatrick scale has been in use for skin colour typing according to the tanning potential of skin since its inception in [1975][1976]. Thomas Fitzpatrick developed the scale to classify persons with 'white skin' in order to select the correct amount of UVA in Joules/cm 2 for PUVA treatment for psoriasis. Since then, it has been widely used in Dermatology to gauge the skin's reaction to UV exposure, tanning potential, assessment of sunburn risk and amount of sun protection required for individual patients. However, the use of this scale has been of limited utility because of different self-perception in different areas of the world, particularly among those with skin of colour. Skin cancer risk is loosely inversely correlated with the initial genetic/inherent amount of melanin (most research has focused on eumelanin) present in the skin, although the pattern of exposure and amount of UV radiation required causing DNA damage varies widely according to different cancers. In this review, we have shown that the Fitzpatrick scale is neither correct nor adequate to reflect sunburn and tanning risk for skin of colour. Therefore, it may give both patients and physicians a false sense of security that there is little risk that people of colour can develop skin cancers. We have reviewed the small but not insignificant risk of skin of colour developing skin cancers and emphasise that there remains much research that needs to be done in this field. Abbreviations: Asian, persons tracing their origins to primarily Asian origins; Black, non-Hispanic persons of primarily African origins; Hispanic, Persons tracing their origins to primarily Central or South American origins; White, non-Hispanic persons of primarily European Caucasian origins. Peter Goon and Nick J. Levell are joint senior authors.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Case Report of a Patient of Black Ethnian With Skin Cancer in a Hospital Downtown in São Paulo

“…In Brazil, these data confirm, as the National Cancer Institute (INCA) records that the non-melanoma type corresponds to 30% of all malignant tumors registered in the country, of which 70% are BCC and 25% are SCC (32) . Among skin tumors, the non-melanoma type has the highest incidence and lowest mortality, both in men and women, being more common in people over 40 years of age and black children, with the exception of those with previous skin diseases (6,18,36,47) .…”

“…Several studies show that the most important risk factor associated with the etiology of these tumors is sun exposure, whose action is more aggressive in light-skinned individuals, with UV-Ba radiation being more harmful and mainly responsible for the carcinogenic effect. (3,4,5,18,43) .…”

“…On the other hand, melanin plays an important role in protecting the skin against ultraviolet radiation, and its levels are inversely correlated with the intensity of radiation-induced DNA damage in the human skin in different ethnic groups. (3,18,24,51) .…”

“…Due to the photoprotection promoted by the more pigmented melanin in the skin, skin cancers are less frequent in black patients, although this population more frequently dispenses with the use of sunscreens and reports less occurrence of sunburns. (3,18) . But despite the lower risk of this population, black patients who develop skin cancer are faced with increased morbidity and mortality, as they present with different characteristics from the white population.…”

“…But despite the lower risk of this population, black patients who develop skin cancer are faced with increased morbidity and mortality, as they present with different characteristics from the white population. (2,3,13,18,50) . In addition, mortality is higher when the lesion arises from an inflammatory process, being greater in spinal tumors, making the prognosis of SCC severe and reserved in black patients.…”