The Epidemiology of Cutaneous Melanoma in the White and Black African Population Groups in South Africa

Abstract

Abstract:In this chapter, two South African population groups, White and Black African, are compared with regard to cutaneous melanoma (CM). The incidence of CM in Black Africans is about 10% of that in Whites, explained at least in part by the protection offered by cutaneous melanin. The incidence has probably risen in Whites over the past 40 years but seems to be unchanged in Black Africans. The commonest CM subtype in Whites is superficial spreading; it occurs on various body sites, the most frequent being the trunk in males and the lower leg/hip in women. Most CMs in both male and female Black Africans are found on the lower leg and/or hip with a significant proportion being acral lentiginous melanoma, a subtype rarely seen in Whites. Risk factors including exposure to the sun, trauma, human immunodeficiency virus infection, albinism, age, and genetics are summarized and are likely to differ between the two population groups. The stage of CM at diagnosis tends to be more advanced in Black Africans than in Whites and, similarly, the survival rates are considerably lower in Black Africans. Reasons for the differences in CM between the two population groups are suggested.

The incidence of melanoma in South Africa: An exploratory analysis of National Cancer Registry data from 2005 to 2013 with a specific focus on melanoma in black Africans

“…Since the black African group is the largest in SA, melanoma in this group has significant public health implications. [9] While melanoma in white individuals is most commonly of the superficial spreading histological subtype and typically affects the trunk in males and the legs in females, [9] melanoma in deeply pigmented people is more likely to be the acral lentiginous histological subtype affecting the palms and soles. [9][10][11][12] Several studies have reported worse disease outcomes for melanoma patients with darker skin types [10,12,13] and melanoma of hands and feet.…”

“…[9] While melanoma in white individuals is most commonly of the superficial spreading histological subtype and typically affects the trunk in males and the legs in females, [9] melanoma in deeply pigmented people is more likely to be the acral lentiginous histological subtype affecting the palms and soles. [9][10][11][12] Several studies have reported worse disease outcomes for melanoma patients with darker skin types [10,12,13] and melanoma of hands and feet. [1,14] Objectives Variation in reported SA incidence rates of melanoma [5,[7][8][9] makes it difficult to form robust conclusions.…”

“…[9][10][11][12] Several studies have reported worse disease outcomes for melanoma patients with darker skin types [10,12,13] and melanoma of hands and feet. [1,14] Objectives Variation in reported SA incidence rates of melanoma [5,[7][8][9] makes it difficult to form robust conclusions. Incidence rates ranging from 11.8 per 100 000 in white females in Northern Cape Province [7] to 69 per 100 000 for the white population in Western Cape Province have been reported.…”

“…Incidence rates ranging from 11.8 per 100 000 in white females in Northern Cape Province [7] to 69 per 100 000 for the white population in Western Cape Province have been reported. [9] For black Africans, the incidence rate is about 1 per 100 000. [9] The objective of this study was to analyse and describe the most recent age-standardised melanoma incidence rates from the National Cancer Registry (NCR) by population group, gender and province in SA.…”

An Analysis of Biopsies for Suspected Skin Cancer at a Tertiary Care Dermatology Clinic in the Western Cape Province of South Africa

“…Although data on MM incidence on the African continent remain scarce, a recent study showed the overall incidence of MM for South Africa to be 2.7 per 100 000, with the incidence in the white population being significantly higher at 23.2 per 100 000 [12]. MM in darker skin types o en presents as acral melanoma (AM), a rare distinct variant of MM that arises from the palms, soles, and nail apparatus and is associated with a poorer prognosis [13][14][15].…”