"Dermatologic Conditions in Skin of Color: Part I. " (My Synopsis)

Dermatologic Conditions in Skin of Color: Part I. Special Considerations for Common Skin Disorders 
ROOPAL V. KUNDU, MD, and STAVONNIE PATTERSON, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Am Fam Physician. 2013 Jun 15;87(12):850-856.

     Ethnic skin has more pigmentation and acts differently than lighter skin. Basal cell carcinoma is the second most common skin cancer in african americans (its #1 in caucasian, asian, and hispanic skin). It is because of the greater protection dark skin gets from the increased melanin. Basal cell looks like a solitary pearly papule with a rolled border and telangiectasias. In patients with darker skin, the lesion will be pigmented. It may thus be difficult to recognize. It can be found on areas that are exposed to the sun, such as the head and neck. There is an elevated risk of basal cell carcinoma in areas of previous trauma, such as in scars, radiated areas, or in those who are immunocompromised. Diagnosis can be done with a shave biopsy. Treatment includes topical fluorouracil, curettage, or excision. It generally has a good prognosis.
     The most common skin cancer in african americans (and indians) is squamous cell carcinoma. It is #2 in hispanics, japanese, and chinese. Lesions most commonly occur in non-sun exposed areas (legs, scalp, groin), but UV light does have some role in the disease. Risk factors in darker colored skin is chronic scarring and inflammation. The lesions appearance varies, but it typically has erythematous patches, plaques, and nodules. Shave biopsy is done on these lesions. Treatment includes topical fluorouracil or imiquimod.
     Melanoma has the highest mortality rate of all the skin cancers, but the rate has dropped. Time of diagnosis and staging is directly related to the mortality rate. Patients with darker skin are often not diagnosed as early as patients with lighter skin, and thus are diagnosed at a more advanced stage, with worse outcomes. Melanoma follows the ACBDE mnemonic;
Asymmetry
Border irregularity
Color variation
Diameter (>6mm)
Evolution
It presents as a singular, pigmented, rapidly changing area. It is commonly found on the back, lower legs, and non-skin exposed areas. The most common subtype in patients of darker skin is acral lentiginous melanoma, which is melanoma affecting the palms, soles or nail beds. In hispanics and whites, the most common subtype is superficial spreading melanoma. Lesions are typically excised with 2 mm margins. Management is largely based on biopsy results.
     Acne must be treated carefully to avoid scarring or hyperpigmentation from the treatment. Skin and hair products could exacerbate acne, so it is important to discuss the use with the patient. Treatment of acne starts with benzoyl peroxide, topical antibiotics, and retinoids. Oral antibiotics can be given to patients with moderate to severe acne. If the acne is resistant, nodular, or cystic, then isotretinoin can be considered. Combination therapy is also effective.
     Postinflammatory hyperpigmentation is a common side effect when treating acne. Treatment for acne should be started at a low dose to avoid inflammation and irritation. Treatment that makes it worse should be avoided (it depends on the patient). When is appears, it looks like tan or brown spots. Treatment consists of managing the underlying condition. Sunscreen use should be encouraged. Hydroquinone cream alone or in combination with a topical steriod or retinoid may be helpful.  It will usually improve within 6-12 months.