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      The Epidemiology of Skin Cancer and Public Health Strategies for Its Prevention in Southern Africa

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          Abstract

          Skin cancer is a non-communicable disease that has been underexplored in Africa, including Southern Africa. Exposure to solar ultraviolet radiation (UVR) is an important, potentially modifiable risk factor for skin cancer. The countries which comprise Southern Africa are Botswana, Lesotho, Namibia, South Africa, and Swaziland. They differ in population size and composition and experience different levels of solar UVR. Here, the epidemiology and prevalence of skin cancer in Southern African countries are outlined. Information is provided on skin cancer prevention campaigns in these countries, and evidence sought to support recommendations for skin cancer prevention, especially for people with fair skin, or oculocutaneous albinism or HIV-AIDS who are at the greatest risk. Consideration is given to the possible impacts of climate change on skin cancer in Southern Africa and the need for adaptation and human behavioural change is emphasized.

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          Most cited references69

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          Skin cancer in skin of color.

          Skin cancer is less common in persons with skin of color than in light-skinned Caucasians but is often associated with greater morbidity and mortality. Thus, it is crucial that physicians become familiar with skin cancer in persons of color so as to maximize the likelihood of early detection of these tumors. In dark-skinned ethnic groups, squamous cell carcinoma is most common; squamous cell carcinoma and melanoma usually occur on nonsun-exposed sites; and ultraviolet radiation is not an important etiologic factor for skin cancer with the exception of basal cell carcinoma. Races of intermediate pigmentation, such as Hispanics and Asians, share epidemiologic and clinical features of dark-skinned ethnic groups and Caucasians. Skin cancers pose a significant risk in skin of color and clinicians should focus on preventive measures in these groups such as regular skin exams, self-examination, public education, and screening programs. At the completion of this learning activity, participants should be familiar with the epidemiology and unique clinical features of skin cancer in skin of color and be aware of strategies to prevent skin cancer in skin of color.
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            The epidemiology of skin cancer

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              Skin cancer in African Americans.

              Skin cancer is the most common type of malignancy in the United States. Incidence within the African American population remains relatively low, but data is limited for this racial group, making accurate determination of incidence and mortality difficult. Factors implicated as causative in the pathogenesis of cutaneous malignancy in African Americans include, but are by no means limited to, sunlight, albinism, burn scars, X-rays, preexisting pigmented lesions, chronic inflammation, and chronic discoid lupus erythematosus. Anatomic distribution of lesions may be similar to that seen in whites for basal cell carcinoma but not for other skin cancers. For squamous cell carcinoma, melanoma, and cutaneous T-cell lymphoma, African Americans do not as well in terms of mortality as do whites. This difference probably is due either to the fact that African Americans have more advanced stages of disease at diagnosis than do whites or, in some cases, because the course of the disease is more aggressive in African Americans for reasons yet unknown. There is a need for heightened awareness of skin cancer in African Americans by patients and physicians. Emphasis should be on education and early diagnosis with the primary goal in mind being the reduction of incidence of and mortality due to skin cancer in African Americans. In addition, because of environmental factors, African Americans will be exposed to more solar ultraviolet radiation in the future. Strategies should be developed for public education to keep this exposure to low levels in this racial group.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                06 February 2020
                February 2020
                : 17
                : 3
                : 1017
                Affiliations
                [1 ]Environment and Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa; Danielle.Millar@ 123456mrc.ac.za
                [2 ]Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria 0002, South Africa; dupreez.dj@ 123456tuks.co.za
                [3 ]LACy, Laboratoire de l’Atmosphère et des Cyclones (UMR 8105 CNRS, Université de La Réunion, Météo-France), 97744 Saint-Denis de La Réunion, France
                [4 ]Biomedical Sciences, University of Edinburgh Medical School, Edinburgh EH8 9AG UK; mary.norval@ 123456ed.ac.uk
                Author notes
                [* ]Correspondence: Caradee.Wright@ 123456mrc.ac.za ; Tel.: +27-12-339-8543
                Author information
                https://orcid.org/0000-0001-9608-818X
                https://orcid.org/0000-0003-1546-9138
                https://orcid.org/0000-0001-9772-3843
                Article
                ijerph-17-01017
                10.3390/ijerph17031017
                7037230
                32041101
                2ffe0ccd-af23-488e-945e-2e842308f02f
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 17 December 2019
                : 23 January 2020
                Categories
                Article

                Public health
                climate change,environmental health,hiv/aids,keratinocyte cancer,melanoma,oculocutaneous albinism,public health,sun exposure

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