Care for All Skin Types and Complexions: Q&A with Shadi Kourosh, MD, MPH

Dr. Arianne (Shadi) Kourosh is a board-certified dermatologist at Mass General Brigham. She serves as the director of the Dermatologic Community Health Program and is the founding director of the Clinic for Pigmentary Disorders at Massachusetts General Hospital.

Dr. Kourosh has a special connection with our Bermudian patient population who seek treatment at Mass General Brigham for various skin conditions. In this Q&A, she discusses her dedicated care for Bermudian patients and how to prevent skin cancer and premature aging.

Why are you passionate about caring for Bermudian patients? How did you develop an interest in treating them?

I am lucky that from my youth I have had dear friends from Bermuda who have showed me the island and taught me so much about what a wonderful and unique place it is with such a rich culture and community. Bermudian people represent a truly diverse population with many different backgrounds, and the skin care and skin cancer education we provide must take into account that ethnic diversity.

As the founder of the Multi-Ethnic Skin Clinic at Massachusetts General Hospital and Harvard Medical School, I am committed to providing skin care and skin cancer prevention that is inclusive to all skin types, which is important for the Bermudian community.

Are there community programs or initiatives you're involved in to support Bermudian patients with skin conditions?

I have been working with news programs in Bermuda to do skin cancer and skin health education and answer peoples’ most common questions about the skin. This year (2024), I also had the pleasure of volunteering at the Bermuda End to End event where Mass General Brigham sponsored a special station to provide water and sunscreen to those participating in the walk. As a dermatologist it was very fitting that I was giving people sunscreen, and it was fun to see some of my friends who live in Bermuda and cheer them on as they walked. Who is vulnerable to developing skin cancer?

It's a common misconception that only those with fair skin are at risk for skin cancer. For patients with darker complexions, it may be tempting to believe that you aren’t at risk. In reality, people of all skin types can be diagnosed with and even die from skin cancer. For example, Bob Marley, the famous Jamaican musician, died because of melanoma. His cancer actually originated on his toe, which isn’t somewhere most people would think to look for skin cancer. So, it’s important to regularly check your entire body with a dermatologist, no matter the color of your skin.

What are the different types of skin cancer? How “severe” is each kind?

There are three main types of skin cancer:

• Basal cell carcinoma: This is the most common type of skin cancer. It usually shows up as a pearly or waxy bump or a flat, flesh-colored lesion.
• Squamous cell carcinoma (non-melanoma carcinoma): This type often looks like a firm, red nodule or a flat lesion with a crusted surface. It can be more aggressive than basal cell carcinoma. It is not as likely melanoma to spread to other parts of the body.
• Melanoma: This is less common than basal and squamous cell carcinomas. However, it is the deadliest type of skin cancer. It can either develop from an existing mole or show up as a new dark spot on the skin. Melanoma can quickly spread to other parts of the body if it is not treated.

Melanoma rates are rising because of increased, intense exposure to harmful UV rays and other radiation from the sun, and due to unhealthy habits like indoor tanning.

Why is skin cancer an important issue for Bermudians?

According to the National Tumor Registry, there are around 90 cases of skin cancer per year in Bermuda, of which 20 cases are melanoma. For a population of 60,000 people, these numbers are considerable. This once again illustrates just how important it is to see your dermatologist regularly to check for skin cancer.

What are the best ways to prevent skin cancer?

These are my top three tips to prevent skin cancer and premature aging:

1. Regular skin checks. I cannot stress this enough. Everyone should be getting their skin checked with a dermatologist on a regular basis. If you have a family history of skin cancer, if you’ve had a lot of sun exposure or sun burns, or if you have a history of using indoor tanning beds, we recommend getting an annual skin evaluation.
2. Mineral sunscreen. Wear sunscreens that protect against UV radiation, visible light, and infrared radiation. Sunscreens need to be mineral based to protect you from all these forms of radiation. Look for active ingredients like zinc, titanium, or iron oxide. Reapply your sunscreen every two hours. Manufacturers only test sunscreen for two hours, so we really don’t know how well they hold up after that.
3. Protect your face from pollution. Pollution contains toxic chemicals that can damage the DNA in the top layers of your skin. Use mineral sunscreen and a cleansing routine to remove chemicals that may have deposited on the skin can protect your skin against pollution. Serums that contain antioxidants also help as they protect your skin from free radicals.

What treatments are available for skin cancer?

Treatment options depend on the stage of your cancer. Skin cancers are labeled from Stage I (least severe, limited to a small area at or near the origin) to Stage IV (most severe, spread across multiple areas of the body). The more severe the cancer stage, the more aggressive the treatment required to try and fight it.

For skin cancers in early stages, treatments may include:

• Surgical removal: Cutting away or freezing the cancerous cells.
• Radiation therapy: Using targeted radiation to destroy cancer cells.
• Topical treatments: Applying medicated creams.
• Photodynamic therapy: Using light-activated drugs to kill cancer cells.

Skin cancers in later stages may require:

• Immunotherapy: Engaging the immune system to fight cancer.
• Biological drugs: Targeting the specific molecules that are involved in cancer growth.
• Chemotherapy: Using drugs to kill cancer cells throughout the body.
• Surgery: Removal of the lymph nodes near the cancer site or cancer that has spread to other parts of the body.