American Melanoma Institute · 5 min read
Skin cancer is less common in darker skin but often found later. Learn where it tends to appear, what it looks like, and why sun protection still counts.
Melanin, the pigment that gives skin its color, absorbs ultraviolet light and offers some built-in protection against sun damage. People with brown and Black skin do develop skin cancer less often than people with light skin. A lower risk still leaves some risk, and the belief that dark skin can't get skin cancer is one reason these cancers tend to be found late.
The American Cancer Society puts the lifetime risk of melanoma at about 1 in 33 for White people, 1 in 200 for Hispanic people, and 1 in 1,000 for Black people.
The outcomes run in the opposite direction from the risk. Citing American Cancer Society data, the Skin Cancer Foundation reports a 5-year melanoma survival rate of 70% for Black patients, compared with 94% for White patients. Stage at diagnosis explains much of that gap. In a Florida study cited by the Foundation, 52% of Black patients and 26% of Hispanic patients already had advanced melanoma when first diagnosed, compared with 16% of White patients.
Dermatologists point to a few causes. Public education about skin cancer has long featured light-skinned people, so many people of color never hear that the message applies to them. Doctors may also be slower to suspect skin cancer in a patient with dark skin, because they see it less often.
Location adds to the problem. In darker skin, these cancers often grow in places that neither patients nor doctors routinely check. Skin cancers can also look different on dark skin than they do in the textbook photographs most clinicians trained on.
The most common form of melanoma in people of color is acral lentiginous melanoma, which grows on the palms, the soles, and under the nails. Sun exposure does not appear to cause it. DermNet reports that this subtype makes up only 2 to 3% of all melanomas, but 40 to 60% of those diagnosed in people of Asian and African American heritage.
On the sole or palm, it starts as a brown or black patch with an uneven edge that slowly widens. Under a nail, it typically shows as a dark stripe running the length of the nail, most often on the thumb or big toe. Melanoma can also arise on mucous membranes, the moist lining of the mouth, nose, and genital area.
Squamous cell carcinoma (SCC) is the most common skin cancer in Black people and in people of Asian Indian heritage, according to the American Academy of Dermatology. In light skin, SCC is mostly a sun-driven cancer of the face and hands. In darker skin, DermNet notes, it more often develops on areas that see little sun, such as the legs, feet, and the anal and genital region.
Long-term inflammation and scarring are leading risk factors. SCC can arise in old burn scars, in leg ulcers and other wounds that have stayed open for months or years, and in skin affected by chronic conditions such as discoid lupus. A cancer growing in a scar or chronic wound is sometimes called a Marjolin ulcer. These tumors are more likely to spread than sun-caused SCCs, which makes a change in an old scar or wound worth a prompt look. Warning signs include a new firm lump, a raised edge, bleeding, or a sore that enlarges despite good wound care.
Basal cell carcinoma (BCC) is tied to sun exposure in every group. The classic description is a pink, pearly bump. In darker skin, about half of BCCs are pigmented, the Skin Cancer Foundation reports, so the bump looks brown or glossy black and can pass for a mole.
The American Academy of Dermatology recommends that people with darker skin pay particular attention to places the sun rarely reaches:
What to look for:
Dark lines in nails deserve some context, because they are common and usually harmless in people with brown or Black skin. Several nails with similar thin, even, stable lines are generally a normal variation. A single band on one nail that is new, widening, uneven in color, or spreading onto the skin beside the nail is the pattern that leads dermatologists to consider a biopsy.
Ultraviolet light contributes to BCC and to many SCCs and melanomas in people of every skin tone.
The American Academy of Dermatology recommends shade, sun-protective clothing, and a broad-spectrum, water-resistant sunscreen of SPF 30 or higher for everyone. Surveys find lower sunscreen use among people of color, and the white cast left by many mineral products is a common complaint. Tinted sunscreens address this. Their iron oxide pigments blend into deeper skin tones.
During any skin exam, a useful request is to have the doctor check your palms, soles, nails, and mouth along with the rest of your skin.
