When most people think of skin cancer, they often imagine it as a disease primarily affecting those with fair skin. The common perception is that darker skin tones offer natural protection from harmful ultraviolet (UV) rays. While it’s true that higher melanin content provides some defense, the reality is that skin cancer does not discriminate, and people of color are not immune. Unfortunately, the conversation about skin cancer often overlooks communities with darker skin tones, leading to delayed diagnoses, worse outcomes, and a critical need for greater awareness.
Understanding the Risk in People of Color
People with darker skin, whether Black, Hispanic, Asian, or Native American, generally have a lower risk of developing skin cancer compared to their lighter-skinned counterparts (Gloster & Neal, 2006). Melanin absorbs UV radiation and reduces DNA damage in skin cells, which lowers the chance of skin cancers like basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). However, this protection is not absolute. Skin cancer still occurs and can be just as dangerous, if not more so, when diagnosed late.
One major challenge is that skin cancer in people of color often presents in less typical ways. Instead of appearing on sun-exposed areas such as the face or arms, tumors frequently develop in less obvious locations, such as the palms, soles of the feet, under the nails, or mucous membranes (Bradford, 2009). Acral lentiginous melanoma (ALM), a rare but aggressive melanoma subtype, is disproportionately diagnosed in people of color and often on the soles of the feet or under nails (Hu et al., 2020). Because these sites are not typically examined closely, detection can be delayed.
Why Awareness Is Critical
A major hurdle is that many people of color and sometimes even healthcare providers believe skin cancer is not a serious concern for darker skin tones. This misconception contributes to fewer skin checks and a delay in seeking medical advice when unusual spots appear. According to the American Academy of Dermatology (AAD), Black Americans are 3 to 5 times more likely to die from melanoma than white Americans, mainly because the cancer is diagnosed at a later stage (AAD, 2022).
Education plays a vital role in bridging this gap. People of color should be informed about their risk and be empowered to conduct regular skin self-examinations, focusing on less typical areas such as the soles of the feet and under nails. Dermatologists also need to be trained to recognize skin cancer’s unique presentations in diverse populations and promote skin health inclusively.
Recognizing Signs and Symptoms
Skin cancer signs can be subtle and easily overlooked in darker skin. Instead of the classic red or pink hues seen in fair skin, lesions may appear darker—brown, black, or even bluish—or might not show much color change at all. The “ABCDE” rule used to evaluate moles for melanoma (Asymmetry, Border irregularity, Color variation, Diameter, and Evolution) still applies but requires careful attention to changes in existing marks or new growths in unusual locations (Rigel et al., 2010).
People of color should watch for:
- New or changing dark spots, especially on the palms, soles, or under nails
- Non-healing sores or ulcers
- Thickened or raised areas that look unusual
- Pigmented streaks under nails
- Any lesion that bleeds, itches, or changes shape
If any of these signs are noticed, it is important to seek prompt evaluation by a dermatologist.
The Importance of Early Detection
Early diagnosis can dramatically improve outcomes for skin cancer. When caught in its initial stages, skin cancer is often curable with simple treatment. However, late-stage cancers require more aggressive interventions and carry a higher risk of metastasis and mortality.
Routine skin checks, both self-exams and professional evaluations, are critical. People of color should include full-body skin assessments in their healthcare routine and communicate any concerns openly with providers. Teledermatology and mobile apps are emerging tools that may help improve access to skin exams for underserved communities.
Practical Prevention Tips for Everyone
Even with increased melanin, people of color should not disregard sun safety. UV rays can still damage skin and contribute to cancer risk. Preventive measures include:
- Using broad-spectrum sunscreen daily, even on cloudy days
- Wearing protective clothing and hats when outdoors
- Avoiding tanning beds and prolonged sun exposure during peak hours
- Staying vigilant about any changes in the skin
While sunscreen is often marketed toward lighter skin, people of color also benefit from it to prevent skin damage and photoaging (Taylor et al., 2019).
Skin cancer in people of color is a hidden threat that deserves more attention. By raising awareness, improving education, and encouraging early detection, we can help reduce the disparities in diagnosis and outcomes. Skin health is for everyone, regardless of skin tone. If you are a person of color, take time to know your skin, watch for unusual changes, and seek medical advice when needed. Your skin deserves care and protection, not just for beauty but for life.
References
- American Academy of Dermatology. (2022). Skin cancer in people of color. https://www.aad.org/public/diseases/skin-cancer/skin-cancer-in-people-of-color
- Bradford, P. T. (2009). Skin cancer in skin of color. Dermatology Nursing, 21(4), 170-177.
- Gloster, H. M., & Neal, K. (2006). Skin cancer in skin of color. Journal of the American Academy of Dermatology, 55(5), 741-760. https://doi.org/10.1016/j.jaad.2006.05.019
- Hu, S., Kirsner, R. S., & Polsky, D. (2020). Acral lentiginous melanoma: A review of clinical presentation, epidemiology, and diagnosis. Dermatologic Clinics, 38(1), 11-18. https://doi.org/10.1016/j.det.2019.08.004
- Rigel, D. S., Friedman, R. J., & Kopf, A. W. (2010). ABCDE rule of melanoma: A guide to early diagnosis. Cutis, 86(1), 14-18.
- Taylor, S. C., et al. (2019). Sunscreen use in skin of color: An evidence-based review. Journal of Drugs in Dermatology, 18(10), 1013-1017.
