While skin cancer is often perceived as a risk primarily for those with lighter skin tones, it poses a significant, and often more deadly, threat to people of color. Although individuals with darker skin have more melanin, which offers some natural protection against UV rays and reduces the incidence of melanoma compared to white populations, they are tragically more likely to die from it when diagnosed.
This alarming disparity isn’t due to melanin offering no protection, but overwhelmingly stems from skin cancer being diagnosed at a much later, more advanced stage in Black patients. The five-year survival rate for Black individuals diagnosed with melanoma is dramatically lower than for white patients, often cited as being around 71% compared to 94%. Understanding the reasons behind these late diagnoses is crucial for improving outcomes.
Why Skin Cancer is Often Missed in Darker Skin
Several factors contribute to the delayed detection of skin cancer in people with darker skin:
- Misconceptions & Lack of Awareness: A prevalent myth exists that darker skin is immune to skin cancer. This leads to lower awareness among patients about their risk and what suspicious changes to look for. Patients may not seek medical attention as early, attributing changes to other causes.
- Different Presentation & Location: The most common type of melanoma in people of color is Acral Lentiginous Melanoma (ALM). Unlike melanomas on lighter skin, which often appear on sun-exposed areas, ALM typically shows up on the palms, soles of the feet, or under the nails. This is tragically illustrated by the case of reggae icon Bob Marley, whose death from ALM began as a dark spot under his toenail initially thought to be a soccer injury. Because these areas aren’t typically associated with sun damage, both patients and sometimes providers may overlook them.
- Inadequate Training for Medical Professionals: Dermatology training has historically focused on recognizing conditions on lighter skin. Many dermatologists and residents report receiving insufficient training on skin conditions in Black patients. This lack of exposure and confidence can lead to misdiagnosis or a failure to consider skin cancer as a possibility when examining patients with darker skin tones. A lack of diverse images in medical textbooks and online resources exacerbates this issue, making it harder for doctors and patients alike to recognize what skin cancer looks like on darker complexions.
- Systemic Barriers to Healthcare: Broader health disparities, including lack of insurance, limited access to specialized providers, transportation issues, inability to take time off work, and historical medical mistrust within communities of color, can all contribute to delays in seeking and receiving timely diagnoses and care.
- Standard Detection Methods Don’t Always Apply: The widely promoted ABCDE rule for melanoma detection (Asymmetry, Border irregularity, multiple Colors, Diameter > 6mm, Evolving) is less effective for identifying ALM, which often presents differently.
- Don’t Skip Sun Protection: While ALM is common in less exposed areas, sun protection is still vital for reducing the risk of other skin cancers and protecting overall skin health. Use broad-spectrum, water-resistant sunscreen with SPF 30 or higher. If you have darker skin, look for sunscreens specifically formulated to avoid leaving a white or ashy cast. Also, seek shade and wear protective clothing.
- www.nebraskamed.com
- www.verywellhealth.com
- www.indystar.com
- www.aamc.org
- med.stanford.edu
Efforts to Improve Recognition and Outcomes
Fortunately, significant efforts are underway to address these disparities:
Improved Medical Education: Organizations like the American Academy of Dermatology have developed curricula focused on skin of color. Medical schools are increasingly updating their teaching materials to include more diverse images and case studies. New programs, like the Skin of Color program at Stanford Medicine, are being established with pillars focused on culturally sensitive care, research, teaching, and community outreach.
Raising Public Awareness: Initiatives like Brown Skin Matters and Skin Deep are creating vital image banks and educational resources to show what dermatological conditions, including skin cancer, look like on a wide range of skin tones.
Increased Diversity in Dermatology: Efforts are being made to increase the representation of Black and other underrepresented groups in dermatology, as studies show that shared racial or ethnic backgrounds between patients and physicians can improve patient experience and potentially outcomes.
How to Check for Skin Cancer on Darker Skin
Early detection remains the most critical factor for improving survival rates. Everyone, regardless of skin tone, should perform regular self-checks. For people with darker skin, paying close attention to less sun-exposed areas is particularly important:
Perform Monthly Self-Exams: Use a full-length mirror and a hand mirror to check your entire body. Pay special attention to hands, feet, and nails. Don’t forget hard-to-see areas like the scalp (ask a barber or hairdresser for help), back, groin, and buttocks. Look for any new spots, moles, discoloration, or sores that don’t heal.
Know the Signs of ALM (Use the CUBED Rule): Since ALM often doesn’t follow the ABCDE pattern, experts developed the CUBED acronym specifically for recognizing potential melanoma on the feet and nails:
C: Colored lesions where any part is a different color.
U: Uncertain diagnosis or a lesion without a clear clinical diagnosis.
B: Bleeding lesions on the foot or under the nail.
E: Enlargement of a lesion.
D: Delay in healing of any lesion beyond two months.
Be especially vigilant about dark streaks under nails (particularly the big toe) that weren’t caused by injury, or flat spots on the soles that might thicken or cause pain. Manicurists and pedicurists can also be helpful in spotting abnormalities.
Find a Knowledgeable Dermatologist: Seek out a dermatologist with experience and expertise in treating skin of color. Organizations like the Skin of Color Society offer directories of such physicians. Academic “ethnic skin centers” also exist.
By increasing awareness among both the public and medical professionals, addressing systemic barriers, and focusing on the specific ways skin cancer presents in darker skin, we can work towards closing the deadly gap in melanoma outcomes for people of color. Early detection saves lives.
