Skin Cancer in Skin of Color

A lot of people with darker skin grow up hearing that skin cancer isn’t really their problem. Melanin does offer some natural protection from UV rays, that part is true. But some protection isn’t the same as immunity, and that misunderstanding is a big reason skin cancer in Black, Hispanic, Asian, and other patients of color tends to be found later, when it’s harder to treat.

Lower Risk, But Later Diagnosis

Melanoma is less common in Black Americans than in white Americans. Nobody disputes that. The concern is what happens once it does show up.

A CDC-published analysis of national cancer registry data found that only about 55% of Black patients with melanoma were diagnosed at a localized stage, compared with 78% of white patients. Black patients were also about three times as likely to be diagnosed after the cancer had already spread to distant parts of the body (16% vs. 5%). The five-year relative survival rate was 66.2% for Black patients and 90.1% for white patients.

The researchers pointed to delays in diagnosis as a likely driver of that gap. Later diagnosis, worse outcomes. It really is that simple, and that frustrating.

Meet Acral Lentiginous Melanoma (ALM)

Acral lentiginous melanoma, or ALM, is a subtype that occurs on the palms of the hands, soles of the feet, and under the fingernails or toenails. Overall, it is rare, but in those with darker skin, it accounts for a much larger share of melanoma cases. In that same CDC study, among melanomas where the subtype was identified, nearly half of those in Black patients were ALM, compared with about 2% in white patients.

Reggae icon Bob Marley is probably the best known example. His melanoma started under a toenail, and he reportedly thought at first it was a soccer injury. He died in 1981 at just 36.

Something that surprises many patients is that it does not appear to be driven by sun exposure, as most melanomas are. So, while still important, sunscreen won’t prevent it. Catching it early is what makes the difference.

What to Look For

ALM doesn’t always follow the classic ABCDE mole rules, and it’s easy to mistake for a bruise, a callus, a wart, or a nail fungus. These are worth getting checked:

• A dark spot or patch on a palm or sole that’s new, growing, or changing in shape or color
• A dark streak running lengthwise down a fingernail or toenail, especially on just one nail, or one that’s getting wider or has blurry edges
• Pigment spreading from the nail onto the surrounding skin or cuticle (dermatologists call this Hutchinson’s sign)
• A “bruise” under a nail that doesn’t grow out as the nail grows
• A sore on the hand or foot that won’t heal, or that bleeds

One note about nails. Many people with darker skin naturally have light brown streaks on several nails, and that’s usually harmless. A single streak that’s changing over time is the one to pay attention to.

Don’t Ignore Other Skin Cancer Types

Although melanoma gets most of the major headlines, it is not the only skin cancer that should cause concern. No skin cancer type should be ignored. Squamous cell carcinoma is the most common in Black patients. It initially appears in areas without sun exposure, and sometimes in old scars, burns, or spots with chronic inflammation. Basal cell carcinoma is the most common type for many Hispanic and Asian patients.

Practical Steps That Help

Check the places you usually skip. Once a month, look at your palms, soles, between your toes and under your nails. Taking off nail polish every so often makes this a lot easier, and a hand mirror (or a family member) helps with the bottoms of your feet.

Ask for a full skin exam that includes your feet and nails. Don’t assume it’s part of the routine, just ask.

Keep wearing sunscreen. It won’t prevent ALM, but UV exposure still plays a role in other skin cancers and in sun damage for every skin tone.

Trust your instincts. If a spot is changing, or something just seems off, get it looked at. If it turns out to be nothing, that’s a good outcome too.

Darker skin is not a free pass from skin cancer. The risk is lower, but when it does happen, it’s more often found late, and frequently in places like the feet and nails that people don’t think to check. Knowing what to look for, and getting suspicious spots evaluated early, is the best way to close that gap. Professional dermatologist Dr. Sherrie Straughn has been supporting Atlanta clients for more than three decades. Her years of experience and professionalism make identifying and treating skin cancer accessible and manageable.