Yes, People with Dark Skin Can Get Skin Cancer

Skin cancer may be associated with fair-skinned redheads who freckle and burn easily, but people with darker skin types aren’t immune.

Bob Marley passed away from acral lentiginous melanoma (ALM), an aggressive form of skin cancer, when he was just 36. (It showed up under a toenail and he initially brushed it off as a soccer injury.) Though Marley is the most famous example of how skin cancer can strike anyone, it’s true that it is much less common in those with darker skin, as melanin pigment offers some protection from UV exposure, says Sunil Kalia, national chair of the Sun Awareness Working Group at the Canadian Dermatology Association and an associate professor in the Department of Dermatology and Skin Science at the University of British Columbia.

“It’s not zero, but [skin cancer] is a thousand-fold less common in darker skin types,” says Kalia. “The risk is different depending on a person’s skin colour.”

In individuals with African or South Asian heritage, the incidence is about one case per one million per year, Kalia notes. The rate increases in those with East Asian, Hispanic and Indigenous heritage, but Kalia says it’s difficult to know the exact incidence because there isn’t enough data. “It doesn’t get studied as well, and there’s a lack of registries.”

Additionally, the ABCDE rule for detecting malignant melanoma—where moles are inspected for their asymmetry, border shape, colour, diameter and whether they’re evolving or changing—hasn’t actually been verified for darker skin types, adds Kalia. “One of the problems is that the melanoma they develop may not meet the same criteria.”

And while dermatologists are trained to recognize skin cancer in all skin types, including darker skin, primary care physicians might lack that awareness. “There could be physicians who are thinking, ‘Okay, this individual probably doesn’t have skin cancer because they are a darker skin type,’” says Kalia.

People with darker skin are also less likely to get regular skin checks. And when they do get skin cancer, it often shows up in places that don’t get a lot of sun exposure, like in nail beds, on palms or on the soles of the feet—in fact, more than half of melanomas in dark skin types are ALMs like Marley’s.

For these reasons, skin cancer is often detected later, and with worse outcomes. A diagnosis of advanced-stage melanoma (after the cancer has metastasized) is more common in Black and Hispanic patients than in white patients, and statistics from the Skin Cancer Foundation, a U.S.-based skin cancer awareness organization, show that the five-year melanoma survival rate in Black patients is 70 percent, compared with 94 percent in white patients.

“We need to have a better screening method for individuals with darker skin,” says Kalia, adding that it’s important to do it in a way that doesn’t cause undue anxiety in patients. “And we need more data on what the risk factors are.”

Next: I’m a Walking PSA for SPF—Don’t Make My Mistakes

Originally Published in Best Health Canada