Skin Cancer in People of Color: Why It's Often Caught Too Late and What You Can Do

When most people picture skin cancer, they imagine fair-skinned individuals with a history of sunburns and a lifetime of outdoor exposure. That image, while not entirely wrong, has contributed to a dangerous and persistent myth: that people with darker skin tones don't need to worry about skin cancer. The truth is more complicated, and more urgent.

Skin cancer does occur in people of color, and when it does, it is far more likely to be diagnosed at a late stage, when treatment is more difficult and outcomes are significantly worse. Understanding why this gap exists, and what can be done about it, is essential for every patient, regardless of skin tone.

The Myth of Melanin as Full Protection

Melanin, the pigment that gives skin its color, does provide some degree of natural protection against ultraviolet (UV) radiation. Darker skin has a higher melanin content and an estimated natural SPF of roughly 13 compared to approximately 3 in very fair skin. This is a meaningful difference, but it is not a shield.

People with darker skin tones can and do develop skin cancer, including the most dangerous form, melanoma. In fact, while the overall incidence of melanoma is lower in people of color than in white individuals, the mortality rate is substantially higher. Data from the American Academy of Dermatology has consistently shown that Black patients are far more likely to be diagnosed with melanoma at an advanced stage and have lower five-year survival rates than white patients with the same diagnosis.

The reason is not biological vulnerability, it is a combination of reduced awareness, delayed presentation, and a healthcare system that has historically underrepresented people of color in dermatology research and public health messaging.

Where Skin Cancer Often Appears in People of Color

One of the reasons skin cancer goes undetected longer in people of color is that it frequently develops in locations that are less commonly checked, and less associated with sun exposure.

Acral lentiginous melanoma (ALM) is a subtype of melanoma that occurs on the palms of the hands, the soles of the feet, and under the nails. This form of melanoma is relatively rare in white populations but accounts for a disproportionately large share of melanoma cases in Black, Hispanic, and Asian patients. Bob Marley, the legendary reggae musician, died of acral lentiginous melanoma that began under his toenail.

Squamous cell carcinoma (SCC) in people of color also behaves somewhat differently than in white patients. It is more likely to develop in areas that are not sun-exposed, including scars, burns, and sites of chronic inflammation. This variant tends to be more aggressive and carries a higher risk of spreading to other parts of the body.

Because these cancers appear in unexpected places, and because patients and even some clinicians may not think to look there, they are more often caught late.

The Role of Awareness and Access

Delayed diagnosis in people of color is not solely a matter of biology or tumor location. Systemic factors play a significant role.

Skin cancer education and prevention campaigns have historically featured fair-skinned individuals, leaving many people of color with the impression that these conditions simply don't apply to them. When awareness is low, people are less likely to perform regular self-exams, less likely to recognize warning signs, and less likely to seek evaluation promptly when something looks unusual.

Access to dermatologic care is also an issue. People of color are underrepresented among dermatology patients relative to their population share, partly due to disparities in health insurance coverage, geographic access to specialists, and cultural barriers including prior negative experiences with the healthcare system.

These are complex, systemic problems, but individual awareness and proactive care can make a real difference in the interim.

What to Look for on Your Own Skin

The classic ABCDE criteria for melanoma, Asymmetry, Border irregularity, Color variation, Diameter larger than a pencil eraser, and Evolution or change over time, apply regardless of skin tone. However, on darker skin, early changes can be subtler and harder to see, which makes it even more important to examine the entire body carefully, including areas not routinely visible.

Be sure to check:

The soles of your feet and palms of your hands. Look for any new dark streaks, patches, or growths that appear unusual.

Under and around your nails. A dark stripe running the length of a nail can be a sign of subungual melanoma. This is different from simple bruising, which typically resolves over time.

Areas of previous injury or chronic skin conditions. Scars, wounds that don't fully heal, or areas of long-standing irritation can be sites where squamous cell carcinoma develops in people of color.

Your entire scalp. Use a mirror or ask a partner to help check areas you cannot easily see on your own.

Any new or changing spot that concerns you, regardless of where it is on your body, deserves professional evaluation.

The Importance of Regular Skin Exams

A self-exam is a valuable first step, but it is not a substitute for a professional full-body skin check. A board-certified dermatologist is trained to evaluate lesions that may be difficult for untrained eyes to interpret, particularly on darker skin tones where color contrast between normal and abnormal tissue may be less pronounced.

The American Academy of Dermatology recommends that all adults, regardless of skin color, establish care with a dermatologist and discuss an appropriate screening schedule based on individual risk factors. If you have a personal or family history of skin cancer, a history of significant sun exposure, or a weakened immune system, more frequent monitoring may be appropriate.

A Note on Equity in Dermatologic Care

The dermatology community is actively working to address the disparities in skin cancer outcomes among people of color. This includes expanding education about how skin conditions present across different skin tones, increasing diversity in clinical research, and improving access to care in underserved communities.

But meaningful change also requires patients to advocate for themselves. If you have a spot that concerns you, trust your instincts and seek evaluation. If you have never had a full-body skin check, consider scheduling one, whatever your skin tone.

How Specialists in Dermatology Can Help

At Specialists in Dermatology, our team is experienced in evaluating skin concerns across all skin tones and complexions. We understand that skin cancer can look different depending on a patient's background, and we take a thorough, individualized approach to every skin exam.

If you have not had a full-body skin check recently, or if you have noticed something on your skin that doesn't look right, we encourage you to schedule an appointment. Early detection saves lives, and that is true for every patient, regardless of skin color.