Maryann Mikhail, MD.
Dr. Mikhail is a board-certified physician in the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine.
As a North African American, I grew up thinking that my dark skin made me invincible to skin cancer. It wasn’t until my first week of dermatology residency that I learned I was wrong. I had an appointment with an elderly Black woman who came into our clinic for a skin check, and I didn’t see anything suspicious. Then, my attending dermatologist, a skin of color expert, came in to double check, and he instantly identified a shiny, black growth on her face as basal cell skin cancer. I had never seen skin cancer in dark skin before. It was a humbling lesson that I still carry into my practice every day.
Many people don’t realize that skin cancer can affect all shades, but recognizing and treating it early is key. We can protect ourselves by learning what to look out for.
How common is skin cancer in people of different races?
Skin cancer is the most common cancer in the United States, but it isn’t clear how much it affects different racial groups. According to a research paper from 2009, skin cancer makes up as much as 45% of all cancers in white people, 5% of all cancers in Hispanic people, 4% of all cancers in Asian people, and 2% of all cancers in Black people.
Skin cancer is becoming more and more commonly diagnosed in white people, but in Black people, the rate of skin cancer seems to be staying low. However, when skin cancer is diagnosed in people of color, the tumor is often bigger, more advanced, and deadlier.
Take squamous cell carcinomas, for example. This type of skin cancer is 10 times more likely to spread if it happens in Black people compared to in white people. Looking at melanoma (another type of skin cancer), a study from 2017 that analyzed a database of patients from 1988 to 2011 found that 92% of white patients were alive 5 years after they were diagnosed compared to just 72% of African Americans.
We know that skin pigmentation provides some protection from cancer, which might partially explain the lower rate of skin cancer among people of color. But there is also a lack of awareness among providers and patients that can lead to delays in diagnosis or a diagnosis being overlooked.
Early diagnosis is critical for treating skin cancer successfully. Before we dive into more details, remember, the best thing about skin cancer is that you can see it. If you find a cancerous spot before it spreads, surgical removal or destruction cures it. This is the case regardless of skin color, so it’s important that all people learn to recognize what skin cancer looks like — and how it might look different on different shades of skin.
Types of skin cancer
If you look under a microscope, your skin cells are organized in layers like a layered cake. Squamous cells are on the top, and basal cells are on the bottom. Melanocytes, the cells that make pigment, are sprinkled in the bottom layer between basal cells.
Skin cancer happens when one of these cell types grows out of control. These are the three main types of skin cancer.
1) Basal cell carcinoma
Basal cell carcinomas (BCC) are the least dangerous form of skin cancer. They usually occur on skin that is often exposed to the sun, like on the head, shoulders, or back. While BCCs rarely ever spread, they can cause damage to surrounding tissues. Treatment is the same regardless of skin color. In most cases, surgical removal or destruction cures it completely.
2) Squamous cell carcinoma
Squamous cell carcinomas (SCCs) are more aggressive than BCCs but are not as bad as melanomas. SCCs in people of color have a higher chance of being aggressive and turning deadly compared to SCCs in people with light skin.
3) Malignant melanoma
Malignant melanomas (MM) are the worst type of skin cancer for people of all races. Fortunately, it’s also the least common. Surgery alone can cure most malignant melanomas if you find them early enough. If the cancer has spread, treatment tends to get more complicated, possibly requiring surgery and medications given through the blood like chemotherapy, targeted therapy, or immunotherapy.
Major risk factors for skin cancer in different shades of skin
Malignant melanomas are the most common type of skin cancer for people with lighter skin, and a major risk factor for MM in white people is sun exposure. Sun exposure is also the main risk factor for SCCs in this population.
But, it’s important to know that you can still get skin cancer from UV rays even if you don’t sunburn. If you’re anything like me, your dark skin might be giving you a false sense of security: I never burn and always tan when I’m in the sun, so I must be safe. It’s true that the skin pigment melanin does protect us to a certain degree. But there’s no such thing as a safe tan. In fact, sun exposure is the major driver for BCCs in all races. Tanning is one way skin responds to injury from harmful ultraviolet (UV) rays. Having dark skin that tans definitely doesn’t make us immune to getting skin cancer.
SCCs are the most common type of skin cancer for people with darker skin. The major risk factor for SCCs in this population is scarring caused by inflammation in the skin. This may be caused by conditions like:
- Lupus of the skin
- Burns
- Ulcers
- Radiation
- Trauma
If you have scars, it is important to keep an eye on them. Watch for new discoloration, growing bumps, or sores that don’t heal in or around those bumps. If you notice something suspicious, show a dermatologist right away.
Pictures of skin cancer in light and dark skin
When you look up skin cancer online, you’ll probably find pictures of what it looks like in light skin. But skin cancers look different in light and dark skin. Here’s a summary of the key differences.
Basal cell carcinomas
| Lighter skin: Dark spots with irregular coloration and borders Usually on the trunk or legs |
| Darker skin: Often darker colored growths, like an onyx, where blood vessels may or may not be visible Might have an open sore that doesn’t heal in the center Usually appear in areas that are normally exposed to the sun, like the face, neck, and chest |
Squamous cell carcinomas
| Lighter skin: Crusty, red bumps or sores that don’t heal Usually appear in areas that are normally exposed to the sun, like the face, neck, and chest |
| Darker skin: Dark-colored warts, bumps, or sores that don’t heal Often hidden in scars or in areas that get less sun exposure, like on the legs, around the anus, or in the genital area |
Malignant melanomas
| Lighter skin: Dark spots with irregular coloration and borders Usually on the trunk or legs |
| Darker skin: A dark patch on the sole of the foot or palm of the hand May also appear as a dark streak in the nails that changes over time |
How can I prevent skin cancer?
The best way to prevent skin cancer, no matter your skin complexion, is to protect your skin from the sun. We know that the sun’s harmful UV rays damage skin, no matter your skin type. So, enjoy the sun in moderation, and protect yourself at the same time. Avoid sitting outside for too long in the middle of the day. Seek shade and use sun protective clothing or sunscreen to make sure your skin doesn’t burn or darken.
When choosing a sunscreen, look for these three qualities:
- Water resistant
- Broad spectrum (i.e., protects against UVA and UVB)
- SPF 30 or higher
Apply sunscreen to your skin 20 minutes before you go outside. You’ll need a nickel-sized dollop for your face and a shot glass amount for your body to get the SPF on the label. While you’re outside, reapply every 2 hours or after swimming and sweating. Luckily, we also now have tinted products that blend well into dark skin!
How do I perform a skin self-exam?
The only way to truly diagnose skin cancer is to get a skin biopsy (more on this below). But it’s a good idea to learn how to check your skin for potential cancer growths so you can see a doctor early and give yourself the best chance at treating it successfully.
A self-exam for skin cancer is a full body screening of your skin that you do yourself. You will need a full-length mirror and a hand mirror to check your skin from head to toe. Pay attention to hard-to-see areas like:
- The bottoms of your feet and between your toes
- Your buttocks and groin
- Within your nails
- Inside your mouth
When you’re doing a self-exam, you want to look for anything abnormal on your skin. These can include:
- Spots that are new, growing, changing, itching, or bleeding
- Moles or dark spots that change over time
- Wounds, scabs, or sores that don’t heal
- Dark, thick, or uneven lines in your nails
- Discoloration in your nails that deforms your nails or crosses over to your skin
If you see anything suspicious, make an appointment with a board-certified dermatologist right away.
When should I see a dermatologist?
A timely diagnosis of skin cancer before it spreads could save your life. When you go to your dermatologist to check a spot, they’ll take a close look at your skin. Many will use a magnifying tool called a dermatoscope to help them see in more detail.
If they see something suspicious, they might recommend a skin biopsy. This is an office procedure done under local anesthesia. Once your skin is numb, the doctor removes a small sample for testing. The sample goes to a laboratory where another doctor looks at it under a microscope to decide if it’s cancerous or not. If a growth turns out to be cancerous, your dermatologist will discuss the next steps of your treatment.
The bottom line
Almost all skin cancers can be cured if they’re treated early enough. Unfortunately, there is a lack of knowledge around how skin cancer affects different racial groups, and how to recognize it in people with lighter and darker skin tones. However, we can change this by learning more about how to detect, prevent, and treat skin cancer in different shades of skin, and ensuring that we share this information with all providers and patients.
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