Skin of Color & Melanoma
Melanoma does not discriminate.
Although melanoma is relatively uncommon in people of color, when it is diagnosed, it is often diagnosed in later stages, making treatment more difficult. The most common locations for melanoma on people of color are areas that have little exposure to the sun – the palms of the hands, soles of the feet, on fingernails and toenails and inside the mouth.1
In Caucasians, more than 90% of cutaneous (skin) melanomas are thought to be linked to UV exposure.2 This includes UV rays that come from either natural sunlight or from tanning beds. However, in people of color, nearly 75% of melanomas occur on the palms of the hands, soles of the feet, under nails and in mucous sites like the mouth, nasal passages or genitals. These types of melanomas may be classified as acral lentiginous melanomas or mucosal melanomas. Melanoma can also occur in the eye. This is called ocular melanoma.
While UV exposure plays less of a role in the development of melanoma in people of color, other risk factors include a depressed immune system, radiation therapy, preexisting pigmented lesions, albinism and burn scars.1
What is skin of color?
According to the Skin of Color Society, “People with skin of color are of diverse racial and ethnic backgrounds, and include African Americans, Asians, Hispanics or Latinos, Native Indians and Pacific Islanders primarily, as well as individuals from these groups who have intermarried.”
What does melanoma look like?
Having your skin checked once each year by a dermatologist, as well as checking your skin at home each month, may help melanoma be caught in its earliest stage. Although melanoma can only be diagnosed with a biopsy, the ABCDE rule can help you and your dermatologist identify a melanoma.
A: Asymmetrical Shape – Melanomas are often irregular, or not symmetrical, in shape. Benign moles are usually symmetrical.
B: Border – Typically, non-cancerous moles have smooth, even borders. Melanomas usually have irregular borders that are difficult to define.
C: Color – The presence of more than one color (blue, black, brown, tan, etc.) or the uneven distribution of color can sometimes be a warning sign of melanoma. Benign moles are usually a single shade of brown or tan.
D: Diameter – Melanomas are often greater than 6 millimeters in diameter (approximately the size of a pencil eraser).
E: Evolution (or change) – The evolution of your mole(s) has become the most important factor to consider when it comes to diagnosing a melanoma. Knowing what is normal for YOU could save your life. If a mole has gone through recent changes in color and/or size, bring it to the attention of a dermatologist right away.
What does melanoma under the nail look like?
Melanoma under the fingernails or toenails is sometimes called subungual melanoma.
The ABCDE rule is modified for melanoma under a nail bed. Remember, each letter is equally important, but these must be used together to best detect subungual melanoma early.
A: Age range of 20-90 years (peak incidence is between the 5th and 7th decades of life) and African-American, Native American or Asian.
B: Band of brown or black pigment in nail OR breadth of > 3mm OR border that is irregular or blurred.
C: Change of size or growth rate of nail band OR lack of change is irregular nail despite treatment.
D: Digit involved (nail melanoma is most common in the thumb, big toe and index finger); pigmented band on a single digit is more suspicious; dominant hand involvement is more common.
E: Extension of brown or black pigment to the side or base of the nail.
F: Family or personal history of melanoma or irregular moles.4
- Melanoma incidence rates vary by racial group:
- African-American – 1 per 100,000
- Asian/Pacific Islander – 1.6 per 100,000
- Hispanic – 4.9 per 100,000
- Indian/Alaskan Native – 7 per 100,000
- Non-Hispanic White – 37 per 100,0004
- Nonwhites are more likely to have advanced and thicker melanomas upon diagnosis and lower melanoma-specific survival compared with whites.4
- People of color benefit from specific doctor recommendations explaining their risk of developing melanoma and which places on the body to check.5
How can YOU make a difference in the fight against melanoma?
- Check your skin every month for new or changing lesions.
- Get a full-body skin check by a board-certified dermatologist once each year.
- Encourage your friends and family members to pay attention to their own skin and check it regularly.
- Schedule an annual dilated eye exam by an optometrist or an ophthalmologist.
- Participate in science and become an advocate. Surveys, mole-mapping apps and other opportunities exist so your voice can be heard.
The bottom line:
“The increased morbidity and mortality rate associated with skin cancer in POC is due to lack of awareness, diagnosis at a more advanced stage and socioeconomic barriers hindering access to care. Raising public health concerns for skin cancer prevention strategies for all people, regardless of ethnic background and socioeconomic status, is the key to timely diagnosis and treatment.”6
Asa Boomer-Brazier was diagnosed with Stage 3b melanoma in 2012. He is now seven years NED.
Jackie was diagnosed with melanoma at the age of 22.
Lashea was diagnosed with ocular melanoma at the age of 36.
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- Gloster HM, Neal K. Skin cancer in skin of color. J Am Acad Dermatol,2006;55:741-60
- Lucas RM, McMichael AJ, Armstrong BK, Smith WT. Estimating the global disease burden due to ultraviolet radiation exposure. Int J Epidemiol. 2008;37(3):654-667
- Levit EK, Kagen MH, Scher RK, Grossman M, Altman E. The ABC rule for clinical detection of subungual melanoma. J Am Acad Dermatol. 2000;42(2 Pt 1):269-274. doi:10.1016/S0190-9622(00)90137-3
- Wu XC, Eide MJ, King J, et al. Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006. J Am Acad Dermatol. 2011;65(5 Suppl 1):S26-S37. doi:10.1016/j.jaad.2011.05.034
- Kundu RV, Kamaria M, Ortiz S, West DP, Rademaker AW, Robinson JK. Effectiveness of a knowledge-based intervention for melanoma among those with ethnic skin. J Am Acad Dermatol. 2010;62(5):777-784. doi:10.1016/j.jaad.2009.08.047
- Gupta AK, Bharadwaj M, Mehrotra R. Skin Cancer Concerns in People of Color: Risk Factors and Prevention. Asian Pac J Cancer Prev. 2016;17(12):5257-5264. Published 2016 Dec 1. doi:10.22034/APJCP.2016.17.12.5257
Content last updated: June 16, 2020