According to the Centers For Disease Control & Prevention (CDC), skin cancer is the most common cancer in the U.S. Between 2007 and 2011 over 4.9 million Americans were treated for one of the several types of skin cancer—melanoma, basal cell carcinoma, squamous cell carcinoma, cutaneous T-cell lymphoma, dermatofibrosarcoma protuberans (DFSP), Merkel cell carcinoma, or sebaceous carcinoma.
Despite these sobering statistics, there is still a popularly held belief that African-Americans are unaffected by skin cancer. Why has this idea endured? And to what extent is it true? Can people of color get diagnosed with skin cancer? Let’s start with the good news.
1. Black skin does offer sun protection.
This scientific truth sounds a lot like an urban myth, but it is actually a well-researched fact that Blacks have more sun protection than their white counterparts, an additional 10.1 SPF to be exact. Darker skin has more melanin, a substance that both increases pigment and helps protect the deeper levels of skin against sun damage.
That being said, a SPF of 10.1 is far below the 30 SPF recommended by the Skin Cancer Foundation in order to prevent damage from ultraviolet (UV) rays. All skin burns, even Black skin.
2. Skin cancer is less common in African-Americans.
The CDC lists among the risk factors for skin cancer, “a lighter natural skin color; skin that burns, freckles, reddens easily, or becomes painful in the sun; blue or green eyes; blond or red hair.” This, along with the fact that damage from (UV) rays is the number one preventable risk factor for skin cancer, makes it easy to assume Blacks, who are naturally less prone to sun damage, are less affected by skin cancer overall.
Indeed, U.S. statistics bear this logic out. Between 2012 and 2016, there were 71,801 cases of invasive melanoma among non-Hispanic whites but only 372 among Blacks.
While this is all good news for people of color, it stops there.
3. Melanoma is often hidden in people of color.
Skin cancer is found in light-skinned patients almost primarily in areas of the body heavily exposed to the sun, such as the face, scalp, neck, nose and lips.
When Black patients are diagnosed with melanoma, it is often a genetic type called acral lentiginous melanoma (ALM). These growths are found in hidden harder-to-detect areas like the soles of the feet, palms, or underneath finger or toenails. In fact, 30-40% of skin cancers in Blacks are found on the soles of the feet.
Bob Marley, the legendary Jamaican musician, was diagnosed with this rare ALM form of melanoma. The black spot he found on his toe nail he initially attributed to a soccer injury. It was not treated and later metastasized leading to his tragic death.
Squamous cell cancer (SCC), another type of skin cancer, affects Blacks similarly. In one 1988 study, 15% of SCC instances in Blacks occurred in the anus.
Regardless of condition or disease, when it’s hard to detect, it’s hard to detect early. And if it’s hard to detect early, it’s hard to treat. And hard-to-treat cancers have lower survivability.
4. Doctors are not as good at detecting skin cancer in darker skin.
With so few instances of Black skin cancer, doctors aren’t going out of their way to look for it. And because these cancers are located in out-of-the-way areas, it’s no wonder that doctors are simply not finding it as often as they do on lighter-skinned patients.
But even once found, doctors still have difficulty correctly diagnosing skin abnormalities present in Black skin. In one survey, 113 dermatologists were shown 20 different images of skin neoplasms or inflammations in both white and Black skin. Doctors were more likely to (correctly) recommend biopsies for lighter-skinned patients, but more than 2.57 times as likely to (incorrectly) recommend biopsies for benign neoplasms in dark skin, and 58% more likely to to (incorrectly) fail to recommend a biopsy for a malignant neoplasm in dark skin.
Some of this may stem from modern-day medical educational curriculum. A 2021 cross-sectional study found that among 1123 skin images found in six major dermatological educational resources aimed at medical students, only 14.9% were classified as brown or black skin tones. Doctors simply have no familiarity with how skin cancer looks on Black skin and that is making it harder for them to make proper diagnoses.
Get our “Thriver Thursdays” Email
Get all the latest cancer prevention and treatment news plus upcoming survivor programs, straight to your inbox every Thursday. Your privacy is important to us.
5. Blacks are diagnosed with later stages of skin cancer.
It’s easy to see how all of these factors—skin cancer rarity in Blacks, harder-to-detect cancer sites, medical unfamiliarity—contribute to Blacks being diagnosed with skin cancer in later stages than their lighter-skinned counterparts. Compared to whites, people of color are almost 1.97 times as likely to be diagnosed with melanoma at Stage II, 2.05 times as likely to be diagnosed at Stage III, and a whopping 4.24 times as likely to be diagnosed at Stage IV. Over 16% of Blacks diagnosed with melanoma are diagnosed as Stage IV, compared to only 3.9% of whites.
Here’s the thing—cancer stage at diagnosis matters. It matters a lot. Melanoma, when detected at stage 0, I or II has a 98% 5-year survival rate, but only a 22% survival rate when detected at its latest deadliest stage, stage IV.
6. Skin cancer is most deadly to people of color.
Despite the initial protective effect of darker skin and rarity of diagnosis, these additional factors add up to a fairly deadly cancer for African Americans. Between 2001 and 2014, Blacks had a 5-year melanoma survival rate of only 66.2% compared to the 90.1% survival rate for whites.
Sadly, even when patients of the same stage were compared and other risk factors were accounted for, African Americans were still 1.48 times more likely to die from melanoma than their white counterparts.
Why are people of color hit hard by skin cancer?
Because melanoma-specific research hasn’t been done, it’s hard to say exactly why these specific health disparities exist. We can say for certain the reasons why inequities exist like this within the greater realm of cancer care though.
Healthcare inequity is caused by a number of things: inability to speak the language, lack of awareness about disease prevention and detection, lack of or understanding of insurance coverage, socioeconomic background, transportation barriers, and immigration status, among other things. All of these affect a patient’s access to cancer prevention, detection, and care services.
What We Can Do
No matter your ethnicity or skin cancer risk level, it’s always a good idea to protect your skin whenever you’re outdoors. Wear a sunscreen of at least 30 SPF, reapply every 2 hours or whenever you swim or sweat, and cover up with clothing, a wide-brimmed hat, and UV-protectant sunglasses. Once a month, do a skin self-exam and mention anything suspicious-looking to your doctor.
SHAREing & CAREing is a non-profit cancer support service based in Queens, New York. Our mission is to break down the very barriers between patients and healthcare we’ve described here. If you are having trouble paying cancer-related medical bills, we can help with grants and links to free and low-cost care. We offer one-on-one counseling to help you navigate insurance coverage claims, cancer care, or just to lend an understanding ear. Our staff and volunteers of cancer survivors are multilingual and can assist with language issues. What’s more, our services are free of charge to our community. Contact us if you need help. We’ve been there and we’re here for you.
- “Melanoma of the Skin Statistics,” Centers for Disease Control and Prevention
- “Prevalence and Costs of Skin Cancer Treatment in the U.S., 2002–2006 and 2007–2011,” American Journal of Preventive Medicine, 2016
- “Common Cancer Types,” National Cancer Institute
- “Skin Cancer Concerns in People of Color: Risk Factors and Prevention,” Asian Pacific Journal of Cancer Prevention, 2016
- “Ask the Expert: Does a High SPF Protect My Skin Better?” Skin Cancer Foundation
- “Melanoma Incidence and Mortality, United States—2012–2016,” Centers for Disease Control and Prevention
- “What Are the Risk Factors for Skin Cancer?” Centers for Disease Control and Prevention
- “10 Common Places to Get Skin Cancer,” Moffitt Cancer Center
- “Skin Cancer in Skin of Color,” Journal of the Dermatology Nurses’ Association, 2010
- “Why are so many Black patients dying of skin cancer?” Association of American Medical Colleges
- “Study Finds Discrepancies in Biopsy Decisions, Diagnoses Based on Skin Type,” Medscape, 2022
- “Ethnic Differences Among Patients With Cutaneous Melanoma,” JAMA Internal Medicine, 2006
- “Skin of color lacks representation in medical student resources: A cross-sectional study,” International Journal of Women’s Dermatology, 2021
- “Melanoma Survival Rates,” Melanoma Research Alliance
- “Melanoma Among Non-Hispanic Black Americans,” Centers for Disease Control and Prevention
- “Skin Cancer in People of Color,” American Academy of Dermatology Association
- “Bob Marley Should Not Have Died from Melanoma,” American Academy of Dermatology Association