Can people of African descent with very dark skin develop melanoma?

Can People of African Descent with Very Dark Skin Develop Melanoma?

Yes, people of African descent with very dark skin absolutely can and do develop melanoma, though it occurs less frequently than in lighter-skinned populations and presents with distinct characteristics that often lead to worse outcomes. 1

Epidemiology and Incidence

While melanoma incidence is approximately 20 times lower in Black populations compared to White populations, this does NOT mean Black individuals are immune to melanoma. 2, 1 The critical issue is that Black patients are diagnosed at later stages and experience significantly higher mortality rates compared to other racial groups. 1

• African Americans have a 5-year survival rate of only 70% compared to 92% for White patients. 3
• Black patients present with more advanced disease at initial diagnosis, contributing to higher cancer-specific mortality. 4, 5
• In the United States, Hispanic and Black individuals have persistently worse survival outcomes, indicating racial and ethnic inequities in diagnosis, access to care, and treatment. 1

Distinct Clinical Presentation in Dark-Skinned Populations

The most critical difference is anatomic location and melanoma subtype:

Acral Lentiginous Melanoma (ALM) Predominance

• ALM is the most common melanoma subtype in Black populations, occurring on palms, soles, and nail beds (subungual sites). 1, 4
• In studies of Black patients, 95% of cutaneous melanomas were located on acral sites, most commonly the foot (87%). 6
• Lower extremities are the most common location overall (52.8-56.1% of cases in Black patients). 5, 7
• ALM accounts for approximately 20.3% of melanomas in Black patients when specific histologic subtype is identified. 7

Advanced Stage at Presentation

• A large proportion (41.8%) of Black patients present with stage III or IV disease. 7
• Median Breslow thickness in African populations is 9 mm, with 84% presenting with thickness over 4 mm. 6
• Black patients present with deeper tumors, more advanced stage, and higher rates of ulceration and lymph node positivity than Caucasians. 5

Why Melanoma is Missed in Dark-Skinned Populations

Lack of Awareness

• Black individuals generally do not feel at risk for melanoma and are surprised that it can occur on palms, soles, and nails. 3
• There is a fundamental lack of understanding of the term "melanoma" and features of skin cancer in Black communities. 3
• Skin cancer awareness messages do not typically apply to or include Black people, creating a dangerous knowledge gap. 3

Healthcare System Failures

• Melanoma education for both Black patients AND healthcare providers is critically needed to increase disease awareness and facilitate early detection. 5
• The relationship with healthcare and habits of utilization significantly impact outcomes. 3

Critical Clinical Pitfalls to Avoid

Never provide false reassurance about melanoma risk to any patient based solely on skin color. 2, 8

High-Risk Sites Requiring Examination

• Always examine palms, soles, and nail beds in Black patients — these are the highest-risk sites. 1, 3
• Do not limit skin examinations to sun-exposed areas in dark-skinned patients. 2

Red Flags Requiring Immediate Dermatology Referral

• Any changing, irregular, or symptomatic pigmented lesion on acral sites. 2, 8
• New or changing pigmentation under nails (subungual). 1
• Any pigmented lesion on palms or soles that is asymmetric, has irregular borders, or is changing. 3

Protective Effect of Melanin is Relative, Not Absolute

While darker skin provides some protection against UV-induced melanoma on sun-exposed sites, this protection does NOT extend to acral sites where melanoma most commonly occurs in Black populations. 4, 6 The pathogenesis of acral melanoma is distinct from UV-related melanoma and involves specific genetic alterations. 4

Public Health Messaging Priorities

Two key messages must be emphasized for Black populations:

1. Melanoma skin cancer DOES occur in Black people. 3
2. High-risk sites include palms, soles, and nail beds — areas that should be checked regularly. 3

Healthcare providers should implement routine examination of these high-risk acral sites in all Black patients, regardless of perceived melanoma risk. 3, 5