Melanin Matters: How Skin Cancer Affects People of Color
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If you have black or brown skin, you have more melanin, or natural pigment, than people with white skin. Extra melanin provides protection from sun-related damage. This defense, however, isn’t perfect.
“Having darkly pigmented skin, skin that’s rich in melanin, offers some natural protection against skin cancer, but it certainly doesn’t provide immunity to skin cancer,” says Andrew Alexis, M.D., MPH, vice chair for diversity and inclusion for the Department of Dermatology and Dermatologist at the Center for Diverse Skin Complexions at Weill Cornell Medicine. “When skin cancers occur in individuals with richly pigmented skin, they tend to have some differences in appearance, location and prognosis [compared with skin cancers in people with less pigmented skin].”
By knowing the signs of skin cancer and practicing sun safety, you can build on your skin’s pigmented protection.
Why Skin Cancer Is (Often) Worse in People of Color
Despite skin cancer occurring less frequently in Black people and other people of color, when it does occur, the outlook is often worse than in non-Hispanic white people. In a 2023 study of men with melanoma, white patients had the highest overall survival rate (75%). That’s despite white people having a much higher lifetime risk for the disease than people of color, according to the American Cancer Society. Hispanic men in the study had the second-lowest overall survival rate (66%), and Black men had the lowest (52%).
Several factors contribute to worse skin cancer prognoses for people of color, Dr. Alexis says, including:
- A higher risk of developing skin cancer in areas that don’t receive much sun exposure, such as the soles of the feet or beneath the toenails, and may be more likely to be overlooked
- A lower likelihood of receiving full-body skin checks by medical providers due to the reduced risk of skin cancer in people of color
- Lack of awareness that people with richly pigmented skin can develop skin cancer
These factors can delay diagnosis, leading primary care providers and specialists, such as dermatologic oncologists, to identify skin cancer in later stages in people of color. When diagnosed later, skin cancer is often more difficult to treat and has a worse outlook than if found early.
Get to Know Your Skin Like the Back of Your Hand
You can gain an advantage over skin cancer by conducting a monthly, full-body check of your skin. These checks help familiarize you with your body’s largest organ, making spotting abnormalities easier— and, potentially, leading to an earlier diagnosis if skin cancer were to occur.
Examine every area of your skin from head to toe using a full-length mirror and a handheld mirror. You can also ask your barber or hairdresser to tell you if they notice any suspicious spots on your scalp while cutting or styling your hair, the American Academy of Dermatology Association recommends.
Don’t overlook parts of your body that rarely or never see the sun.
“In populations of color, the No. 1 site for a melanoma [the most serious form of skin cancer] is on the lower extremity, including the foot,” Dr. Alexis says. “An example of a famous individual who was diagnosed with a melanoma on the foot is the late reggae legend Bob Marley, who had a melanoma on his big toe.”
When examining your body, look for both new moles and ones that appear different from your last check. If a mole’s color, size, texture or shape has changed, you should have a medical provider look at it. You should also tell your medical provider about any moles that are bleeding and won’t heal, have uneven edges or are asymmetric in color or shape.
Some skin cancers may look different in people of color than people without richly pigmented skin. Basal cell carcinoma, for example, which is the most common form of skin cancer, may be pink in someone with light skin. For a person of color, however, this type of cancer may appear as a brown spot, according to Dr. Alexis.
Be Sunscreen Smart
People of color, like all people, should regularly apply one ounce of sunscreen to all uncovered skin. Reapply sunscreen at least every two hours or more often if you sweat or spend time in the water, which can make protection wear off sooner.
Dr. Alexis recommends wearing a sunscreen of at least sun protection factor 30 that protects against both UVA and UVB, the types of ultraviolet radiation that can cause skin damage. You’ll know the product offers this protection if you see “broad-spectrum” on the label. To get in the habit of wearing sunscreen every day, Dr. Alexis suggests using a moisturizer that contains sunscreen.
Wearing sunscreen—especially a tinted variety, which features mineral ingredients and added pigments—may help people of color protect against a common skin problem that occurs with age: hyperpigmentation, which is when a spot of skin is darker than the skin around it.
“Sunscreens with tint protect against visible light, which is another important component of the light emitted by the sun,” Dr. Alexis says. “That visible light can induce hyperpigmentation. We see conditions such as melasma, which is a common facial condition in which hyperpigmentation occurs. You can minimize your risk by using tinted sunscreens that are also UVA- and UVB-protective.”
Take Your Sun Protection to the Next Level
Start by protecting your skin with sunscreen, but don’t stop there. Take additional steps to reduce your risk of sunburn and skin cancer, including:
- Avoid spending time in the sun from 10 a.m. to 2 p.m., when the sun’s rays are strongest.
- Seek shade outside when you can.
- Wear a wide-brimmed hat.
- Wear full-coverage sunglasses with a UV rating of 400.
- Wear pants and long-sleeved shirts.
Finally, in addition to performing monthly skin self-exams, see a dermatologist once each year so they can look for potentially problematic skin spots. With two pairs of eyes on your skin on a regular basis, skin cancer is less likely to go unnoticed.
Concerned about a mole or patch of skin that doesn’t look quite right? Schedule an appointment with a dermatologist at Weill Cornell Medicine.