Skin Cancer in Skin of Color: Why the “It Won’t Happen to Me” Myth Is Dangerous
For many years public messaging has focused on skin cancer as a disease that mostly affects people with fair skin who burn easily. Campaigns often show pale complexions, dermatology images are usually pink or red and people with Black, Brown, South Asian, East Asian, Middle Eastern or Indigenous skin are rarely represented.
This has allowed a persistent myth to form: “People with skin of colour don’t get skin cancer.”
Due to this aged messaging, it’s understandable to feel less cautious when outside if you have naturally darker skin or you do not burn easily. Relying on this myth can delay diagnosis at the very stage when skin cancer is most treatable. The reality is that skin cancer does occur in skin of colour and when it is diagnosed late outcomes are significantly poorer.
In this blog I will go through what you need to know, how skin cancer can look different in darker skin tones and why regular skin checks still matter.
Melanin Helps, But It Is Not Complete Protection
Melanin provides a level of natural protection by absorbing and scattering UV radiation. This is why deeper skin tones (Fitzpatrick types IV to VI) tend to burn less and tan more easily.
However, melanin is not a shield against skin cancer.
While the lifetime risk of melanoma is lower in people with darker skin, the outcomes are worse when melanoma does occur. International data shows that patients with darker skin are more likely to be diagnosed at a later stage and with thicker tumours, which significantly reduces survival rates.
Because these cancers are discovered late the chance of successful treatment is reduced, even though the overall risk is lower.
Skin Cancer Looks Different in Skin of Colour
At Shade Skin, we regularly see that skin cancers present differently depending on skin type. In people with lighter skin, cancers tend to appear on sun-exposed areas and are often pink or red. In skin of colour, this pattern changes.
Common patterns include:
Squamous cell carcinoma (SCC): Areas not normally exposed to the sun
Basal cell carcinoma (BCC): Appearing as a dark, shiny or pigmented growth rather than pink
Acral lentiginous melanoma (ALM): The palms, soles or under the nails
Melanoma: Dark patch that slowly changes over time
Acral lentiginous melanoma is particularly important to recognise. It is the most common melanoma subtype seen in people with Black, Asian, Hispanic and some Indigenous backgrounds. Importantly, ALM is not caused by UV exposure, which means sunscreen alone is not enough as a preventive strategy.
Symptoms and Warning Signs to Look For
Traditional melanoma checks such as the ABCDE rule were developed for fair skin, where cancers usually change colour or become red. In skin of colour these rules still help, but additional signs are especially important.
Look for:
A new or changing dark spot on the palms, soles or under a nail
A streak under a nail (even a single narrow line that gets wider over time)
A non-healing sore, ulcer or growth
A shiny black or dark brown bump that looks different from other spots
Any mole that stands out as unusual compared with your other moles (the “ugly duckling” sign)
If something looks new, slow to heal or different from your usual pattern it is worth having checked by a doctor.
Why Skin Cancers in Darker Skin Are Diagnosed Later
There are several reasons why skin cancer is picked up later in people with darker skin:
Patient factors
Belief that darker skin does not develop skin cancer
Lower likelihood of seeking skin checks early
Uncertainty about what concerning lesions look like
Clinician factors
Less training on how skin cancer appears in pigmented skin
Assumptions that lesions are benign because they do not match the classic “pink” appearance
Access factors
Difficulty accessing regular skin checks
Fewer skin cancer clinics in some communities
Delayed presentation due to low perceived risk
The result is that many patients present at stage III or IV, when treatment is more complex and outcomes are poorer.
How to Protect Your Skin and Detect Problems Early
Protecting your skin and catching problems early is equally important for all skin types.
Practical steps include:
Monthly skin self-checks: This includes the palms, soles, between the toes, under the nails, the scalp and the groin.
Yearly skin checks with a qualified doctor: A full body skin check with a skin cancer doctor is useful even if you rarely burn.
Sunscreen on exposed areas: Sunscreen helps reduce the risk of squamous cell carcinoma and photoageing. Choose a broad-spectrum SPF 50 suitable for your skin type.
Protective clothing: Hats, long sleeves, rash shirts for swimming and seeking shade remain important habits for all ages.
Treat anything that does not heal: A “bruise” or dark patch on a palm or sole that lingers is worth checking promptly.
It is completely normal to feel unsure about what is normal for your skin. If something feels unfamiliar or you are simply not confident, it is always better to ask.
Regular skin checks, awareness of what skin cancer looks like in darker skin, and early medical review can significantly improve outcomes.
No matter your skin tone, early detection saves lives.
Written by Dr Emily Alfonsi
MBBS, FRACGP, DRANZCOG
Medical Director, Shade Skin
Dr Emily is a skin cancer doctor with advanced training in diagnosis and treatment. She has personally detected and treated hundreds of skin cancers and is passionate about early intervention and patient education.
