What Melanoma Looks Like on Skin of Color

This content was created as a collaboration between HealthCentral and the Skin Cancer Foundation.

Not all skin cancer is caused by the sun—including one type of melanoma that hits people of color harder. This fact, combined with misconceptions about skin cancer risk in darker skin tones, can be deadly, as melanomas tend to be aggressive and can spread quickly, according to the American Academy of Dermatology (AAD).

“While melanoma is less common in people with darker skin tones, it still does occur,” says Jane Yoo, M.D., a dermatologist and Mohs surgeon practicing in New York City and a spokesperson for the Skin Cancer Foundation (SCF). “Because people do not think they are susceptible to skin cancer, they tend to wait and also disregard things on their skin that look suspicious.”

We spoke to the experts about what BIPOC should know about melanoma, including warning signs to watch for on darker skin tones and the best means of protection against this potentially stealthy cancer.

Melanoma, by definition, is a skin cancer that impacts the melanocytes, or the pigment-producing cells within the body that give skin, hair, and eyes their color. It’s important to note that, although people with darker skin tones have more natural pigment, or melanin, produced by melanocytes than those with lighter skin tones, the number of melanocytes in skin is basically the same no matter what your ethnicity.

Melanoma Prevalence in Skin of Color

Still, it’s true that people of color are less likely to get skin cancers like melanoma than people with fair skin. Per the Centers for Disease Control and Prevention (CDC), melanoma occurs in 1 out of 100,000 non-Hispanic Black adults, 1.3 out of 100,000 Asian/Pacific Islander adults, 4.6 out of 100,000 in Hispanic adults, 5.6 out of 100,000 American Indian/Alaska Native adults, and 24.9 out of 100,000 white adults.

However, when people of color are diagnosed with melanoma, they tend to have worse outcomes, possibly because the skin cancer is not caught until it is in its later stages: 52% of non-Hispanic Black patients and 26% of Hispanic patients are first diagnosed when melanoma is at an advanced stage, compared with 16% of non-Hispanic white patients, per the Skin Cancer Foundation. This can be life-threatening—for example, Black folks diagnosed with melanoma have an estimated five-year survival rate of 71%, compared with 94% for white folks, according to the SCF.

“The misconception that only fair-skinned people can develop skin cancer has contributed to lower awareness of the risks of skin cancer among people of color. This in turn can lead to skin cancers being diagnosed at later, more dangerous stages,” explains Dr. Yoo.

Another reason why melanoma diagnosis may be delayed in people of color is because of a lack of education, even among health care providers. “Health care providers may not always recognize melanoma in people of color because it can present differently from what is typically taught in medical education, which often focuses on how it appears on lighter skin tones,” says Oma N. Agbai, M.D., a dermatologist and director of multicultural dermatology and hair loss disorders at the University of California, Davis School of Medicine in Sacramento.

Disparities in health care are also at play, Dr. Agbai adds: “People of color may face barriers to accessing quality health care, including lack of insurance, limited access to dermatologists, and cultural or language barriers, which can impact the timely diagnosis and treatment of melanoma.”

All of these reasons make it a must to learn the warning signs of melanoma, no matter your skin tone. “Most skin cancers can be successfully treated if caught early, before they’ve had a chance to spread,” Dr. Yoo says.

While people of color are susceptible to all types of melanoma to some degree, there are certain rare types and subtypes that are actually more common in people with darker skin tones. Some of these particular types are actually not caused by sun exposure, so where they show up on the body tends to differ from the main type of melanoma—cutaneous—that is caused by the sun’s harmful ultraviolet (UV) rays.

“Up to 60% to 75% of tumors in people of color arise on the palms, soles of the feet, mucous membranes, and nail regions,” Dr. Yoo says. Because of this, melanoma can go undetected until after the cancer has spread, so checking these areas is a must. When you do a self-check, keep these expert tips in mind for what to look for, head to toe.

Cutaneous melanoma, a.k.a. melanoma of the skin, is the most common type of melanoma, and it is caused by overexposure to the sun’s UV rays. It’s a myth that your skin’s natural melanin is enough to protect you from these rays—even if you rarely if ever get a sunburn, warns Dr. Yoo.

Cutaneous melanoma often resembles moles, and sometimes develops from an existing mole, Dr. Yoo explains. In general, you should watch for the ABCDE warning signs of melanoma, regardless of your skin color. Per the Melanoma Research Alliance, this means looking head to toe for moles that are:

• Asymmetrical

• have an irregular Border

• have multiple Colors or have changed color

• have a Diameter larger than a pencil eraser (6 millimeters)

• have Evolved in size or thickness

That said, melanoma may look different in skin of color than it looks on fairer skin. “Melanomas in people of color may not show the classic signs, such as changes in pigmentation or the appearance of irregular moles,” explains Dr. Agbai. For example, sometimes a sore that won’t heal or a rough or dry patch of skin could be a warning sign, per the AAD.

Spots Not to Miss: Legs and Feet

Per the CDC study, 48.2% of melanomas in non-Hispanic Black adults occurred in the lower extremities, with legs and feet the most common sites for melanoma to occur. Make a point to look over the skin on your legs and feet regularly, such as when you’re applying lotion or shaving.

Example of Cutaneous Melanoma on Dark Skin

A more severe subtype of cutaneous melanoma, acral lentiginous melanoma (ALM) is actually the most common form of melanoma found in people of Asian and African descent, according to Memorial Sloan Kettering Cancer Center (MSKCC).

ALM occurs on the palms, soles, or nails of the hands and feet. As Dr. Agbai notes, “Bob Marley, the legendary reggae singer, tragically died of a melanoma that was diagnosed on his foot.”

ALM commonly appears as black or brown discoloration or patchiness on the skin, Dr. Yoo explains. Usually it’s surrounded by skin that is your normal skin color, per the AIM at Melanoma Foundation. Watch for spots or patches of skin that are changing, such as having an unusual color or thickened or raised appearance, even if they are small. Sometimes, ALM can be a spot that has no pigment or looks red or pink (regardless of your normal skin tone), according to MSKCC. When it occurs under the nail (also called subungual melanoma), ALM can sometimes be mistaken for blood or fungus and look like a dark stripe—this was the case with Bob Marley.

Spots Not to Miss: Palms, Soles of Feet, Fingernails, and Toenails

According to a recent study in the journal Oncologist, the pigmentation of ALM lesions “can follow the skin markings of the palms and soles, concealing the lesion and further hindering early diagnosis.” Per the study, over two-thirds of cases of ALM are diagnosed at stage II or above (versus one-third of cases involving other types of cutaneous melanoma).

Make it a habit to regularly scan over these areas—for example, when applying lotion to dry hands, clipping your nails, or changing out your pedicure color. Vertical lines or strange marks in the nails or skin should be a cue to get checked out ASAP.

Examples of ALM on Dark Skin

Nodular melanoma is another type of melanoma caused by exposure to UV rays. Watch for raised, dome-shaped growths that are discolored. They can often buck the typical ABCDE warning signs for melanoma since they can be symmetrical and one color. That said, they may appear as red, pink, brown, black, or blue-black, and sometimes itch or bleed, per the Cleveland Clinic. Sometimes, they look like blood blisters.

Nodular melanoma is more common in people with fair skin than in those with skin of color. The incidence rate of nodular melanoma is 1.80 per 100,000 person-years for non-Hispanic white people, 0.49 for Hispanic white people, 0.14 for Asian/Pacific Islanders, and 0.06 for Black people, according to one study in the journal BMC Cancer. But, like other forms of melanoma, nodular melanoma tends to be diagnosed at later stages and have worse outcomes for non-Hispanic Black people, per the CDC.

Spots Not to Miss: Arms, Legs, Scalp, and Torso

While nodular melanoma can show up anywhere, areas that get more sun are most common. Look for spots that are bigger than your typical moles—about the length of a staple and raised to the height of 60 sheets of paper above the skin, per the Cleveland Clinic.

Example of Nodular Melanoma on Dark Skin

A rare type of melanoma that accounts for 1% of all melanomas and can occur in people of color is called mucosal melanoma, which develops in the lining of the mouth, anus, or vagina. In these areas, melanoma appears as a dark or black mass most often, but again, can also lack pigment or look red or pink in people of color in some cases, per MSKCC.

Spots Not to Miss: Mouth, Vagina, and Anus

While it can be hard to regularly check these areas yourself, getting annual checkups with your health care team can help. Your dermatologist can check for you during your full body skin exams, but other providers can help, too. For example, your dentist will scan your mouth for ulcers or other changes during your regular teeth cleanings, and an obstetrician/gynecologist can point out any worrisome signs down below. The symptoms of this type of melanoma vary based on where it occurs. For example, in the anus, bleeding and constipation could be warning signs, per MSKCC. Any concerning changes in your body should always be reported to your doctor.

“It’s vital for people with darker skin tones to pay attention to changes in their skin and to consult a dermatologist if they notice any concerning signs or symptoms,” Dr. Agbai says. “Early detection and treatment of melanoma can improve outcomes, regardless of skin color.”

The AAD recommends people with skin of color do a monthly full-body exam using a full-length mirror and the help of a partner or handheld mirror to check your skin from head to toe, including difficult-to-see areas like the top of your head and back.

During your monthly skin checks, if you notice a mole or growth that meets any of the ABCDE warning signs or is otherwise new, changing, or unusual, that’s a reason to make an appointment with your health care provider or dermatologist ASAP. You can also follow what’s known as the Ugly Duckling rule, says Dr. Yoo: “If a spot doesn’t look like any of your other moles in color, shape, or size; looks or feels different than your other moles; or over time changes differently from your other moles, you should get that mole checked out.”

The same goes for any of the warning signs on palms of the hands, soles of the feet, nails, or other areas of the body.

And dermatologists can’t stress this enough: Everyone should follow sun protection strategies—such as wearing a broad spectrum SPF 30 sunscreen daily—no matter what their skin tone.