For decades, skin cancer has been framed as a threat primarily to those with lighter skin tones, leaving a dangerous gap in awareness and medical attention for Black individuals. This misconception has led to late diagnoses, higher mortality rates, and a lack of targeted education on the unique ways melanoma manifests in darker skin.
Melanoma may be less common among Black individuals, but when it strikes, it is far more deadly. Studies reveal that Black patients face a 26% higher melanoma mortality rate than their white counterparts, a gap driven by delayed detection, the cancer’s hidden nature, and disparities in healthcare access. The belief that melanin provides full immunity has created a false sense of security—one that has deadly consequences.
Where melanoma hides
Unlike the more familiar presentations of melanoma in sun-exposed areas, Black individuals are disproportionately affected by a specific subtype known as acral lentiginous melanoma. This aggressive form of skin cancer often develops in places that escape routine scrutiny: the palms, soles of the feet, and even beneath fingernails and toenails.
These hidden locations make early detection incredibly difficult. Against darker skin tones, the initial signs of acral lentiginous melanoma—subtle discolorations, small dark streaks under the nails, or painless growths—can easily go unnoticed or be mistaken for harmless changes. By the time symptoms become obvious, the cancer has often progressed to an advanced, more dangerous stage.
Because these symptoms do not fit the common understanding of melanoma, both patients and doctors often overlook them. Routine self-checks and professional skin screenings tailored to darker skin tones are critical in catching these warning signs before the disease reaches a life-threatening stage.
Why early detection fails
The late-stage diagnoses common among Black patients are not merely a result of the cancer’s hidden nature. Gaps in medical training and healthcare infrastructure have left many professionals unprepared to recognize melanoma in darker skin. Most dermatology textbooks and diagnostic tools have historically centered on white skin, making it more challenging for doctors to identify early-stage melanoma in patients of color.
This oversight is compounded by systemic healthcare barriers. Black patients are less likely to be referred to dermatologists for routine skin checks, and they often face longer wait times for specialized care. In some cases, concerns about unusual skin changes are dismissed or misdiagnosed, allowing melanoma to advance unchecked.
Additionally, economic disparities mean that many Black individuals may lack access to preventive healthcare or delay seeking medical attention due to cost concerns. When melanoma is finally diagnosed, it is often at a point where treatment options are limited, and survival rates are lower.
Understanding the science
It is true that melanin, the pigment responsible for darker skin tones, offers some natural protection against UV radiation. This has led to the widespread belief that Black individuals are nearly immune to skin cancer. However, while melanin does reduce the risk of sun-related skin cancers, it does not eliminate the possibility of melanoma, particularly the acral lentiginous form that is unrelated to sun exposure.
Genetic factors and environmental influences also play a role in melanoma risk. Researchers are still working to fully understand why certain populations develop skin cancer in non-sun-exposed areas, but the data is clear: Black individuals are not exempt.
Unfortunately, because melanoma in Black patients is often diagnosed at later stages, survival rates are significantly lower. The five-year survival rate for Black patients with melanoma is around 70%, compared to nearly 90% for white patients. This gap highlights the urgent need for increased awareness and earlier detection.
What needs to change
The first step in addressing this crisis is ensuring that both healthcare providers and the general public are better informed. Medical schools and dermatology training programs must include more comprehensive education on diagnosing melanoma in darker skin tones. Standardized screening protocols should be adapted to consider the unique ways melanoma presents in Black individuals.
Public health campaigns must also shift their messaging. Skin cancer prevention efforts have traditionally focused on sunscreen use and sun avoidance—important factors, but ones that do not address the primary risks facing Black individuals. Instead, messaging should emphasize self-examinations, particularly of high-risk areas like the palms, soles, and nail beds.
Patients themselves can take proactive steps by advocating for skin checks during routine medical visits and seeking second opinions if concerns are dismissed. Increased representation in dermatology—both in terms of medical professionals and educational materials—can also help bridge the gap in care.
Moving forward with awareness
The myth that Black individuals do not get skin cancer has allowed melanoma to become a silent killer in the community. This is not just a medical issue—it is a public health crisis that demands urgent attention.
By challenging outdated assumptions and pushing for more inclusive healthcare practices, the tide can begin to turn. Black patients must be empowered with knowledge, and the medical field must take responsibility for addressing its blind spots. With improved education, routine screenings, and proactive medical care, the devastating disparity in melanoma outcomes can be reduced.
Melanoma is a disease that thrives in the shadows—both literally and figuratively. It is time to shine a light on this overlooked risk and ensure that everyone, regardless of skin color, has the information and medical support needed to detect and treat melanoma before it is too late.
