Melanoma on Black skin: Examples, prevalence, and more - Medical News Today

Melanoma is an aggressive form of skin cancer. Black people with melanoma have a higher risk of dying from the condition for various reasons.

Melanoma, the deadliest form of skin cancer, is more common in white people than in Black people. Only about 1 in 1,000 Black people will develop melanoma, but doctors typically diagnose melanoma much later in Black people, increasing their risk of developing a serious case. Knowing how to identify melanoma on darker skin can be lifesaving.

Darker skin produces more melanocytes. These color pigments help protect the skin from sun damage, including the kind of damage that causes skin cancer. Darker skin is less likely to burn, causing some people to mistakenly believe that Black people cannot get skin cancer.

Consequently, some people may not check their skin for skin cancer. They may also delay seeing their doctors for skin changes. And when they do see a doctor, a doctor may take their concerns less seriously because of the relatively low rate of skin cancer in Black people.

Training for doctors in melanoma on darker skin is often inadequate. White doctors may have less familiarity with darker skin. Even artificial intelligence interventions that attempt to catch cancer earlier may fail to detect it in darker skin because programmers may not include any, or enough, samples of darker skin.

Below, we take a closer look at how melanoma affects Black people and what the skin cancer looks like on darker skin.

Black people are significantly less likely to get melanoma than people of other races. Darker skin produces more protective melanocytes, reducing the damage of the sun and lowering the risk of cancer.

However, Black people who have melanoma are more likely to die from it. Some factors that contribute to this phenomenon include:

• Black people may not notice lesions because they may blend in with darker skin.
• Black people might think they are not vulnerable to melanoma, causing them not to inspect their skin or seek treatment.
• Doctors may not take Black people's concerns about skin cancer seriously.
• Doctors may not be familiar with darker skin or the ways skin cancer presents on it.

As a result of these factors, doctors usually diagnose melanoma on darker skin at a more advanced stage.

There are several types of melanoma, including:

Superficial spreading melanoma

Superficial spreading melanoma is the most common type of skin cancer in the general population. This type of cancer affects the superficial layers of skin, but IT can spread quickly. It may grow out across the skin, or grow down into the deeper layers of skin.

Compared with other racial groups, doctors are less likely to diagnose this form of melanoma in Black people. Doctors tend to catch their cancers at later stages, when they have spread.

Overall, 91.1% of Black people with superficial spreading melanoma are still alive 5 years after diagnosis, according to 2011–2014 data from the Centers for Disease Control and Prevention (CDC).

Some signs of this type of cancer include:

• a small mole, freckle, or mark on the skin that is initially less than 2 centimeters (cm) in diameter
• a smaller mark on the skin that begins to grow
• a flat mark that becomes more elevated
• indentations in the mark on the skin
• irregular edges to the mark on the skin
• a mole that begins changing shape or color
• a mole or other skin mark that is several different colors

Lentigo maligna melanoma

Lentigo maligna melanoma usually begins as a small, freckle-like mark that is less than 3 cm in diameter.

Some hallmarks of lentigo maligna melanoma include:

• a growth or freckle that begins as a flat lesion of less than 3 cm in diameter
• skin growths that spread outward on the skin
• a flat patch on the skin that is brown or tan with an irregular border
• a growth that appears on areas frequently exposed to sun, such as the arms and face

Like superficial spreading melanoma, lentigo maligna melanoma has higher survival rates. In a population study of Lithuanians, 89.28% of people with this type of cancer were still alive at 5 years. This cancer is so rare in Black people, however, that the CDC does not have specific survival rates.

Acral lentiginous melanoma

The most common form of melanoma in people with dark skin, acral lentiginous melanoma has a prevalence rate of just 2–8% in white people, but 35–60% in people with dark skin. The 5-year survival rate is much lower, at 66.1%.

It commonly appears on the soles of the feet and under the nails. It begins as dark spots that spread across the skin for a long time before penetrating the deeper layers of the skin. Because it is on less visible areas and may blend in with darker skin, this cancer often remains undiagnosed for longer.

Some signs to look for include:

• a new or changing growth under the nails or on the soles of the feet
• a flat dark brown or tan spot with irregular borders
• a growing spot that may eventually develop sores

Nodular melanoma

This is the most dangerous form of melanoma. The 5-year survival rate for nodular melanoma in Black people is 56.6%. This is an aggressive cancer that grows quickly, spreading into the deep layers of the skin.

Some signs to look for include:

• a growth that sticks out of the skin
• a red, pink, or blue-black colored lump or growth

Growths typically appear on the torso, arms, or legs.

Other types of melanoma

There are some other atypical melanomas that are very rare. The overall survival rate after 5 years for these unusual melanomas is 62.1%, but survival rates vary greatly depending on the specific type of melanoma a person has. Some other melanomas include:

• Intraocular melanoma: This is melanoma that affects the skin of the eye. Look for changes to the surface of the eyeball, such as lesions or changes in texture or appearance.
• Desmoplastic melanoma: This can affect the dermis of the skin (a deeper layer of skin), or the tissue surrounding mucous membranes. It usually causes a flesh-colored lump.
• Mucosal lentiginous melanoma: This is melanoma that affects the skin that lines organs, the mouth, and throat. It is very aggressive, and sun damage does not cause it. A person might notice lesions in the mouth or throat, or begin having difficulty with the affected organ. For example, when this cancer affects the throat, a person may struggle to swallow.

It can be difficult to diagnose the type of melanoma based on symptoms alone.

On Black people, melanoma may be less noticeable because darker skin may camouflage darker growths. Skin cancer can begin as a new growth, or can occur as changes in an existing mole or freckle.

Regardless of the type of melanoma a person has, the ABCDE can help detect cancer:

• Asymmetrical: Does the freckle or mole have an irregular or asymmetrical shape?
• Border: Is there an irregular or oddly shaped border?
• Color: Look for uneven coloration, or strange hues such as blue or red.
• Diameter: Growths that are larger than the circumference of a pencil eraser are more likely to be cancerous.
• Evolving: Regardless of shape or size, has the growth changed? Rapid changes in any growth, including a mole a person has had their entire life, may signal cancer.

These symptoms may be more subtle on darker skin.

Diagnosis begins with an examination of the skin. A doctor may use a dermatoscope to look at suspicious growths. This tool allows the doctor to more closely examine the growth.

If the growth looks cancerous, a doctor may perform a biopsy. This involves shaving off a piece of the growth, then sending it to the lab to test for cancer. In some cases, a doctor may completely remove the growth to send to the lab. The doctor does this after numbing the affected area with an injection.

A doctor may also perform blood tests to check for signs of cancer.

If the biopsy shows that there is cancer, a doctor may order additional tests, such as a chest X-ray, to see whether the cancer has spread.

Treatment depends on the type of cancer, the person's overall health, and whether the cancer has spread. In general, a person will need surgery to remove the cancerous lesion. Sometimes, a doctor can do this in the office under local anesthesia instead of general anesthesia.

A person may also need chemotherapy. If the cancer has spread to other locations, a person might need additional surgery, additional chemotherapy, radiation, or targeted cancer medications.

The outlook depends on the type of cancer. Most people survive melanoma, but certain cancers, such as superficial spreading melanoma, have higher survival rates. Overall, the 5-year survival rate for Black people with skin cancer is 66.2%.

A 2017 analysis found that certain factors correlate with a higher survival rate. Those include:

• female sex
• earlier stage cancers
• being at a younger age at the time of diagnosis
• having cancer anywhere other than the back or breast

Catching skin cancer early greatly improves the chances of survival and makes it less likely that the cancer has spread throughout the body. Yet most skin cancer guides use white skin to show people how to detect cancer. People with darker skin may not see themselves represented in public health messages.

To counteract this bias, it is important for Black people to monitor their own skin so they know what is normal and what is not. Annual skin exams with a dermatologist can help with monitoring skin changes. Seeing a doctor who treats Black patients may increase the likelihood of catching cancer early.

Because skin cancer is less common in Black people, Black people with unusual skin growths may need to strongly advocate for themselves, especially if a doctor has little experience with darker skin. If a growth changes or seems suspicious, connect with a doctor. Always ask for a second opinion if the doctor is dismissive.