Consumer Reports emphasizes that it has no financial ties with any advertisers on its platform. The high levels of melanin in Black skin, which gives it color, provide an inherent advantage by offering additional protection against harmful ultraviolet (UV) rays. This factor contributes to a lower incidence of melanoma, the most lethal form of skin cancer, among Black individuals compared to their White counterparts. However, a troubling statistic reveals that once diagnosed, Black individuals with melanoma face a significantly higher risk of mortality, being approximately five times more likely to die within five years than White patients. This disparity is largely attributed to delayed diagnoses, often stemming from a lack of awareness regarding how melanoma can manifest on darker skin tones. Understanding the signs and symptoms of melanoma is crucial for early detection and improved survival rates.
The story of reggae legend Bob Marley, who passed away at just 36 years old, serves as a poignant reminder of the dangers of delayed detection. Marley initially dismissed a dark spot under his toenail as a soccer injury, only to later discover it was acral lentiginous melanoma (ALM). This aggressive type of melanoma typically appears as a dark patch on less exposed areas of the body, such as the palms, soles of the feet, or even under the nails, rather than on sun-exposed skin, which is the more common presentation for melanoma on lighter skin.
One of the primary reasons acral lentiginous melanoma often goes undetected until it is too late is that its characteristics are not included in the widely known early detection strategies, such as the ABCDEs of melanoma. These guidelines, established in 1985, focus on identifying moles that are Asymmetrical, have irregular Borders, exhibit multicolored patterns, are larger than 6 millimeters in Diameter, or Evolve in appearance over time. Unfortunately, ALM requires its own diagnostic criteria, which many may not be aware of.
The medical community, including dermatologists, are expected to recognize ALM, especially when examining patients of color. However, a 2012 study published in the journal Dermatology Clinic revealed that nearly half (47%) of dermatologists and dermatology residents felt inadequately trained to identify skin conditions in Black patients. In response to this gap, the American Academy of Dermatology introduced the Skin of Color Curriculum to enhance training on dermatological issues affecting people with skin of color.
The lack of visual representation of skin conditions in dermatology resources exacerbates the issue. A simple Google search for “What does skin cancer look like?” illustrates this disparity, as it may take several pages before encountering images of skin conditions on Black skin. As noted by Dr. Adewole Adamson, a board-certified dermatologist, this lack of representation leads to delays in both recognition and treatment.
Efforts are in progress to combat this issue. For instance, the Instagram account Brown Skin Matters encourages followers to submit photographs depicting various dermatological conditions on darker skin, creating a resource for better awareness. Additionally, the Skin Deep initiative provides a free educational platform showcasing images of skin conditions across diverse skin tones.
Another contributing factor to delayed ALM diagnoses is the lack of diversity among dermatologists. A 2020 study published in JAMA found that patients often experience improved outcomes when their physicians share similar racial or ethnic backgrounds. Currently, only 3% of dermatologists in the United States are Black, while Black individuals comprise 13% of the population.
Regardless of the causes behind delayed diagnoses, there are proactive measures individuals can take to reduce their risk of ALM. Early detection remains paramount. Here are some recommendations:
Perform Regular Self-Checks: Utilize a full-length mirror to examine your entire body for unusual spots, moles, discoloration, or sores that do not heal. Use a handheld mirror for hard-to-see areas or enlist the help of a loved one. Check Covered Areas: Skin cancer in individuals with darker skin often develops in areas not typically exposed to the sun, such as the soles of the feet and palms. Dermatologist Andrew Alexis highlights the importance of monitoring these regions.To facilitate early detection of acral lentiginous melanoma, experts have developed the acronym CUBED:
C: Colored lesions with multiple colors. U: Uncertain diagnosis or lesions lacking a clear clinical classification. B: Bleeding lesions on the foot or under the nail. E: Enlargement of a lesion. D: Delayed healing of any lesion beyond two months.Keep in mind that while ALM can occur on any toenail, it frequently develops on the big toe. Be vigilant for narrow dark streaks on nails that are not injury-related, and note that ALM lesions may appear flat even as they penetrate deeper into the skin. Consulting a manicurist or pedicurist can also help in identifying abnormalities on hands and feet.
It is essential to find a dermatologist knowledgeable about darker skin. The Skin of Color Society provides a directory of board-certified dermatologists specializing in skin-of-color dermatology. Furthermore, a growing number of academic institutions in the U.S. are establishing ethnic skin centers to address the specific needs of patients with skin of color.
While it is vital to recognize that Black individuals are more prone to melanoma in areas usually less exposed to sunlight, sun protection remains crucial. The Dermatology Education Foundation notes that even dark skin has a natural sun protection factor (SPF) of only 13. The American Academy of Dermatology recommends using broad-spectrum, water-resistant sunscreen with an SPF of at least 30 to mitigate risks.
Some individuals with darker skin may hesitate to use sunscreen due to difficulty finding products that do not leave a visible white cast. A Consumer Reports evaluation found several sunscreens that effectively absorbed without leaving a chalky appearance. Products like Black Girl Sunscreen Kids Spray & Play SPF 50 and Supergoop Play Everyday Lotion SPF 50 were well-received among participants with olive to deep-brown skin tones.
In addition to sunscreen, limiting sun exposure through shade or protective clothing can further reduce the risk of developing skin cancer.
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