What People With Darker Skin Need to Know About Preventing Skin Cancer
Summer is upon us (finally!). And after this pandemic year of being cooped up indoors, you’re probably ready for some fun in the sun.
You deserve it—but don’t forget: It’s crucial to practice sun safety when you head outdoors. Skin cancer is the most common cancer in the U.S., and roughly one in five Americans will develop it over their lifetime, according to the American Academy of Dermatology.
Although skin cancer is less prevalent in people of color, when it does occur, the outcomes are poorer than they are for white people. One study analyzed data from over 95,000 patients diagnosed with melanoma (the most serious type of skin cancer) and found that white patients had the longest survival time, followed by Hispanic patients, Asian and Native American patients, and, finally, Black patients.
The reason for the disparity? Non-white patients may not be screened for skin cancer or educated about risks and symptoms at the same level as white patients, the researchers note. Plus, many dermatologists aren’t trained to treat skin of color, and medical textbooks tend to focus on white skin, making it difficult for docs to make a proper diagnosis.
Like so many areas of medicine, the field of dermatology is currently reckoning with these racial disparities. It’s important to be aware of them so you can advocate for yourself and others in your community.
At the same time, there are steps you can take to reduce your individual risk of skin cancer. Here’s what doctors want you to know.
1. First, understand how melanin works.
Melanin is a natural pigment found in skin and hair, and it’s what gives skin its different colors. The more melanin you have, the darker your skin. And melanin serves an important function—protection from UV rays.
“You can think of melanin as an ‘umbrella’ covering and protecting your skin cells’ DNA from harmful sun radiation,” explains Duane Dilworth, M.D., F.A.A.D., a board-certified dermatologist at Deluxe Dermatology in St. Louis, MO. “The more melanin in your skin, the more protection you have from developing skin cancers like basal cell carcinoma, squamous cell carcinoma, and melanoma. In lighter-skinned people, the ‘umbrella’ protecting the DNA is much smaller. UV radiation is absorbed by the DNA which leads to damaged DNA—the precursor to skin cancer.”
Nada Elbuluk, M.D., a board-certified dermatologist and Assistant Professor at the USC Keck School of Medicine, says that people with darker skin have a “built-in SPF of 8-15.”
However, that’s not enough to protect you from skin cancer. “Individuals with darker skin can still get skin cancer and unfortunately it is often diagnosed at later stages, which increases morbidity and mortality,” she says. “There are also other factors besides sunlight exposure including genetics and medical history, like a history of cancer or sunburns, which can affect one’s chances of getting skin cancer.”
2. Know the symptoms of skin cancer.
Skin cancer can present differently depending on your skin tone. “For example, basal cell, which is the most common skin cancer overall, tends to be darker in appearance in individuals with darker skin,” Dr. Elbuluk says. “In a lighter skin person, it can be a pearly pink bump, whereas in darker skin individuals it can be a dark brown to black bump, which is often termed pigmented basal cell.”
It’s important to be able to spot the warning signs of skin cancer, especially if it runs in your family. Ask your dermatologist for resources like this image gallery from the American Cancer Society.
3. Check your skin in unexpected places.
“When melanoma occurs in people with dark skin tones, it’s more likely to happen in areas not normally exposed to the sun, such as the palms of the hands and soles of the feet,” Dr. Dilworth says. “In lighter skinned individuals, skin cancers arise primarily on areas of sun-exposed skin, including the scalp, face, lips, ears, neck, chest, and arms.”
It’s unclear why skin cancer shows up in places “the sun doesn’t shine” in people of color but it’s especially important to pay attention to these areas. Dr. Elbuluk says that many people don’t notice skin changes that happen in places like their feet or nail beds, which can lead to delayed diagnoses. Regularly checking these areas can help (more on that below).
4. Wear sunscreen every day.
Yep, that’s every single day—even if it’s cloudy out. “Choose a broad spectrum sunscreen that protects against both types of ultraviolet radiation, UVA and UVB, that comes from the sun,” Dr. Dilworth recommends. “Make sure it is water resistant and has a sun protection factor (SPF) of 30 or higher. Other sunscreens may help keep you from getting sunburned, but they won’t protect against skin cancer.” The picks below are all melanin-friendly:
5. Make sure you’re using sunscreen properly.
Apply at least one ounce of sunscreen—enough to fill a shot glass—at least 15 to 30 minutes before going outside. “Also, use a lip balm or lipstick that contains sunscreen to help prevent sun damage on the lips,” Dr. Dilworth says. “Reapply sunscreen every two hours, or every hour if you are swimming or sweating.”
6. Limit your time in direct sun, and wear protective clothing.
Avoid being in the sun between 10:00 AM and 4:00 PM, which is when the sun’s rays are strongest, notes Dr. Dilworth. If you must be out during that time, wear sunscreen and sun-protective clothing like a long-sleeved shirt and long pants. “Dark clothing with tightly woven fabric blocks more sun than white or loosely woven fabrics,” Dr. Dilworth says.
7. Do a monthly skin self-exam.
Use a hand mirror to check yourself all over. The American Academy of Dermatology recommends that people of color look out for the following symptoms:
A dark spot, darker patch of skin, or growth that is growing, bleeding, or changing
A sore that won’t heal, or returns after healing
A sore that takes a long time to heal
Dry, rough patches of skin
Dark lines underneath or around fingernails or toenails
Because some of these symptoms overlap with harmless and noncancerous conditions, like eczema, it’s worth getting a dermatologist to look at any places on your skin that are bothering you.
8. Pay close attention to your moles.
Unusual-looking moles could be a sign of melanoma. To check yourself, follow the “ABCDE” guidelines recommended by the National Institutes of Health:
Asymmetry: A mole with an odd shape, meaning half of it does not match the other half
Border: A mole with a ragged or irregular border
Color: A mole that is uneven in color
Diameter: A mole that is larger than a pea or a pencil eraser
Evolving: A mole that has changed in size, shape, or color
9. Find a dermatologist you trust.
In addition to monthly self-checks, see a dermatologist annually to get expert eyes on your skin. If possible, seek out a derm who has experience treating skin of color. This info might be available on their website or in their publication history; you can just call their office and ask. The Skin of Color Society also has a database patients can search through.
If you notice any unusual skin changes, it’s worth setting up an appointment with your derm to see what they think. And if you feel like your doctor isn’t listening to your concerns, you can always, always ask for a second opinion.
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