Skin Cancer in Blacks: What You Need to Know

Skin cancer in Blacks to many may seem unlikely. It is often thought of as a condition that primarily affects people with fair skin. While it’s true that people with lighter complexions are more likely to develop certain types of skin cancer, it’s a dangerous myth that Black people and those with darker skin tones are immune. In fact, some types of skin cancer are more common or more deadly in people of African descent. This article explores the truth about skin cancer in Blacks, including sun-related and non-sun-related types, why early detection matters, and how to protect yourself.

Can Black People Get Skin Cancer?

Yes. The belief that melanin-rich skin is immune to skin cancer is false and potentially dangerous. While melanin does provide some natural protection against ultraviolet (UV) radiation, it doesn’t eliminate the risk altogether. Black people can get skin cancer from the sun—and from other causes unrelated to UV exposure.

In fact, non-sun-related skin cancers—such as cutaneous T-cell lymphoma (CTCL) and dermatofibrosarcoma protuberans (DFSP)—can be more common in Black individuals than in White populations.

Types of Skin Cancer: Sun-Related vs. Non-Sun-Related

Skin cancers fall broadly into two categories:

• Sun-related skin cancers (caused or worsened by UV exposure)
• Non-sun-related skin cancers (associated with genetic, inflammatory, or other non-UV risk factors)

Let’s break these down further.

Sun-Related Skin Cancers

Basal Cell Carcinoma (BCC)

• Definition: The most common type of skin cancer overall, usually appearing as a pearly or pigmented bump on sun-exposed areas.
• Incidence: Most common in Whites; extremely rare in Blacks.
  • Whites: extremely common
  • Blacks: very rare
• Note: African Americans with lighter complexions are more likely to develop this type of cancer. BCC can be pigmented in people with darker skin, which may make it harder to recognize.

Squamous Cell Carcinoma (SCC)

• Definition: Can develop in sun-exposed skin or from chronic wounds, scars, or mucosal surfaces.
• Incidence:
  • In fair-skinned people, SCC is the second most common skin cancer and mainly sun-related.
  • In Black individuals, SCC is the most common skin cancer and often develops in non-sun-exposed areas, such as scars, chronic inflammatory lesions (e.g. lupus), or mucous membranes (e.g. mouth or genitals).
• Historical Note: Studies from the southern U.S. describe higher rates of SCC on the legs of Black women who sat for long periods in front of open stoves, linking chronic heat exposure and cancer risk.

Malignant Melanoma

• Definition: A potentially deadly cancer that begins in pigment-producing cells.
• Incidence (per 100,000):
  • White: ~26
  • Hispanic: ~4.6
  • Asian/Pacific Islander: ~1.3
  • Black: ~1.0
• Key Concern: Although rare in Black people, melanoma has a lower 5-year survival rate (~66%) compared to Whites (~90%) due to delayed diagnosis.

Acral Lentiginous Melanoma

• Special Note: A subtype of melanoma that appears on the palms, soles, or under nails.
• Incidence: More common in Black, Asian, and Hispanic populations.
• Famous Case: Bob Marley died of acral lentiginous melanoma that started under his toenail.

Non-Sun-Related Skin Cancers

Cutaneous T-Cell Lymphoma (CTCL)

• Definition: A rare cancer of skin-homing immune cells, often appearing as red, scaly patches.
• Incidence (per 100,000):
  • Black: ~1.0–1.2
  • White: ~0.8
  • Asian: ~0.2–0.3
• Fact: CTCL is more common in Black Americans than in any other racial group.

Dermatofibrosarcoma Protuberans (DFSP)

• Definition: A slow-growing, soft tissue cancer that starts in the skin.
• Incidence (per 100,000):
  • Black: ~0.65
  • White: ~0.39
• Fact: DFSP is about twice as common in Black Americans compared to Whites.

SCC from Non-Sun Causes

• Definition: SCC may arise in long-standing scars, burns (Marjolin ulcers), lupus lesions, and chronic inflammation.
• Risk in Blacks: About 20–40% of SCC cases in Black patients originate from chronic wounds or inflammation.
• Prognosis: These types of SCC tend to behave aggressively and contribute to higher mortality rates in Black and Hispanic populations.

Infographic: Non-Sun-Related Skin Cancers by Race

Why Do Black Patients Have Worse Outcomes?

Although the overall incidence of skin cancer is lower in Black populations, the outcomes are often worse due to:

• Delayed diagnosis
• Misunderstanding of risk
• Atypical presentation (e.g., non-sun-exposed areas)
• Lack of regular skin exams

How to Prevent Skin Cancer

1. Use Sunscreen

• Choose a broad-spectrum sunscreen with SPF 30 or higher and reapply every 2 hours if out for long periods
• Avoid prolonged sun exposure between 10am -3 pm
• Wear hats, long-sleeves and sunglasses

2. Avoid Chronic Inflammation and Heat Exposure

• Properly treat wounds, scars, or inflammatory skin conditions.
• Be mindful of prolonged exposure to heat (e.g., heating pads, space heaters or stoves).

3. See a Board-Certified Dermatologist

• Everyone—regardless of skin color—should have regular skin checks.
• Early detection saves lives.
• Find a dermatologist near you

Conclusion

Skin cancer in African Americans is less common but often more dangerous due to delayed detection and nontraditional presentations. Awareness, prevention, and regular screenings are essential. If you notice an unusual lesion—especially in a scar, on the palms, soles, or under the nails—don’t wait. Talk to a board-certified dermatologist.

Sources: SEER Cancer Statistics, American Academy of Dermatology, Journal of the American Academy of Dermatology, CDC, peer-reviewed literature