Skin Cancer in Dark Skin: What You Need to Know

December 27, 2024

Skin cancer in dark skin is often underestimated, although it does occur and can have serious consequences. Even though it occurs less frequently than in people with light skin, it is often diagnosed too late in people with dark skin, resulting in higher mortality rates and more serious health problems. This blog focuses on skin cancer in people with dark skin, the risk factors, and the importance of early detection.

What is dark skin?

The term ‘dark skin’ does not refer to a sun-tanned skin in the summer, but to skin types that naturally contain more melanin. Melanin is the pigment that gives color to the skin, eyes, and hair and is produced by melanocytes in the top layer of the skin, the epidermis. “The more melanin, the darker the skin. The Fitzpatrick scale, which classifies skin types based on their reaction to UV radiation, helps to understand these differences. People with dark skin usually fall into categories IV to VI on this scale.

Fitzpatrick skin types:

Type I (Very light skin): Always burns very quickly, never tans. Often seen in people with red or blonde hair, light eyes, and presence of freckles. This skin type is typical for people from Northern Europe, such as Scotland and Ireland.
Type II (Light skin): Almost always burns, tans with difficulty. Mostly found in people with light eyes and hair, who primarily come from Northern Europe and Eastern Europe.
Type III (Lightly tinted skin): Sometimes burns, gradually turns brown. Often found in people with darker blonde or light brown hair and widely distributed geographically, including parts of Europe, Central Asia, and East Asia.
Type IV (Moderately brown skin): Burns minimally, tans easily. Often found in people from Latin America, some Middle Eastern countries, and Southeast Asia.
Type V (Dark Brown Skin): Rarely burns, tans very easily. Typical for people of African, Indian, and darker Middle Eastern origins.
Type VI (Very dark or black skin): Never burns, tans very easily to a deep brown. Often found in individuals of Sub-Saharan African descent.

Huidkanker Bij Donkere Mensen, Fitzpatrick, Aziaten, Blanke Huid

Different Forms of Skin Cancer

Skin cancer is the growth of abnormal skin cells that form tumors. The main types are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. BCC and SCC are less severe but occur more frequently, while melanoma is the most deadly form due to its rapid spread. Learn more about Skin Cancer, What Now?

Skin Cancer in Dark Skin

Research from the United States shows that skin cancer occurs less often in people with darker skin than in people with lighter skin, but it is often associated with higher morbidity and mortality. This is mainly due to late diagnoses and the more aggressive nature of the cancers that develop.

In dark-skinned ethnic groups, squamous cell carcinoma (PCC) is most common; both PCC and melanoma usually occur in areas not exposed to the sun; and ultraviolet radiation is not a major etiological factor for skin cancer except for basal cell carcinoma (BCC).

Races with intermediate pigmentation, such as Hispanics and Asians, share epidemiological and clinical characteristics of dark-skinned ethnic groups and whites. Skin cancer poses a significant risk for people with dark skin and doctors should focus on preventive measures in these groups such as regular skin exams, self-examination, public education, and screening programs.

Basal Cell Carcinoma (BCC)

BCC is the most common form of skin cancer in white individuals, but it is rarer in individuals with darker skin. In African Americans, the incidence of BCC is about 1% to 2% per year, while it is about 19 times more common in whites. BCC in individuals with darker skin is most often associated with scarring, ulcers, chronic infections, and physical trauma. It generally does not have increased morbidity compared to whites, except in cases where BCC develops in areas with chronic scarring or inflammation.

Squamous Cell Carcinoma (SCC)

PCC is the most common form of skin cancer in people with dark skin, representing 30% to 65% of all skin cancers in this group. It often occurs on parts of the body not exposed to the sun, such as the lower limbs and the anogenital region. PCC that develops in chronic scars or inflammatory processes is more aggressive and has a higher risk of metastasis (20% to 40%), compared to a metastasizing risk of 1% to 4% in sun-induced PCC in whites.

Melanoma

Melanoma is rare in people with dark skin, but when it occurs, it often has a worse prognosis than in whites. This is because melanomas in people with dark skin often occur in areas not exposed to the sun such as the palms of the hands, soles of the feet also called acral melanoma and under the nails. These melanomas are often diagnosed at a later stage, resulting in a higher mortality rate. The survival chances for black patients with melanoma are significantly lower than for white patients, mainly due to delays in diagnosis and treatment.

Risk factors in people with dark skin:

Pigment Protection: Although melanin provides some protection against UV radiation, it is not completely effective. People with dark skin are less likely to get sunburned, but are not immune to UV damage. Melanin, the pigment that darkens the skin, provides some protection against UV radiation. Dark skin types have a higher concentration of melanin, resulting in a higher inherent (intrinsic) sun protection factor (SPF) of about 13.4, compared to an SPF of 3.3 for lighter skin types. Although this provides some protection, it is not complete protection, and people with dark skin can still develop DNA damage and skin cancer from UV exposure.
Unusual locations of tumors: In people with dark skin, skin cancers often appear in less exposed places such as the palms of the hands, soles of the feet, and under the nails. And also the mucous membranes in the mouth, throat, nose, eyes, and around the genitals. This can contribute to late detection and diagnosis because these places are less frequently checked for signs of cancer.
Late diagnosis: One of the biggest challenges with people with dark skin is the late diagnosis of skin cancer. Skin cancer is often only detected in an advanced stage in this group, which limits treatment options and worsens the prognosis. This is partly due to a lack of awareness and education about the risks of skin cancer in people with dark skin.
Awareness, not informed: Many people with dark skin mistakenly believe they cannot get skin cancer, leading to less use of sunscreen and fewer skin checks.
Socio-Economic factors: Access to medical care plays a crucial role in the early detection and treatment of skin cancer. People with a lower socio-economic status often have less access to regular dermatological check-ups and education about skin cancer prevention, which may contribute to higher mortality rates.

In other words

Skin cancer is less common in individuals with dark skin but can be more deadly due to late discovery. Regular skin checks, the use of sunscreen, and education are essential to lower mortality. Everyone, regardless of skin color, should be aware of the risks of skin cancer and take preventative measures.

Dr. Francis Wu

Dr. Francis Wu, een vooraanstaande dermatoloog, is de drijvende kracht achter Iconic Elements. Hij heeft sinds 2004 zijn expertise ingezet om een veilige en effectieve huidverzorgingslijn te creëren, geschikt voor zowel gezonde huid als huidproblemen. Iconic Elements, opgericht in 2016, is de eerste brede skincare lijn in Nederland ontwikkeld door een dermatoloog. Als medisch specialist streeft Dr. Wu naar het bevorderen van het welzijn van mensen door hoogwaardige en effectieve huidverzorgingsproducten te bieden. De proefdiervrije en vegan producten vermijden schadelijke chemicaliën en bevatten natuurlijke ingrediënten.