Identifying Skin Cancer on Black Skin: Symptoms, Risks, and Prevention

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Basal cell carcinoma (BCC) is the most common skin cancer that develops in the areas of the body most exposed to the sun.

“(BCC) tends to present as reddish to brown spots with a sheen or pearlescence (iridescence similar to a pearl) to them,” says Zaineb H. Makhzoumi, MD, MPH, a dermatologist surgeon at the University of Maryland School of Medicine in Baltimore.

Pigmented basal cell cancer is a subtype of BCC that exhibits more pigmentation (color). Though this subtype tends to be rare overall, BCC in people with darker skin tones is almost always pigmented.

 These are more likely to have darker areas that are brown, blue, or gray in color.

BCC occurs most commonly in the head and neck region, but it can also be found in areas that are not chronically sun-exposed, such as the anal and genital areas.

Squamous Cell Carcinoma in Black Skin

Squamous cell carcinoma (SCC) is the most common skin cancer in Black people, according to Dr. Haynes. It causes an overgrowth of squamous cells on the top layer of the skin.

“It can present as ill-defined scaly brown hyperpigmented plaques, papules, or nodules that bleed or ulcerate,” says Haynes, whereas on lighter skin tones there may be scaly red patches or open sores.

Haynes adds that SCC typically appears in areas that are not chronically exposed to the sun, such as the anogenital area (anus and genitals) and limbs, in people with darker skin tones.

Melanoma in Black Skin

Melanoma is the most dangerous type of skin cancer. Although it occurs more frequently in white individuals, melanoma is diagnosed at more advanced stages in people with skin of color, and is associated with worse outcomes.

 The reasons for these disparities are multifactorial, but include lower rates of screening, reduced access to health care, lack of focus on educating communities of color, and underrepresentation in research.

skin cancer on nail
This photo shows melanoma that originated in the nail bed in a patient with skin of color.Photo courtesy of Jonathan Leventhal, MD

According to the National Cancer Institute, melanoma begins in the melanocytes (cells that make the pigment melanin) and can cause changes in the shape, size, color, or feel of an existing mole. It can also appear as a new mole or discolored spot with an irregular shape or color.

“Melanomas present in dark skin as rapidly expanding brown or black spots anywhere on the body, but especially around the palms, soles, and nails,” says Dr. Makhzoumi. She notes that these symptoms can indicate acral melanoma, which is a rare but deadly type of melanoma.

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