Skin Cancer in Skin of Colour: What Australians Need to Know
When most Australians think of skin cancer, they imagine fair-skinned individuals with a history of sunburns. However, people with skin of colour — including those of African, Asian, Middle Eastern, Pacific Islander, and Hispanic descent — are not immune to skin cancer. In fact, while the overall incidence of skin cancer is lower in these populations, when skin cancers do occur, they are often diagnosed later and associated with worse outcomes.
In this article, we highlight the unique risks, presentation patterns, and prevention strategies for skin cancer in individuals with skin of colour. Early detection and education are key — for everyone.
Lower Incidence, Higher Consequences
Compared to light-skinned Caucasians, individuals with darker skin tones have a significantly lower risk of developing skin cancer. Melanin, the pigment responsible for darker skin, offers a natural degree of protection against ultraviolet (UV) radiation. However, this protection is not absolute.
When skin cancer does occur in people with darker skin, it is often found at a more advanced stage. This delay in diagnosis is partly due to the misconception that people with skin of colour do not get skin cancer. As a result, both patients and clinicians may overlook early signs.
Most Common Types of Skin Cancer in Skin of Colour
1. Squamous Cell Carcinoma (SCC)
SCC is the most frequently diagnosed skin cancer in individuals with skin of colour. It often appears in non-sun-exposed areas such as the legs, genital region, or inside the mouth. Unlike in fair-skinned individuals, UV radiation is not the primary cause. Instead, chronic inflammation, scars, burns, or other underlying skin conditions may contribute to its development.
2. Melanoma
In people with skin of colour, melanoma most often appears on non-sun-exposed parts of the body, especially the palms of the hands, soles of the feet, under the nails, and mucous membranes. This type of melanoma, known as acral lentiginous melanoma, is more aggressive and often diagnosed at a later stage.
3. Basal Cell Carcinoma (BCC)
Though less common, BCC can still occur in people with darker skin. Unlike other cancers in this group, BCC is linked to UV exposure and typically appears on sun-exposed areas like the head and neck.
Unique Challenges in Diagnosis
Melanomas and other skin cancers can be harder to identify in darker skin tones due to differences in appearance. For example:
- A dark spot on darker skin may not raise immediate concern.
- Skin cancers may resemble other common skin conditions, such as fungal infections or keloids.
- Changes to nail beds or pigmentation in the mouth might go unnoticed.
These subtleties require both the patient and the clinician to be alert and informed.
Risk Factors Beyond UV Exposure
For skin of colour, UV light is not the main culprit behind skin cancer. Instead, the following play a more significant role:
- Scars or chronic wounds (e.g. from burns or ulcers)
- Chronic inflammation (e.g. lupus or other autoimmune skin conditions)
- Viruses (e.g. HPV in some SCC cases)
- Genetics and family history
Doctors in multicultural areas such as Melbourne need to consider these alternative risk factors when conducting a skin cancer check.
Prevention and Early Detection Strategies
1. Routine Skin Checks
While people with darker skin may not burn as easily, they should still have regular skin cancer screenings, especially if they have a history of scars, burns, or suspicious lesions. Clinics offering skin checks in Melbourne can help identify early signs, even in unusual areas like the feet or inside the mouth.
2. Self-Examinations
Patients should examine their entire body monthly, including the soles of the feet, under nails, between fingers and toes, and inside the mouth. Any new, changing, or persistent spots should prompt a visit to a GP or skin cancer clinic.
3. Public Education
More targeted public health education is needed. Many campaigns focus on sun safety, which may not resonate with people who don’t see themselves at risk. Including skin of colour in campaigns about skin cancer screening in Melbourne can improve awareness and lead to earlier diagnoses.
Conclusion
Skin cancer in skin of colour is rare but dangerous. Due to misconceptions and diagnostic challenges, it often carries a higher risk of morbidity and mortality. Both healthcare providers and patients need to be aware that skin cancer can occur in anyone, regardless of pigmentation.
If you are of African, Asian, Middle Eastern, Hispanic or Indigenous Australian background, speak to your GP about getting a professional skin cancer check — especially if you have scars, chronic skin conditions, or unexplained skin changes.
At clinics providing skin cancer screening in Melbourne, including mole removal and sun spot removal services, early diagnosis and treatment remain the best protection against serious complications.
References:
- Halder RM, Bridgeman-Shah S. Skin cancer in African Americans. Cutis. 1995;55(3):140-145.
- Cancer Council Australia. Skin Cancer Statistics and Issues.
- Sinclair R. Skin Checks. Australian Family Physician. 2012;41(7):464-469.
- Culp B, Lunsford N, Brown J, et al. Skin cancer in skin of colour: A review of the literature and implications for clinical practice. PubMed.