Racial and Ethnic Differences in Skin Cancer
By Clarissa Portocarrero
Reviewed by Dr. Nicole Joy
Skin cancer is the most common cancer in the United States, but its impact varies by race and ethnicity. Though often associated with fair skin and sun exposure, skin cancer can also occur in people with darker skin tones and is often associated with more serious outcomes due to delayed detection. Understanding how skin cancer appears on different skin types and why some communities face greater risks is key to early detection and prevention.
Overview of Skin Cancer Types
Basal Cell Carcinoma
Basal cell carcinoma (BCC) is the most common type of skin cancer, primarily affecting non-Hispanic White individuals with fair skin and a history of cumulative sun exposure. It typically arises on sun-exposed areas such as the face, neck, and upper trunk. BCC is rare in Black individuals and less common in Hispanic and Asian populations. When it does occur in people of color, it usually appears on sun-exposed sites like the head and neck. In these populations, BCCs are more likely to be pigmented, which can make clinical recognition more difficult. Diagnosis may be delayed in people of color due to differences in appearance and lower rates of routine skin exams.
Squamous Cell Carcinoma
Squamous cell carcinoma is the second most common type of skin cancer, primarily affecting non-Hispanic White individuals with fair skin and a history of cumulative sun exposure. It often appears on sun-exposed areas, such as the face, ears, scalp, and hands.
In Black individuals, SCC is the most common skin cancer and typically arises on non-sun-exposed areas, especially sites of chronic inflammation, scars, or prior injury. Common locations include the lower legs, genital area, and skin around the anus. Hispanic and Asian individuals may also develop SCC in both sun-exposed and non-sun-exposed sites. In people with skin of color, SCC may be more aggressive and is often diagnosed at a later stage, which can impact outcomes.
Melanoma
Melanoma is less common than BCC and SCC, but is the most aggressive form of skin cancer due to its high potential for metastasis. It most frequently affects non-Hispanic White individuals with fair skin and a history of intense, intermittent sun exposure, especially those who experienced blistering sunburns during childhood. Melanoma typically appears on the trunk in men and the legs in women, and often presents as an evolving dark or irregular lesion.
In Black, Hispanic, and Asian individuals, melanoma is less common overall, but more likely to present as acral lentiginous melanoma (ALM). This subtype occurs on non-sun-exposed areas, including the palms, soles, and beneath the nails. ALM is frequently diagnosed at a later stage in these populations, due to low clinical suspicion, atypical location, and limited public awareness that people with darker skin are also at risk for melanoma. These delays contribute to poorer prognoses and higher mortality.
Spotlight on Acral Lentiginous Melanoma
Acral lentiginous melanoma is a distinct and aggressive subtype of melanoma that disproportionately affects people of color. While it represents less than 5% of all melanomas in the general population, ALM is the most common form of melanoma among Black and Asian individuals and also occurs in Hispanic patients.
Unlike other melanoma subtypes, ALM develops on areas not typically exposed to the sun, which can lead to delays in recognition and diagnosis.
Key facts:
ALM is not caused by sun exposure and typically appears on the palms, soles, or under the nails.
It is the most common melanoma subtype in Black and Asian patients and can also be seen in Hispanic populations.
Early signs may include a dark stripe beneath a nail or a slowly growing dark spot on the sole or palm.
ALM can resemble benign conditions like bruises or fungal infections, which can make early diagnosis more challenging.
It is frequently diagnosed at a more advanced stage, contributing to higher mortality in affected populations.
Raising awareness about acral lentiginous melanoma in the community and ensuring that skin cancer education includes how it presents across all skin tones can lead to earlier detection and better outcomes. At Veriderma, we aim to empower the community through education while partnering with healthcare providers to promote early recognition, reduce disparities, and ensure more equitable access to skin cancer care.
Images of Acral Lentiginous Melanoma (ALM)
Images sourced from DermNet New Zealand and Te Whatu Ora – Health New Zealand
https://dermnetnz.org/topics/acral-lentiginous-melanoma
Why Are Outcomes Worse for People of Color?
People with darker skin often experience:
Delayed diagnosis due to atypical presentation and lack of awareness
Lower access to dermatologists
Fewer routine skin checks and screenings
Limited representation of skin cancer in medical education and public health campaigns
For example, studies show that Black patients with melanoma are more likely to be diagnosed at later stages and are 17–42% more likely to die from it compared to White patients, even when controlling for socioeconomic status.
Prevention Strategies for All Skin Tones
Sun protection is important for everyone—not just people with fair skin. Here’s how to lower your risk:
Use sunscreen with SPF 30 or higher every day, even on cloudy days
Reapply sunscreen every 2 hours when outdoors
Wear protective clothing like hats, sunglasses, and long sleeves
Avoid tanning beds
Seek shade, especially between 10 AM and 4 PM
Check your skin monthly, including less obvious places like under nails, soles, and scalp
Equitable Skin Cancer Awareness
Healthcare should reflect the diversity of the communities it serves. In dermatology, this means improving how we educate, diagnose, and engage with patients of all backgrounds. At Veriderma, our mission is to advance inclusive skin health by addressing gaps in awareness, representation, and access to care.
Key strategies include:
Incorporating images of skin cancer on darker skin tones in public health materials, educational campaigns, and social media outreach.
Promoting routine skin exams in communities that have historically been underrepresented in dermatologic care
Designing education campaigns that reflect the beliefs, languages, and risk perceptions of diverse cultural groups
Hosting community events with dermatologists and medical students to offer on-site education and free spot checks
Collaborating with local organizations and schools to bring skin health education directly to trusted community spaces
By integrating these principles into outreach, we can move toward more equitable outcomes and earlier skin cancer detection for all.
Takeaway: Early Action Saves Lives
Skin cancer can be deadly, but early detection and prevention are powerful tools, especially for communities that have historically been underserved. Don’t wait for a spot to “look bad.” If you notice anything new, unusual, or changing on your skin, talk to your doctor!
References
Carter TM, Tran KT, Farrow NE, et al. Does acral lentiginous melanoma subtype account for differences in patterns of care in Black patients? Am J Surg. 2021;221(4):706-711. doi:10.1016/j.amjsurg.2020.12.040.
Mohsin N, Hamid O, Mahalingam M. Differences in Merkel Cell Carcinoma Presentation and Outcomes Among Racial and Ethnic Groups. JAMA Dermatol. 2023;159(5):536–540. doi:10.1001/jamadermatol.2023.0061.
Shao K, Feng H. Racial and Ethnic Healthcare Disparities in Skin Cancer in the United States: A Review of Existing Inequities, Contributing Factors, and Potential Solutions. J Clin Aesthet Dermatol. 2022;15(7):16-22.
Lam M, Roh YS, Zhao G, et al. Racial Differences in the Prognosis and Survival of Cutaneous Melanoma From 1990 to 2020 in North America: A Systematic Review and Meta-Analysis. J Cutan Med Surg. 2022;26(2):181–188.
Rizvi Z, Thomas C, Badran E, et al. The Bias of Physicians and Lack of Education in Patients of Color With Melanoma as Causes of Increased Mortality: A Scoping Review. Cureus. 2022;14(11):e31669. doi:10.7759/cureus.31669.
Fliorent R, Podwojniak A, Adolphe L, Milani K. Racial Differences in Perceived Risk and Sunscreen Usage. Cureus.2023;15(1):e33752. doi:10.7759/cureus.33752.
Wang Y, Hung MC, Cheng C, et al. Racial differences in six major subtypes of melanoma: descriptive epidemiology. BMC Cancer. 2016;16:691. doi:10.1186/s12885-016-2747-6.
Lim JL, Asgari M. Cutaneous Squamous Cell Carcinoma: Epidemiology and Risk Factors. UpToDate. Updated January 29, 2025.
Aasi SZ. Treatment and Prognosis of Basal Cell Carcinoma at Low Risk of Recurrence. UpToDate. Updated May 7, 2025.
Aasi SZ, Hong AM. Treatment of Basal Cell Carcinomas at High Risk for Recurrence. UpToDate. Updated May 7, 2024.
