Columbia University: Skin Cancer in People of Color

Dark skin does provide some protection against the sun’s ultraviolet rays, but it’s a myth that people with dark skin tones are immune to the harmful effects of UV radiation.

People of color have a lower risk of developing skin cancer than people with fair skin tones, but UV exposure raises the risk for everyone.

Studies show that Black and Hispanic Americans who live in sunnier parts of the country have greater rates of melanoma and that UV radiation also correlates with other types of skin cancer in people with darker skin tones.

UV radiation also ages the skin, leading to wrinkles, spots, and changes in skin texture in people of all skin tones.

We spoke with Dawn Queen, MD, a dermatologist at Columbia University Vagelos College of Physicians and Surgeons, to get the facts about skin color, skin cancer, and other effects of ultraviolet rays.

Dark skin is not sunscreen.
“Dark skin does confer some degree of natural protection due to the increased melanin content in the skin,” Queens says. But melanin is only protective up to an SPF of about 13, while current recommendations are to use sunscreens with an SPF of at least 30 every day and especially when outdoors.

“Depending on the skin’s natural protective factor alone is not sufficient to protect you from sunburn. Although it’s true that people with darker skin won’t burn quite as quickly, they are still at risk for skin cancer and photoaging and should take preventative measures to minimize those risks.”

Dark skin does burn.
“There’s a misconception that people with darker skin tones can’t burn and don’t need to wear sunscreen,” Queen says. “While it is true that they will burn less frequently than their lighter counterparts due to increased protective melanin in the skin, melanin is not impervious to all UV rays. Burns can and do occur.”

According to a CDC survey, 32% to 38% of Hispanic adults and 9% to 13% of Black men and women experience at least one burn a year.

“Burns significantly increase the risk for skin cancers, and protecting the skin from UV rays is our best tool to prevent them before they happen,” Queen says.

Melanoma survival rates are lower among people of color.
Overall, skin cancers are less prevalent in Black and Hispanic people compared with lighter skinned individuals in the United States. For instance, for melanoma, age-adjusted incidence rates (per 100,000) among Hispanic and Black Americans (4.5 and 1.0) are significantly lower than among white non-Hispanic people (21.6).

“But what is crucially important to understand is that melanomas in darker-skinned populations have consistently been associated with a higher rate of metastasis and poorer outcomes,” Queen says. For example, among non-white Hispanic males, the five-year survival rate of melanoma is 77.1%; it is around 78% for Black men and 86.5% in non-Hispanic white males.

“In part, this is due to the fact that skin cancers such as melanoma are often diagnosed at a later stage in these populations.”

Melanomas in people of color are often hidden.
The most common forms of melanoma diagnosed in Black people occur on body parts that are usually shielded from the sun: the palms, soles of the feet, under the nails, and inside the mouth.

“It is important to examine these areas to monitor for any new, changing, or growing moles,” Queen says. “Or in the case of nails, changes in color or a new or growing streak of pigment that runs the length of the nail.”

Watch for other types of skin cancer.
Among non-melanoma skin cancers, almost 90% of basal cell carcinomas are found on the head or the neck in people of color.

“People should look for pearly growths that may bleed spontaneously,” Queen says.

Another type of skin cancer—squamous cell carcinoma—can appear on any part of the body and often looks like a hard or scaly growing bump or plaque.

Get vitamin D through food or supplements.
Vitamin D deficiency is an issue among everyone, but in people with dark skin, melanin absorbs the UV rays that activate vitamin D production in the skin, contributing to and worsening vitamin D deficiency.

“Vitamin D is important as it has protective effects against cardiovascular disease, diabetes, and some cancers,” Queen says, “but the preferred method of vitamin D intake is through oral supplementation. It is just as effective and significantly safer than obtaining vitamin D through cutaneous absorption.”