Skin Cancer in Skin of Colour

Feb 24, 2026 | Blog

Skin Cancer in Skin of Colour

Skin cancer is less common in people with darker skin tones, but it does occur — and when it is diagnosed later, outcomes are often worse.

Melanin provides some natural UV protection, but it does not make anyone immune to skin cancer. Darker skin can still develop UV-related damage and skin cancer, and some skin cancers in skin of colour appear in areas that don’t get much sun exposure. 

A common problem is that people may not expect skin cancer in darker skin, so warning signs are mistaken for something less serious, such as a bruise, wart, callus, or non-healing sore.

Skin cancer can present differently in darker skin tones

In skin of colour, skin cancer can present as:

  • a non-healing sore or pimple-like lesion
  • a rough/scaly patch that doesn’t go away (sometimes darker than the surrounding skin, sometimes mixed in colour)
  • a new dark spot that changes, grows, bleeds, or becomes painful
  • a nail change, especially a dark line/streak, pigment around the nail, nail splitting, or nail lifting
  • a lesion that looks like a callus or wart, especially on the foot (important for acral melanoma)

What are the most common sites of occurrence in skin of colour? 

One of the biggest differences is where melanoma often appears.

In people with darker skin, melanoma more often occurs on less sun-exposed areas, especially:

  • palms of the hands
  • soles of the feet
  • under or around the nails (subungual/nail-unit melanoma)

This pattern is often linked to acral lentiginous melanoma (ALM), a subtype that arises on palms, soles, and nail beds. While ALM is rare overall, it makes up a much larger proportion of melanoma cases in people of colour. In people of colour, many melanomas arise on palms, soles, and nail areas, and delayed-stage diagnosis is more common. 

Why is diagnosis often delayed?

Delayed diagnosis is usually not one single issue — it is a combination of factors:

  1. The myth that darker skin is “protected”

Many people underestimate their risk, so warning signs are watched for too long or ignored. This misconception is repeatedly linked to delayed diagnosis. 

  1. Lesions appear in unexpected places

A melanoma on the heel, sole, or under a nail is easier to miss than one on the face or arm. These sites are less visible and may be mistaken for trauma, fungal nail changes, bruising, or friction-related skin thickening. 

  1. Signs may not match classic public messaging

One reason for delay may be that common melanoma education (such as the ABCDE mole rule) does not always fit the patterns most often seen in darker skin, particularly acral/nail presentations. 

  1. Access and education barriers

Peer-reviewed reviews also point to lower awareness, fewer prevention discussions, and barriers to care/access as contributors to later-stage diagnosis and worse outcomes. 

What should patients check regularly?

For patients with darker skin tones, skin checks should include the “usual” areas and the commonly missed ones:

  • palms
  • soles (including heels and between toes)
  • toenails and fingernails
  • around the nail folds
  • scalp
  • inside the mouth (if any persistent pigmented lesion or sore)
  • any scar or chronic non-healing area

When should you seek a medical review?

Arrange a skin check if you notice:

  • a spot that is new, changing, or unusual
  • a non-healing sore
  • a dark streak in a nail that doesn’t grow out like a bruise
  • a thickened patch on the sole or palm that grows, changes colour, or becomes painful
  • a lesion that bleeds, crusts, or persists

Early review matters. Even serious skin cancers are much more treatable when found early. 

Prevention still matters in skin colour

Although some melanomas in skin of colour (especially acral melanoma) are not primarily caused by sun exposure, sun protection is still important because people with darker skin can still develop UV-related skin damage and skin cancers. Prevention should include:

  • broad-spectrum sunscreen on exposed skin
  • hats and protective clothing
  • avoiding intentional tanning
  • routine self-checks (including palms/soles/nails)

Peer-reviewed reviews emphasise that prevention and education remain important for all skin tones. 

The key message

If you have skin, you can get skin cancer.

In skin of colour, skin cancer may look different and appear in less obvious places — especially the palms, soles, and under the nails. That is exactly why awareness and early assessment are so important. Recognising these patterns earlier can reduce delayed diagnosis and improve outcomes.