ATHENS, Greece — Although melanoma occurs much more frequently in people with lighter complexions, people with darker skin are also at risk, according to experts who spoke at the 11th World Congress of Melanoma and 21st EADO Congress 2025 on the challenges of diagnosing the condition in patients with dark skin.
“Melanoma is colorblind,” said Willie Visser, MD, head of dermatology at Stellenbosch University, Stellenbosch, South Africa, presenting during the session.
Having lighter skin color is a major risk factor for melanoma, but “there is no such thing as safe skin type,” agreed co-presenter Dagmar Whitaker, a dermatologist at Cape Town Dermatologists in South Africa. “Don’t trust your instinct when it comes to dark skin. Just because it’s rare, it doesn’t mean it doesn’t exist.”
In the United States, the rate of new melanoma cases per 1000,000 people is about 38 for White men vs 1 for Black men and 25.6 for White women vs 0.9 for Black women (global incidence rates are similar to those in the United States). The lifetime risk for being diagnosed with melanoma in the United States is about 3% (1 in 33) for White people and 0.1% (1 in 1000) for Black people.
However, because melanoma occurs much less frequently in Black individuals, and the disease presents differently depending on skin color, people with darker skin may experience significant delays in diagnosis and are often diagnosed at later stages.
Diagnosis Problems
The challenge often begins with a lack of awareness and access.
In Africa, for instance, Whitaker explained that resources are stretched thin. A dermatologist shortage has been reported in many countries in Africa alongside a high prevalence of untreated skin cancer, especially in rural areas. In Ghana, for example, there’s about one dermatologist per million people in the population and only three per million in South Africa, compared with about 36 per million in the United States and 65 per million in Germany.
This scarcity of dermatologists in Africa probably contributes to the limited data collection on skin cancer across the continent. “Most countries do have a registry, but the collection is neither compulsory nor standardized,” Whitaker said.
For example, Nigeria collected data from 54 cases between 1991 and 2000 in a population of 100 to 125 million. “They managed to collect only 54 cases over a decade. What does it tell you? They don’t look, and they don’t find,” she said.
In the United States, “complex factors, such as socioeconomic differences, lower healthcare access, structural racism, and higher rates of medical comorbidities, likely contribute to these inequalities,” according to three US-based dermatologists, Michael A. Marchetti, MD, Adewole S. Adamson, MD, MPP, and Allan C. Halpern, MD, writing in a recent Viewpoint in JAMA Dermatology.
But perhaps the biggest issue is that melanoma in darker skin presents differently from in lighter skin, Whitaker explained. More specifically, melanoma in Black patients doesn’t fit the classic ABCDE criteria (asymmetry, border, color, diameter, and evolving).
Cancers in Black patients are often mistaken for unhealed wounds or infections, and the location of melanomas in people with darker skin also differs significantly from those with lighter skin.
“We don’t get it in sun-exposed areas,” Visser said, which means “don’t start with a typical [full-body] examination.”
In Black patients, it is much more common for melanoma to occur on the palms, soles, nail beds, and genitals. The different ways melanoma presents in Black patients often leads to misdiagnoses or delays in diagnoses, because these areas are not typically the first to be examined for skin cancer. And when melanoma is diagnosed, it’s typically at a more advanced stage.
“We hardly ever pick up cutaneous melanoma which isn’t already metastasized,” Whitaker said. So, despite the overall improvement in melanoma-specific survival over the past decade or so, there’s a survival gap between Black and White patients, Whitaker explained.
A recent analysis that included over 200,000 participants in the United States found that 5-year overall survival rates in men with melanoma are highest for White men (75%) and lowest for Black men (52%); survival rates for American Indian/Alaskan Native (69%), Asian (68%), and Hispanic men (66%) fell in between. In a multivariate model that adjusted for confounding variables, Black race was independently associated with a 26% increased mortality risk compared with White race, according to the authors, led by Jennifer M. Fernandez, MD, RD, from the University of Nebraska Medical Center, Omaha, Nebraska.
However, Adamson and colleagues explained in their recent Viewpoint that survival outcomes aren’t always worse in Black patients. When looking at acral lentiginous melanoma — the most common melanoma type diagnosed in Black individuals — the majority of studies have found no differences in survival rates between Black and White individuals. But, given the low incidence of melanoma among Black patients, the viewpoint authors acknowledged that these analyses may not be large enough to adequately study and compare survival outcomes.
Need for Targeted Education and Research
Whitaker and Visser both stressed the need for increased education and awareness, targeting both the general public and healthcare professionals.
Whitaker noted the limitations of generic awareness campaigns given the low incidence of melanoma in Black individuals as well as the different ways melanoma presents itself in this population.
The lower incidence should not lead to complacency, noted Visser. Instead, healthcare professionals must be educated to recognize the atypical presentations and where melanoma is likely to occur in darker skin.
“We don’t need to give them pictures of ABCDE. We need to show them where they get it: on their toes, fingers, and nails,” he said.
He also called for more research on people with darker skin. The underrepresentation of Black patients in major melanoma trials can lead to treatment guidelines that don’t necessarily apply to those with darker skin, he added.
US-based experts also noted the importance of having quality population-based datasets across racial and ethnic groups as well as medical education that includes images and curricula that include differences across racial/ethnic groups.
Adamson and colleagues stated that it will be critical to prioritize including more Black patients in studies exploring diagnostic accuracy and that these “studies should also include efforts to improve melanoma diagnostic criteria and specificity for potentially fatal disease.”
“The goal of eliminating preventable deaths from melanoma and reducing melanoma-related disparities among Black individuals is a necessary pursuit,” they concluded.
Whitaker and Visser reported no relevant financial relationships.
Manuela Callari is a freelance science journalist specializing in human and planetary health. Her work has been published in The Medical Republic, Rare Disease Advisor, The Guardian, MIT Technology Review, and others.