Skin of Colour

SKIN OF COLOUR

Quick Facts

  • Melanoma can occur in skin of colour individuals.
  • Acral Lentiginous Melanoma (ALM) is the most common type of melanoma found in people with skin of colour. This would mainly include people with Fitzpatrick skin types 5 and 6.[i] See Table below.
  • ALM usually occurs in the palms of the hands or soles of the feet. It can also occur under the nail; this is known as Subungual Melanoma (SM)[ii]
  • ALM and SM can affect people of all skin types. In patients with lighter skin types it makes up a smaller percentage of melanoma while in darker skin types, it makes up a majority of cases of melanoma [iii]
  • ALM often looks like a bruise or stain mark that won’t heal. SM usually looks like a dark vertical stripe on the nail.[iv]
  • For ALM and SM, skin self-exams are an effective strategy for early detection [v]
  • The ABCDE technique is commonly used to identify signs and symptoms of melanoma but [vi] when it comes to identifying ALM and SM different techniques are used. See detection below.
Table 1. The Fitzpatrick skin types. [i]

1. Very Pale White Skin

Often with green or blue eyes and fair or red hair

2. White Skin

Often with blue eyes

3. Fair Skin

With brown eyes and brown hair

4. Light brown skin

Dark eyes, and dark hair

5. Brown Skin

Dark eyes, and dark hair

6. Dark brown or black skin

Dark eyes, and dark hair

WHAT DOES THIS MEAN FOR ME?

Acral lentiginous melanoma (ALM)A in situ (local melanoma) is not dangerous. However, it can become potentially life-threatening if the melanoma grows into surrounding tissue. Prognosis depends on multiple factors, such as gender, race, age and clinical features of the tumor. ALM is best treated with a wide local excision performed by a qualified physician. Early detection and adequate patient education are crucial for improving survival in patients affected by ALM. Patients who require digit or limb amputation for treatment purposes may experience loss of function of the affected limb, significant interference with their activities of daily living, poor cosmetic outcomes and phantom pain. Large excisions may also lead to painful scarring and contractures.

Subungual Melanoma (SM) is a type of malignant melanoma that occurs in the nails. SM presents as brown-black discolorations in the nails that can progress to painful destruction of the nails. Unlike melanoma on the skin, subungual melanoma is not related to sun exposure. It is important to consider other causes of discoloration to the nails such as fungal infection or bruising.

DETECTION 

  • ALM can present as dark spots or bruises on the palms of the hands or soles of the feet that do not go away or won’t heal. [i]
  • SM can present as a dark vertical stripe on the fingernails or toenails. [i]

Get a skin examination with your family doctor or a dermatologist (a doctor who specializes in treating skin, nails and hair) if you possess any risk factors or if you have an area of concern so  they can note if there is anything on your body that warrants further attention. Find a dermatologist.

Use the Alphabet of Nail melanoma To help identify Subungual Melanoma (SM)

A

Age range 20-90 years.

B

Band of Brown or Black pigment in nail OR Breadth of >3mm OR Border that is irregular/blurred.

C

Change in size or growth rate of nail band OR lack of change in irregular nail despite treatment.

D

Digit involved (nail melanoma is most common in the thumb>big toe>index finger). Pigmented band on a single digit is more suspicious than on multiple digits.

E

Extension of brown or black pigment to the side or base of the nail.

F

Family or personal history of melanoma or irregular moles.

To help identify acral melanoma CUBED can be used

C

Coloured lesions where any part of the skin is a different colour

U

Uncertain diagnosis or a lesion without a clear clinical diagnosis

B

Bleeding lesions

E

Enlargement of a lesion

D

Delay in healing beyond two months

PREVENTION

  • For ALM and SM, monthly self-exams and yearly exams by a physician are an effective strategy for early detection
  • Pay attention to any changes in your skin and body; if you notice anything new or different see your doctor or go to your local walk-in clinic. [i]
  • Advocate for yourself, if there is something concerning you about your body make sure to get checked by your family doctor or go to your local walk in clinic.

SKIN CHECK REMINDER

75% of melanomas are detected by patients themselves!

Receive a notification email with helpful tips every full moon.

Myths

scroll over the box for the answer

People with dark skin cannot get melanoma

People with dark skin do not need to wear sunscreen

RISK FACTORS

  • Genetic factors. If your family has a history of melanoma you could be at a higher risk for developing melanoma.[i]
  • Late diagnosis. There is a common misconception that people with skin of colour cannot develop melanoma, so these types are often caught at a later stage compared to people with white skin[ii]
  • Misdiagnosis: Sometimes ALM and SM can be mistaken for a bruise but if it does not heal then this could be a sign of melanoma.[iii]

YOU ARE NOT ALONE

A skin cancer diagnosis can be overwhelming and navigating the healthcare system as a patient of colour presents unique challenges. But you don’t have to face those challenges alone. The Melanoma Network of Canada offers a wide variety of free services to support patients, families and caregivers through every step of their journey. 

Contact Mary Zawadzki Patient Care Specialist B.A, SSW, RSSW, Certified Professional Cancer Coach, Member of CAPO –  call 905.901.5121 x108 or 1.877.560.8035 x108 or email mzawadzki@melanomanetwork.ca

Acknowledgement: edits were provided by Dr. Boluwaji Ogunyemi-BSc, MD, FRCPC, FAAD

IMAGE Resources
ACL Image 1 provided by Skin of Color society  skinofcolorsociety.org
ACL Images 2-4 provided by DermNet NZ https://dermnetnz.org/

REFRENCES

[i] [ii] [iii] [iv] [v] [vi] [vii] [viii] [ix]

[i] https://www.melanomanetwork.ca/types-of-melanoma/

[ii] https://www.melanomanetwork.ca/types-of-melanoma/

[iii] https://skinofcolorsociety.org/

[iv] https://www.ncbi.nlm.nih.gov/books/NBK559113/ – Cancer, Acral Lentiginous Melanoma. Hall & Rapini 2020

[v] https://www.aimatmelanoma.org/melanoma-101/types-of-melanoma/cutaneous-melanoma/acral-lentiginous-melanoma/

[vi] https://www.curemelanoma.org/about-melanoma/people-of-color/

[vii] https://www.curemelanoma.org/about-melanoma/people-of-color/

[viii] https://www.aimatmelanoma.org/melanoma-101/types-of-melanoma/cutaneous-melanoma/acral-lentiginous-melanoma/

[ix] https://www.aimatmelanoma.org/melanoma-101/types-of-melanoma/cutaneous-melanoma/acral-lentiginous-melanoma/

https://www.ncbi.nlm.nih.gov/books/NBK559113/#article-17107.s9

https://dermnetnz.org/topics/acral-lentiginous-melanoma/

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