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Skin of Colour

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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

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]

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

A

Age range 20-90 years. African American, Native American, or Asian.

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

  • Get a skin examination with 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 sos they can note if there is anything on body that warrants further attention.
  • 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.

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. But you don’t have to face the 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

Find Support

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/

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