Melanoma in Darker Skin and the Danger of Being Left Out of the Conversation

Written by: Sarah Kashkari

Reviewed by: Katie Kugler and Ethan Bendayan

Introduction

When people picture skin cancer, many imagine fair skin, sunburns, and tanning beds. And while that narrative may reflect those at highest statistical risk, it often leaves out an entire group of people, especially those with darker skin tones who are just as deserving of awareness, early detection, and care.

As someone deeply invested in equity within dermatology, I've often noticed how voices and visuals surrounding melanoma education on social media rarely reflect people of colour. The result isn’t just a lack of visibility; it leads to delayed diagnoses, misinformed patients, and higher death rates in communities already navigating systemic barriers in health.

It’s time for change. Let’s talk about melanoma in darker skin: what it actually looks like, why it’s so often overlooked, and what needs to be done differently.

Yes, People With Darker Skin Can Get Melanoma

Melanoma is the most aggressive form of skin cancer. It begins in melanocytes, the pigment-producing cells that give skin its colour, and can spread rapidly if not detected early. It typically appears on sun-exposed areas like the face, back, arms, or legs, but in individuals with darker skin, it often shows up in areas that receive little sun exposure. This includes places like the soles of the feet, palms, nail beds, and even inside the mouth or nose. These spots are often missed during routine skin exams.

Although melanoma is statistically less common in individuals with darker skin tones (Fitzpatrick IV to VI), it is consistently more. Black patients, for instance, are over two times more likely to be diagnosed at a later stage compared to white patients, and survival rates are significantly lower. These aren’t just numbers. They reflect real consequences tied to systemic gaps in awareness, screening, and education.

A major part of the problem is representation. The idea that melanoma only affects white people is still deeply rooted in both public messaging and medical training. Educational images, online resources, and even diagnostic tools overwhelmingly reflect lighter skin, leaving those with darker skin out of the picture. When people do not see themselves reflected in medical education or awareness campaigns, they are less likely to recognize warning signs or feel that the information applies to them. That silence can be deadly, and it is exactly why this conversation needs to happen.

What Melanoma Looks Like on Darker Skin

Melanoma doesn’t always show up the way we expect. On deeper skin tones, it often looks different from the typical images used in textbooks or online, which usually show a light brown mole changing shape on pale skin. This limited representation is one of the reasons why melanoma in people with darker skin tones is often diagnosed late.

The most common type of melanoma in individuals with skin of colour is called acral lentiginous melanoma (ALM). Unlike other forms, ALM tends to appear in areas that receive little or no sun exposure These include the palms, soles of the feet, under or around the nails, and sometimes even mucous membranes such as inside the mouth or nose. These are not areas most people routinely check during skin exams, which makes early detection even harder.

Here are signs to watch for:

●      A dark brown/black stripe under a nail, especially with widening/irregular borders

●      A new or changing dark spot on the palm or sole

●      Any mole or spot that stands out from the others, also known as the "ugly duckling"

●      Sores or lesions on pigmented skin that bleed, crust, itch, or do not heal

The ABCDE rule remains helpful (Asymmetry, Border, Color, Diameter, Evolution), but the way melanoma presents on darker skin can vary. The colour may appear much deeper, bluish-black, grey, or even look like a bruise. These differences are subtle and often missed, especially if clinicians are not trained to identify melanoma on skin of colour.

This lack of education and awareness is part of a larger problem, when patients and providers alike are taught what to look for on only one skin tone, others get left out of life-saving conversations. That is why increasing representation and awareness is not just important, it is urgent.

Is Social Media a Missed Opportunity for Representation?

Social media is where many people turn to learn about their health. Platforms like TikTok are filled with videos explaining what to look out for and when to see a doctor. But when you scroll through content about melanoma, one thing becomes clear: people with darker skin are barely represented.

A 2023 study looked at the 100 most viewed TikTok videos about longitudinal melanonychia, which is a dark brown or black stripe under the nail that can be an early sign of nail melanoma. Although this condition is more common in people with darker skin tones, most of the videos featured white skin, and very few provided helpful or accurate guidance. In fact, less than one-third of the videos advised viewers to seek medical.

This problem goes far beyond one platform. A 2024 review of over 100 studies found that misinformation about skin cancer is widespread across social media, and most content still centers white skin. One study found that 97% of skin cancer posts on Pinterest featured only white skin. In interviews, Black participants shared that they rarely saw their communities represented in public health posts about skin cancer, so the messaging felt irrelevant to them.

When people do not see themselves in health information, they are less likely to recognize the signs or take them seriously. This can lead to late diagnoses and worse outcomes. Representation is not just about feeling seen. It is about making sure everyone has the information they need to protect their health.

The Mental Health Impact of Being Left Out

Being consistently excluded from medical narratives affects more than just physical health; it can have significant psychological consequences. For individuals with darker skin, the ongoing lack of representation in medical education, public health messaging, and dermatologic imagery can reinforce feelings of invisibility and invalidation. These experiences often manifest as racial microaggressions, subtle but harmful signals that suggest certain identities are less valued in healthcare settings. Over time, exposure to such microaggressions has been linked to increased rates of anxiety, depression, suicidal ideation, and a growing mistrust in the healthcare system. In the context of melanoma, a delayed diagnosis can carry an additional emotional burden, not only due to the seriousness of the disease but also the awareness that earlier detection might have been possible with more inclusive educational efforts. As Togioka and Young emphasize, both structural and interpersonal discrimination compromise patient outcomes and undermine trust in care. Ensuring inclusive representation, especially in dermatology, is not only a step toward better clinical outcomes but a necessary affirmation that every patient’s health, identity, and experience matter.

What Needs to Change and How You Can Help

It starts with awareness, but it doesn’t stop there.

1.     Representation in Educational Materials

We need to make sure dermatology content actually reflects all of us. That means seeing more examples of melanoma on darker skin tones across social media, websites, and public health campaigns. Studies have shown that platforms like Pinterest and TikTok overwhelmingly feature white skin in posts about skin cancer, even when the conditions they’re describing (like longitudinal melanonychia) are more common in people of colour.

2.     Community-Based Education

Public health messages need to meet people where they are, culturally and literally. That means tailored outreach in Black, South Asian, Indigenous, and Latinx communities that says: yes, this applies to you, and here’s what to look out for. When health education doesn’t include your community, it’s easy to tune it out or assume it’s not relevant. But representation makes education stick.

3.     Medical Education Reform

Training for doctors and healthcare providers needs a serious update. We can’t keep teaching melanoma based on how it looks on just one skin tone. The lack of diverse images in textbooks and exams isn’t just an oversight, it’s dangerous. Black patients are already more likely to be diagnosed at later stages, and that’s partly because the warning signs aren’t being caught early enough.

4.      Doing Your Own Skin Checks

No matter your skin tone, monthly self-checks are important. And don’t skip the hard-to-see areas, soles, palms, under your nails, and your scalp. If something looks new or weird, trust your gut and get it checked. You know your body better than anyone, and your concern is always valid.

Final Thoughts

Skin cancer doesn’t discriminate, but the way we talk about it still does. When awareness campaigns, educational materials, and social media content centre only on white skin, people with darker skin are left out of the conversation, and that comes with real consequences.

At SkinPact, we’re working to change that. We believe that skin cancer education should reflect the diversity of the people it aims to protect. Every skin tone deserves to be seen, recognised, and informed.

Because when someone searches for “melanoma,” they shouldn’t see one version of it, they should see the whole picture.

References

Agbai, O. N., Buster, K., Sanchez, M., Hernandez, C., Kundu, R. V., Chiu, M., Roberts, W. E., Drodge, B. L., Bhushan, R., & Taylor, S. C. (2014). Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public. Journal of the American Academy of Dermatology, 70(4), 748–762. https://doi.org/10.1016/j.jaad.2013.11.038

Albucker, S. J., & Lipner, S. R. (2023). Social media creators are far from nailing it: A cross-sectional analysis of 100 longitudinal melanonychia TikTok videos. Journal of Cutaneous Medicine and Surgery, 27(2), 170–173. https://doi.org/10.1177/12034754231159649

American Academy of Dermatology. (2014, February 4). Dermatologists provide recommendations for preventing and detecting skin cancer in people of color [Press release]. https://www.aad.org/news/skin-cancer-in-people-of-color

Gloster, H. M., & Neal, K. (2006). Skin cancer in skin of color. Journal of the American Academy of Dermatology, 55(5), 741–760. https://doi.org/10.1016/j.jaad.2005.08.063

Haff, P. L., Jacobson, A., Taylor, M. M., Schandua, H. P., Farris, D. P., Doan, H. Q., & Nelson, K. C. (2024). The new media landscape and its effects on skin cancer diagnostics, prognostics, and prevention: Scoping review. JMIR Dermatology, 7, e53373. https://doi.org/10.2196/53373

Hong, E. M., Atoot, R., Decker, M. E., Ekwueme, A. C., Stanislaus, C., Ayeni, T., Duffy, C. P., Piazza, A. E., Mitre, M., Siracusa, L. D., & Zepf, J. F. (2024). Standing up for representation in undergraduate medical education curricula. Journal of the Medical Library Association, 112(4). https://doi.org/10.5195/jmla.2024.1939

Mayo Clinic. (2023, October 13). Melanoma. https://www.mayoclinic.org/diseases-conditions/melanoma/symptoms-causes/syc-20374884

Niu, Z., Rivera, Y. M., Lozada, C., Hudson, S. V., Penedo, F. J., Manne, S. L., & Heckman, C. J. (2024). Designing a culturally relevant digital skin cancer prevention intervention for Hispanic individuals. JMIR Dermatology, 8, e56939. https://doi.org/10.2196/56939

Pollitt, R. A., Geller, A. C., Brooks, D. R., Johnson, T. M., Park, E. R., & Swetter, S. M. (2009). Efficacy of skin self-examination practices for early melanoma detection. Cancer Epidemiology, Biomarkers & Prevention, 18(11), 3018–3023. https://doi.org/10.1158/1055-9965.EPI-09-0310

Qian, Y., Johannet, P., Sawyers, A., Yu, J., Osman, I., & Zhong, J. (2021). The ongoing racial disparities in melanoma: An analysis of the SEER database (1975–2016). Journal of the American Academy of Dermatology, 84(6), 1585–1593. https://doi.org/10.1016/j.jaad.2020.08.097

Reichman, M., Jaramillo Gil, H. D., O'Neill, B. C., Corines, M. J., Coleman, N., Shin, H., Meservey, J., da Silva, M., Wimbush, A., & Babagbemi, K. (2024, September 30). Creating scalable health equity frameworks: A cancer screening campaign in Black and Hispanic women. JCO Oncology Practice, 20(10_suppl), 75. https://doi.org/10.1200/OP.2024.20.10_suppl.75

Sadur, A., Nasseri, M., McCormick, E. T., & Friedman, A. (2024). Skin tone representation on patient-facing skin cancer education websites. Journal of Drugs in Dermatology, 23(5), e137. https://doi.org/10.36849/JDD.7905e

Togioka, B. M., & Young, E. (2024). Diversity and discrimination in health care. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK579996/