A new dark streak under a nail, a sore on the sole of the foot that will not heal, or a changing patch of skin may be easy to dismiss. For people with darker skin, that delay can be dangerous. Skin cancer darker skin is less common than it is in people with fair skin, but it can still occur – and it is often diagnosed later, when treatment may be more complex.
No one should be told that their natural skin tone makes them immune. In Australia, where ultraviolet (UV) radiation is intense, knowledge can save your life. Knowing what to look for, including signs that do not fit the usual image of a changing brown mole, helps you act quickly.
Can people with darker skin get skin cancer?
Yes. People of African, Asian, Middle Eastern, Pacific Islander, Aboriginal, Torres Strait Islander, South Asian and other darker-skinned backgrounds can develop melanoma, basal cell carcinoma and squamous cell carcinoma. Risk is generally lower when the skin has more melanin, because melanin provides some natural protection against UV damage. It is not complete protection.
Skin cancer in people with darker skin may develop in areas that receive little sun, including the palms, soles, nails, mouth and genital region. Some skin cancers are associated with UV exposure, while others may be linked with chronic wounds, scarring, inflammation, immune suppression, certain infections or genetics. This is one reason a quick glance at sun-exposed skin alone is not enough.
The practical message is simple: lower risk does not mean no risk. A lesion that is new, changing, bleeding, painful or not healing deserves medical assessment, whatever your skin colour.
Why skin cancer in darker skin can be diagnosed later
Delayed diagnosis is not simply a matter of someone failing to notice a mark. Skin cancer awareness campaigns have often centred on fair skin, freckles and obvious sun damage. That can leave people with skin of colour, and sometimes health professionals, less prepared to recognise how cancer may appear on darker skin.
Pigment can also make changes in colour, borders and subtle redness harder to see. A melanoma may not look like the classic dark, uneven mole described in public campaigns. It can be pink, red, skin-coloured, purple, blue-black or appear as a persistent non-healing area.
There are practical barriers too. People may have previously been reassured that they are not at risk, may not know that a nail or foot lesion needs checking, or may delay an appointment because the mark seems minor. Yet early treatment is usually simpler and more successful. Every minute counts when a suspicious lesion is changing.
Where to check for suspicious changes
Check your whole body in good light, ideally using a mirror for hard-to-see areas or asking someone you trust to help. Do not limit your attention to the face, arms and shoulders. Look closely at the palms, soles, between toes, under and around nails, scalp, ears, lips and inside the mouth if you notice a persistent change.
Acral lentiginous melanoma is one form of melanoma that occurs on the palms, soles and beneath nails. It can affect people of any skin tone, and is proportionally more common among people with darker skin. Under a nail, it may look like a brown or black band that becomes wider or darker, has irregular edges, extends onto the surrounding skin, or is present with nail splitting, lifting or bleeding.
Not every dark nail band is cancer. Trauma, normal pigmentation and some medicines can cause colour changes. But a new or changing band, especially on one nail, should not be diagnosed at home. A clinician can assess it properly and arrange further testing if needed.
Warning signs that need a skin check
The ABCDE guide can still be useful for pigmented lesions. Look for asymmetry, an irregular border, colour variation, a diameter that is growing, and evolution or change over time. However, it does not identify every skin cancer, particularly those that are not brown or black.
Book a skin check or GP appointment promptly if you notice a spot, patch, lump or sore that:
- is new and persists for several weeks
- changes in size, shape, colour, texture or sensation
- bleeds, crusts, ulcerates or does not heal
- is itchy, tender or painful without a clear reason
- looks different from other marks on your skin
- develops in a scar, chronic wound, burn site or area of longstanding inflammation
Pay attention to the “ugly duckling” sign: a mark that stands out from the rest. On darker skin, this may be a pale, pink, reddish, purple or unusually dark lesion rather than a typical mole. Trust a persistent concern. A skin check is appropriate even if you cannot describe the change perfectly.
Sun protection still matters
Darker skin may burn less easily, but UV can still damage skin and eyes. In Australia, sun protection remains part of good health for everyone, particularly during periods of high UV, when working outdoors, at the beach, on the water, or around reflective surfaces such as sand and concrete.
Use broad-spectrum, water-resistant SPF 50+ sunscreen on exposed skin and reapply according to the product directions. Combine sunscreen with shade, protective clothing, a broad-brimmed hat and UV-rated sunglasses. Sunscreen is one layer of protection, not a reason to stay outside longer.
Your individual approach depends on your work, daily sun exposure, skin sensitivity and medical history. Someone who works on a building site, drives for long periods, plays outdoor sport or has a weakened immune system may need a more deliberate protection and checking routine. If you take medicines that increase sun sensitivity, ask your GP or pharmacist for advice.
Who should be especially vigilant?
Anyone can develop skin cancer, but some factors increase the need for regular attention. This includes a personal history of skin cancer, a strong family history of melanoma, many moles, immune-suppressing medication, organ transplantation, previous radiotherapy, chronic skin ulcers or scars, and substantial occupational or recreational sun exposure.
Smoking also increases the risk of cancers affecting the lip and mouth. A persistent lip sore, crusted area, lump or colour change should be reviewed, particularly if it does not settle. For Aboriginal and Torres Strait Islander people and people from culturally diverse communities, culturally safe, respectful care is part of getting the right support. You deserve to have your concern heard and examined properly.
What happens at a skin check?
A GP, dermatologist or trained skin cancer clinician will ask about the lesion, how long it has been present and whether it has changed. They may examine the area with a dermatoscope, a specialised handheld instrument that helps assess structures beneath the skin surface. A full skin examination may be recommended depending on your risk factors and the reason for your visit.
If a spot is suspicious, the clinician may photograph it for monitoring, refer you to a specialist, or arrange a biopsy. A biopsy is the only way to confirm whether a lesion is cancerous. It is understandable to feel anxious about that possibility, but waiting for a spot to become unmistakable is not the safer option.
There is no one-size-fits-all schedule for skin checks. Some people need regular clinician-led checks because of their history or risk factors, while others should book when they identify a concerning change. If you are unsure, ask your GP what is appropriate for you.
A spot does not need to be dramatic to deserve attention. Check skin that rarely sees the sun as well as the areas that do, take changes seriously, and arrange a prompt assessment when something is not right. Early action can protect your health and give you clarity when you need it most.