Hit the beach with your pale-skinned friends, and they’ll likely want to slather on some sunscreen before beachcombing and body surfing. For your friends of color, however, sunscreen may never make it out of the beach bag.
Studies show that minority populations, particularly people are Hispanic or Black, do not regularly wear sunscreen or take other steps to protect themselves from the sun.
Sun Damage, Sunburn, and Skin Cancer In People of Color
We talked with dermatologists Darren Guffey, MD, and Arturo Saavedra, MD, PhD. They addressed common myths and misconceptions that may keep people of color from taking sun protection seriously.
Myth: The Sun Doesn’t Damage Dark Skin
Fact: Sun damage — including sunburn — happens no matter what color the skin. To understand why, Guffey provides a lesson in skin makeup. “Darkly pigmented skin has the same number of cells that give off pigment as light-colored skin,” he explains.
However, these melanocytes, or cells that make melanin (the substance in skin that gives off color), work differently in different skin types. In pigmented skin, those cells make more melanin and in bigger clumps. This melanin absorbs the sun’s rays before they can damage the cell’s DNA.
By contrast, in light-colored skin, these melanocytes make fewer and smaller clumps of this pigment. That makes it easier for sunlight to get through to damage the cells’ DNA. “It’s like an umbrella with a bunch of holes in it,” says Guffey. “The lighter the skin, the bigger the holes.”
Any time you get a sunburn, that’s a sign of damage to the DNA. Even a tan is a sign that your body is trying to adapt to an insult. “It’s trying to make its umbrella bigger by producing more melanin because you’ve harmed the DNA,” says Guffey. In other words, there’s no such thing as a healthy tan.
Darker skin may not show these visible signs of sun damage as readily. But it’s still happening. “Melanin offers some natural protection. But no skin is 100% effective at preventing sunlight from coming through,” says Guffey.
When sunlight penetrates cells, UV radiation damages the cell’s DNA, which compromises the body’s basic blueprint for growing new cells and structures. As a result, you get an overgrowth of atypical cells that the body is less equipped to recognize and destroy. This is basically cancer, Guffey explains: The rapid, unchecked growth of atypical cells.
Myth: People With Dark Skin Don’t Need to Wear Sunscreen
Fact: Sunscreen provides added protection against the UV rays that can cause skin cancer and is recommended for all skin types. Sunscreen increases the skin’s natural resistance to sun damage by absorbing and reflecting sunlight.
"This additional resistance against sun damage occurs with sunscreen use regardless of the baseline pigment of the skin,” says Guffey. “To revisit our umbrella analogy: if the skin’s natural melanin pigment is comparable to the body’s umbrella, wearing sunscreen can be likened to using that umbrella and wearing a raincoat. No matter how good the umbrella, you’ll end up less wet if you also wear a raincoat.”
Myth: Skin Cancer in People of Color Is Less Common
Fact: It's true skin cancer is more common in those with lighter skin. But people of color are more likely to die of the disease. That’s because they often don’t get a diagnosis until it’s at a later stage.
The rate of skin cancer diagnoses is proportional to the pigment in the skin, says Guffey. That explains why just 1-2% of all skin cancers occur in Blacks, 2-4% occur in Asians, and 4-5% in Hispanics. However, many darker-skinned patients think they won’t get skin cancer. So by the time they see a provider for a suspicious spot, the cancer is more advanced and difficult to treat.
“Contrary to a common misconception, those with skin of color can develop skin cancer. That’s why it’s important to consult your physician if any new skin lesions arise that do not heal within a month or two,” Saavedra says.
Myth: Skin Cancer Looks the Same in All Skin Types
Fact: Skin cancer symptoms differ depending on the type of cancer and skin color. Not sure what to look for? These are the three most common types of skin cancer in people of color.
Squamous Cell Carcinoma
Squamous cell carcinoma is the most common cancer in darker skin. Two things can cause it: Sun exposure and the human papillomavirus (HPV). If you have a compromised immune system, you’re at greater risk for both UV radiation and HPV-induced skin cancers.
“In pale skin, we tend to see this in chronically sun-exposed areas like the back of the arms, top of the hands, the tops of the ears or on a man’s bald scalp,” says Guffey.
Darker skin can get squamous cell in these places as well. But you’re most likely to see it:
- In the genital area or another site not typically exposed to the sun
- In an area with chronic scarring due to a condition like lupus
Squamous cell carcinoma symptoms include:
- A painful or tender bump
- A growing warty lesion in the genital area
- A sore that fails to heal
- Thick scaly patches that crust or bleed
Basal Cell Carcinoma
Basal cell carcinoma looks basically the same in all skin colors. The signs of basal cell in darker skin include a non-painful bump that:
- Is translucent in appearance
- Bleeds easily
- Has flecks or globules of pigment, like a dark marble suspended in gelatin
“Most of the cases of basal cell carcinoma in pigmented skin are directly related to sun exposure,” says Guffey.
Melanoma isn’t as common as other skin cancers. But it’s the most deadly because of its tendency to spread rapidly to other organs. That’s why early detection is so important. However, people of color, in particular, tend to overlook the first signs of melanoma.
“On white skin, melanoma most commonly presents on the back or on the lower legs as a dark spot that is changing colors or growing,” says Guffey. “But people with pigmented skin get melanoma in different locations like the palms, the soles of the feet, the lips, and the fingernails.”
Reggae music legend Bob Marley, for example, had a type of melanoma that appeared first under the nail of his big toe. There’s less pigment in these areas of the skin. That is one explanation. But “there are genetic factors that predispose you to melanoma as well,” says Guffey. So if a family member had melanoma, you should be extra vigilant about looking for signs of skin cancer.
If you have darker skin, watch for these common melanoma symptoms:
- New or changing dark spot (brown, black or tan), particularly on the soles or palms, that is asymmetrical and has an irregular border
- A darker line in the nail that is wider than 3mm, especially if it is wider at the cuticle, splitting, and causing damage to the nail
- A dark spot on the lips that grows or changes
“Keep in mind that spots may start off flat, but then become raised,” says Guffey. “We like to catch them when they are flat because raised lesions are typically a sign the cancer is more advanced. Unfortunately, people often don’t come in for evaluation until that happens.”
Myth: People of Color Don’t Need Regular Skin Cancer Screening
Fact: Everyone, regardless of skin color, should see a dermatologist regularly. How often? That varies depending on your family history and skin type. For people of color, Guffey recommends a baseline screening around age 20. If there are no concerns, have a follow-up appointment every 2-3 years.
“The rate of skin cancer is low enough in patients of color that I don’t see them on an annual basis unless they have a personal or family history of skin cancer,” he says. “I perform a baseline examination and evaluate their risk based on clinical signs of sun damage. Then I educate them on the signs of skin cancer and generally see them every few years. Often by that point, there is something going on with their skin that they’ll want to discuss, or I’ll have new data to share that wasn’t available in the years prior.”
Get a Skin Cancer Screening
See your healthcare provider or a dermatologist.
How to Protect Darker Skin
Regardless of your skin color, sun protection will lower your risk for cancer. If that’s not enough of an incentive, keep in mind that those pesky UV rays also cause signs of aging like fine lines, wrinkles and age spots.
Here’s how to ensure your skin remains protected and retains that youthful glow:
- Use a broad-spectrum sunscreen that’s at least SPF 30 or higher. Apply every 2 hours when you’re out in the sun. (There are more sunscreen options these days, including tinted lotions for different skin tones.)
- If you're in the water, be sure to choose waterproof or water-resistant sunscreen, and follow instructions about reapplying after swimming.
- Avoid peak hours when the sun’s rays are strongest — between 10 a.m. and 2 p.m.
- Wear photoprotective clothing.
- Don’t forget a hat and sunglasses.
Most importantly: Pay attention to your skin! Talk to your doctor if you have any questions about even minor skin changes.