While melanoma can affect anyone regardless of their background, the statistical risk and the way the disease presents vary significantly between different ethnic groups and skin tones. In the United Kingdom, individuals with lighter skin tones have a much higher incidence of sun-related melanoma due to lower levels of protective pigment. Conversely, while melanoma is rarer in people with darker skin tones, it is frequently diagnosed at a more advanced stage and often appears in different physical locations. Understanding these disparities is a vital part of clinical dermatology and ensuring that every individual knows how to monitor their skin effectively.
What We’ll Discuss in This Article
- Disparities in melanoma incidence rates across ethnic groups in England
- The prevalence of acral lentiginous melanoma in people of colour
- Why survival rates and diagnosis stages differ between populations
- The biological role of melanin and eumelanin in skin protection
- Common locations for melanoma development in different skin tones
- Addressing the misconception that darker skin is immune to sun damage
Incidence rates are highest among White populations
Statistically, individuals of White ethnicity face the highest overall risk of developing melanoma in the United Kingdom. Recent retrospective population studies in England have revealed that the age-standardised incidence rate for cutaneous melanoma is approximately thirty-three times higher in White populations compared to Asian populations. Similarly, White individuals are roughly sixteen times more likely to be diagnosed with melanoma than those of Black ethnicity.
Melanoma skin cancer incidence is significantly lower in Asian and Black ethnic groups compared with the White ethnic group in England, though cases are still recorded across all demographics. These differences are largely attributed to the varying amounts of melanin present in the skin, which serves as a natural barrier against the harmful effects of ultraviolet radiation. Because lighter skin has less of this protective pigment, the DNA within the skin cells is more vulnerable to the mutations that lead to cancer.
Acral lentiginous melanoma in people of colour
While overall melanoma rates are lower in people with darker skin tones, a specific subtype called acral lentiginous melanoma is disproportionately common in these groups. Unlike most melanomas, this type is not primarily caused by sun exposure and develops on the palms of the hands, the soles of the feet, or under the fingernails and toenails. In the Black ethnic group, acral lentiginous melanoma is the most frequent form of the disease, representing a much higher proportion of cases than it does in White populations.
Because this type of melanoma appears in areas that are not typically exposed to the sun, it can often go unnoticed during routine self-examinations. NHS guidance emphasizes that everyone should check their skin including the soles of the feet and nail beds because acral melanoma can be aggressive and is often caught late. Clinicians must be particularly vigilant when examining these areas in patients of colour to ensure that any unusual pigmentation or new streaks in the nails are investigated promptly.
Disparities in survival and diagnosis stages
One of the most concerning aspects of melanoma in people of colour is the disparity in survival rates. Clinical data indicates that the five-year survival rate for Black patients is approximately seventy percent, whereas it is roughly ninety-five percent for White patients. This gap is not typically due to biological differences in how the cancer grows, but rather because the disease is often identified much later in people with darker skin.
Research shows that around thirty-nine percent of Black patients are diagnosed at Stage Three or Stage Four, compared to only fifteen percent of White patients. Several factors contribute to this delay, including a lower self-perception of risk and a lack of awareness regarding how melanoma appears on darker skin. When melanoma is diagnosed at a later stage, it is thicker and more likely to have spread, which significantly limits the effectiveness of primary surgical treatments. Improving early detection through better education for both patients and healthcare providers is a major priority in reducing these mortality gaps.
The biological protection provided by melanin
The primary reason for the lower incidence of melanoma in darker skin is the presence of eumelanin, a type of pigment that is highly effective at absorbing and scattering ultraviolet radiation. Individuals with darker skin tones genetically produce more eumelanin, which provides a natural level of protection roughly equivalent to a sun protection factor of thirteen. In contrast, individuals with fair skin often produce more pheomelanin, which is a redder pigment that does not provide any significant protection against sun damage.
While eumelanin is a powerful natural defence, it is important to realise that it does not provide total immunity. Even the darkest skin can still suffer from DNA damage if exposed to intense or prolonged sunlight. Furthermore, the presence of melanin can sometimes make it harder to see the early signs of a changing mole or a new lesion, as the surrounding skin colour may mask subtle variations in pigmentation. For these reasons, clinical advice remains consistent: everyone, regardless of their skin tone, should use sun protection and perform regular skin checks to catch any changes as early as possible.
Conclusion
Melanoma risk differs greatly between ethnic groups, with White populations having the highest incidence but people of colour experiencing more late-stage diagnoses. Acral lentiginous melanoma is a specific risk for those with darker skin and requires focused monitoring of the hands and feet. Understanding these variations helps ensure that every person receives appropriate care and remains vigilant about their skin health.
If you experience severe, sudden, or worsening symptoms, call 999 immediately.
Is it true that Black people do not need sunscreen?
No, while darker skin has more natural protection, it can still sustain sun damage, and everyone should use sunscreen during periods of high ultraviolet intensity.
What is the most common place for melanoma in Asian populations?
In many Asian populations, melanoma is most frequently found on the feet and hands, often presenting as acral lentiginous melanoma.
Do skin checks take longer for people with darker skin?
A thorough check should take the same amount of time, but clinicians must pay extra attention to the palms, soles, and nails where cancer is more likely to hide.
Why is the survival rate lower for Black melanoma patients?
The lower survival rate is primarily linked to late diagnosis, as the cancer is often more advanced by the time it is identified.
Does a tan protect me if I have fair skin?
A tan is actually a sign of skin damage and provides very little protection against future ultraviolet radiation.
Are children of colour at risk for melanoma?
Melanoma is rare in children of all backgrounds, but sun safety should be practised from a young age to reduce lifetime risk.
What does acral melanoma look like under a nail?
It often appears as a new, dark, vertical streak that does not grow out with the nail or as a changing spot on the nail bed.
Authority Snapshot (E-E-A-T)
This article is designed to provide clear and factual information regarding skin health for the general public. The content is written by the Medical Content Team and has been reviewed by Dr. Stefan Petrov. He is a UK-trained physician with an MBBS and postgraduate certifications including Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and the UK Medical Licensing Assessment (PLAB 1 & 2). He has hands-on experience in general medicine, surgery, anaesthesia, ophthalmology, and emergency care. Dr. Petrov has worked in both hospital wards and intensive care units, performing diagnostic and therapeutic procedures, and has contributed to medical education by creating patient-focused health content and teaching clinical skills to junior doctors.
