Skin cancer on Black skin often looks different from the images most people encounter online or in medical brochures. It tends to appear as dark, pigmented spots or growths rather than the pink or red lesions typically shown in textbook examples, and it frequently develops in areas that get little or no sun exposure, like the palms, soles of the feet, nails, and mucous membranes. These differences matter because they contribute to later diagnoses. According to the CDC, the five-year melanoma survival rate for non-Hispanic Black Americans from 2001 through 2014 was 66.2%, significantly lower than for white Americans, largely because the cancer is caught at more advanced stages.
Where It Shows Up
One of the biggest misconceptions about skin cancer is that it only appears on sun-exposed skin. In Black patients, the pattern is often reversed. Melanoma most frequently develops on the palms, soles of the feet, and under the nails. This type, called acral lentiginous melanoma, is the most commonly diagnosed skin cancer in people with Black or darker skin. It has nothing to do with sun damage.
Squamous cell carcinoma, the most common skin cancer in Black patients, also tends to appear in non-sun-exposed areas. It’s more strongly linked to chronic scarring, long-standing inflammatory skin conditions like lupus, old burn sites, and immunosuppression than to ultraviolet radiation. These cancers can develop in areas you’d never think to check, including the genitals, lower legs, and even inside the mouth.
Melanoma on Palms, Soles, and Nails
On the palms or soles, melanoma typically starts as a dark, irregularly shaped patch. It may look like a bruise that doesn’t heal or a spot of discoloration with uneven borders and more than one shade of brown or black. Because people rarely examine the bottoms of their feet closely, these spots can grow unnoticed for months or years.
Under a fingernail or toenail, melanoma appears as a dark streak running from the base of the nail to the tip, as though someone drew a line with a brown or black marker. A concerning streak is usually less than 3 millimeters wide at first but gets wider over time. The pigment may look uneven, and the color can bleed into the skin surrounding the nail. That spillover of pigment onto the cuticle or fingertip is called a Hutchinson sign, and it’s a strong red flag. Any new, single dark line on one nail that changes over weeks or months deserves a professional evaluation, especially if it appears on the thumb or big toe, where this type of melanoma is most common.
How Squamous Cell Carcinoma Looks
Squamous cell carcinoma on Black skin can take several forms. It may appear as a rough, scaly patch that doesn’t go away, a raised growth that feels firm to the touch, or what looks like a sore that won’t heal. The color can match your natural skin tone, or it can be darker, appearing brown, black, pink, red, or a mix of these. A key feature is texture change: the surface often feels rough, crusty, or scaly compared to the surrounding skin.
These growths commonly appear on the scalp, lower legs, and areas of chronic irritation. If you have old scars from burns, long-standing wounds, or a chronic inflammatory condition, pay attention to any new growth or change within that scar tissue. Squamous cell carcinoma is the most common cancer to develop in scar tissue, and chronic inflammation at the site is thought to drive the transformation. Cancers arising from old burn scars are sometimes called Marjolin’s ulcers, and they can appear decades after the original injury.
Basal Cell Carcinoma in Dark Skin
Basal cell carcinoma is the most common skin cancer overall, though it’s less common in Black patients than squamous cell carcinoma. When it does occur, it looks different than the classic description. In lighter skin, basal cell carcinoma typically appears as a pink, pearly bump with visible blood vessels on the surface. In darker skin, those features are much harder to spot. The bump is almost always pigmented, appearing brown or black rather than pink or translucent. The tiny blood vessels on the surface blend into the surrounding skin and are difficult to see.
Because pigmented basal cell carcinoma can resemble a mole, a dark age spot, or even melanoma, it’s easy to misidentify. These growths tend to develop slowly on the head and neck, and they may have slightly raised, rolled edges. If you notice a new, dark, shiny bump in those areas that slowly enlarges over months, it’s worth having it examined.
Telling Cancer Apart From Common Benign Spots
Dark skin is more prone to certain benign growths that can cause confusion. Dermatosis papulosa nigra, for example, produces small, round, dark brown bumps that commonly appear on the cheeks, temples, and forehead. They start during adolescence and slowly increase in number with age. The key differences: these benign spots are typically small and uniform in size, appear symmetrically on both sides of the face, and don’t have scaling, crusting, or ulceration. They look like each other.
A helpful principle for spotting something suspicious is the “ugly duckling” concept. When you look at all the spots on your skin, the one that looks different from the rest is the one most worth watching. It might be darker, shaped differently, larger, or changing when nothing else is. That mismatch is often more telling than any single feature of the spot itself.
For individual spots, the classic ABCDE checklist still applies. Look for asymmetry (one half doesn’t mirror the other), border irregularity (edges are ragged or blurred), color variation (multiple shades of brown, black, or other colors within a single spot), diameter greater than 6 millimeters (about the size of a pencil eraser), and evolution (any change in size, shape, or color over time). Evolution is the most important of these. Any spot that is clearly changing deserves attention, even if it doesn’t check the other boxes.
What to Look For in a Self-Check
Because skin cancer in Black patients tends to favor hidden areas, a thorough self-check covers different ground than you might expect. Focus on your palms, the spaces between your fingers, your fingernails and toenails (including the skin around them), the soles of your feet, your lower legs, and your scalp. Use a mirror or ask someone to help with areas you can’t see easily.
Look for any new dark streak on a single nail, a sore or rough patch that doesn’t heal within a few weeks, a dark spot on the sole or palm that’s irregularly shaped or changing, and any growth within an old scar or area of chronic skin irritation. Changes in both color and texture together are especially significant. A patch that becomes scaly, crusty, or starts bleeding intermittently is more concerning than a smooth, stable dark spot that has been there for years.
The US Preventive Services Task Force currently has no formal screening recommendation specifically for people with darker skin, which means routine professional skin checks aren’t always part of standard care. This gap makes self-awareness even more important. Knowing what your skin normally looks like, including in the places you’d never think to look, is the most practical tool for catching something early.