Skin Cancer Disparities in Patients with Skin of Color: Site Distribution, Awareness, and Early Detection

Conclusions

• Skin cancers in people with skin of color are often diagnosed later and at more advanced stages, which helps explain their disproportionate morbidity and mortality despite lower overall incidence.
• Melanoma in skin of color is especially lethal and commonly appears as acral or mucosal disease on sites such as the palms, soles, nails, lower extremities, mouth, or genitals rather than on classic sun-exposed areas.
• Trauma, chronic irritation, scarring, inflammation, immunosuppression, and mechanical stress may be more relevant contributors to melanoma and some other skin cancers in skin of color than ultraviolet exposure alone.
• A significant share of acral melanoma cases in safety-net populations were associated with prior injury or infection at the lesion site, suggesting that trauma can delay recognition or prompt evaluation of lesions that were already malignant.
• Black patients with melanoma are disproportionately affected by acral disease and have particularly poor outcomes when tumors are advanced, mucosal, ocular, or of unknown primary origin.
• Non-melanoma skin cancers also carry disproportionate burden in skin of color, including higher healthcare costs and larger surgical defects in some Hispanic/Latine and Black patients.
• Squamous cell carcinoma in skin of color often presents in unusual or high-risk locations such as the genital, perianal, and lower-extremity regions, and SCC arising in chronic scars or inflammation has especially high metastatic potential.
• Basal cell carcinoma is less common in deeply pigmented skin but is frequently pigmented when it does occur, which can make it harder to recognize and sometimes leads to repeated or multiple tumors in Hispanic/Latine patients.
• Rare malignancies such as DFSP and Merkel cell carcinoma are more dangerous in skin of color when diagnosis is delayed, and limited access to Mohs surgery or timely specialty care may worsen outcomes.
• The biggest drivers of disparity appear to be low patient and provider awareness, nontraditional lesion locations, fragmented education, language barriers, insurance and access gaps, and delayed dermatology evaluation rather than biology alone.
• Black, Medicaid, and low-income patients are less likely to receive immunotherapy for melanoma, indicating that access to modern treatments remains inequitable.
• People with skin of color have been underrepresented in clinical trials, limiting the generalizability of evidence and slowing progress toward equitable treatment.
• Improving outcomes will require targeted provider education, culturally relevant public awareness campaigns, earlier biopsy of suspicious lesions on any body site, better access to dermatology and Mohs surgery, and policy changes that reduce barriers to care.