Skin Cancer in Dark Skin — Rarer, But More Dangerous When It Occurs
It is a widespread belief among Nigerians that skin cancer is a white person’s disease. The reasoning is logical — melanin, the pigment that gives darker skin its colour, does provide significant protection against ultraviolet radiation, which is the primary driver of the most common types of skin cancer. This protection is real, and it explains why melanoma and other UV-driven skin cancers are indeed less common in Black Africans than in people with lighter skin. However, less common does not mean absent — and the particularly dangerous reality is that when skin cancer does occur in people with dark skin, it tends to be diagnosed at a later stage because the signs are missed, dismissed, or attributed to other causes. Late diagnosis means worse outcomes.
Types of Skin Cancer and Where They Appear in Dark Skin
Melanoma — the most dangerous type — behaves differently in darker-skinned individuals. Rather than appearing as a changing mole on sun-exposed skin, melanoma in dark-skinned people more commonly arises in areas that receive little sun exposure: the soles of the feet, the palms of the hands, under the fingernails and toenails, the mouth, genitals, and the nail bed. Acral lentiginous melanoma — the type most common in sub-Saharan Africans — presents as a darkening or irregular patch on the sole of the foot, and is frequently dismissed for years as a bruise, a callus, or a growth with no significance. Squamous cell carcinoma can arise in burn scars, in chronic wounds, and in areas of chronic inflammation — all situations more relevant to the Nigerian context than sun exposure alone. Kaposi’s sarcoma — associated with HIV — remains relevant in Nigeria given the burden of HIV infection.
Warning Signs in Dark Skin — What to Look For
- A dark patch, stripe, or growth on the sole of the foot or palm of the hand that is new or has been changing
- A dark streak under a fingernail or toenail that appeared without an injury or has not grown out after months
- A sore on the foot, leg, or elsewhere that has been present for more than 4 to 6 weeks and is not healing
- A mole or dark lesion that has changed in size, shape, or colour
- The ABCDE rule applied to any lesion: Asymmetry, irregular Border, more than one Colour, Diameter larger than 6mm, and Evolving over time
- Reddish-purple spots or patches on the skin, particularly in someone who is HIV-positive (Kaposi’s sarcoma)
- A firm, irregular growth arising in the site of an old burn scar or chronic wound
The Men Most at Risk in Nigeria
- Men who work outdoors for extended hours without head covering or protective clothing — farmers, construction workers, commercial motorcyclists (okada riders), market traders
- Men with albinism — who have significantly reduced melanin protection and face very high rates of skin cancer in equatorial sun
- Men with HIV — at increased risk of Kaposi’s sarcoma and squamous cell carcinoma
- Men with chronic wounds, burn scars, or persistent skin inflammation — these areas can undergo malignant change over years
Protection and Prevention
For men working outdoors, wearing a wide-brimmed hat and long-sleeved shirt during peak sun hours (10am to 4pm) is the most practical protection. Applying sunscreen with SPF 30 or higher on exposed skin matters even with dark skin — while melanin provides partial protection, it does not eliminate UV damage entirely. For men with albinism, strict sun protection is a medical necessity, not a cosmetic preference. Inspect your feet, hands, nails, and the skin on your scalp and body regularly — once a month is reasonable. Any spot, growth, or sore that has not resolved within six weeks should be shown to a doctor.
How Doc on Wheels Can Help
If you have a skin lesion that concerns you — a persistent sore, a changing dark patch, or a growth you cannot explain — you can speak to a doctor through the Doc on Wheels app. Our doctors can assess your description and history, advise on the urgency of an in-person skin examination, and refer you for a biopsy if indicated. Do not ignore the skin because it is on the outside — what happens to it matters.