Are there any unique presentations of skin cancer when it does occur in patients with darker skin?

Although skin cancer is decidedly less common in people with skin of color, it is often associated with greater morbidity and mortality. Squamous cell carcinoma (SCC) is the most common skin cancer in blacks and Asian Indians, and it is the second-most common cancer in Chinese and Japanese. Also, in skin of color, malignancies occur more often upon non–sun-exposed surfaces and the lower extremities. In fact, the most important risk factors for developing SCC in blacks are chronic scarring processes and areas of chronic inflammation. Acral lentiginous melanoma presents more often in persons with skin of color. Other reported risk factors for melanoma in blacks include albinism, burn scars, radiation therapy, trauma, immunosuppression, and preexisting pigmented lesions. Mycosis fungoides (MF), a type of cutaneous T-cell lymphoma (CTCL), occurs more often in persons with skin of color (see Chapter 46). Because many individuals with dark skin do not believe that they are susceptible to skin cancers, they may delay seeking care for a suspicious lesion, thereby leading to a less favorable prognosis. Public education in ethnic communities regarding the performance of self-skin examination, and the utility of regular visits to a dermatologist when skin conditions exist may lessen the associated morbidity and mortality of skin cancer in these populations.

Gloster HM, Neal K: Skin cancer in skin of color, J Am Acad Dermatol 55:741–760, 2006.

Hinds GA, Herald P: Cutaneous T-cell lymphoma in skin of color, J Am Acad Dermatol 60:359–375, 2009.