SKIN OF COLOUR

Quick Facts

Melanoma can occur in skin of colour individuals.
Acral Lentiginous Melanoma (ALM) is the most common type of melanoma found in people with skin of colour. This would mainly include people with Fitzpatrick skin types 5 and 6.[i] See Table below.
ALM usually occurs in the palms of the hands or soles of the feet. It can also occur under the nail; this is known as Subungual Melanoma (SM)[ii]
ALM and SM can affect people of all skin types. In patients with lighter skin types it makes up a smaller percentage of melanoma while in darker skin types, it makes up a majority of cases of melanoma [iii]
ALM often looks like a bruise or stain mark that won’t heal. SM usually looks like a dark vertical stripe on the nail.[iv]
For ALM and SM, skin self-exams are an effective strategy for early detection [v]
The ABCDE technique is commonly used to identify signs and symptoms of melanoma but [vi] when it comes to identifying ALM and SM different techniques are used. See detection below.

Table 1. The Fitzpatrick skin types. [i]

1. Very Pale White Skin

Often with green or blue eyes and fair or red hair

Burns without tanning

2. White Skin

Often with blue eyes

Burns and does not tan easily

3. Fair Skin

With brown eyes and brown hair

Burns first then tans

4. Light brown skin

Dark eyes, and dark hair

Easily tans to a darker colour and rarely burns

5. Brown Skin

Dark eyes, and dark hair

Easily tans to a darker colour and rarely burns

6. Dark brown or black skin

Dark eyes, and dark hair

Never burns but tans darker

What Does this Mean for Me?

Acral lentiginous melanoma (ALM)A in situ (local melanoma) is not dangerous. However, it can become potentially life-threatening if the melanoma grows into surrounding tissue. Prognosis depends on multiple factors, such as gender, race, age and clinical features of the tumor. ALM is best treated with a wide local excision performed by a qualified physician. Early detection and adequate patient education are crucial for improving survival in patients affected by ALM. Patients who require digit or limb amputation for treatment purposes may experience loss of function of the affected limb, significant interference with their activities of daily living, poor cosmetic outcomes and phantom pain. Large excisions may also lead to painful scarring and contractures.

Subungual Melanoma (SM) is a type of malignant melanoma that occurs in the nails. SM presents as brown-black discolorations in the nails that can progress to painful destruction of the nails. Unlike melanoma on the skin, subungual melanoma is not related to sun exposure. It is important to consider other causes of discoloration to the nails such as fungal infection or bruising.

Detection

ALM can present as dark spots or bruises on the palms of the hands or soles of the feet that do not go away or won’t heal. [i]
SM can present as a dark vertical stripe on the fingernails or toenails. [i]

Get a skin examination with your family doctor or a dermatologist (a doctor who specializes in treating skin, nails and hair) if you possess any risk factors or if you have an area of concern so they can note if there is anything on your body that warrants further attention. Find a dermatologist.

Use the Alphabet of Nail melanoma To help identify Subungual Melanoma (SM)

AGE

Age range 20-90 years.

BAND

Band of Brown or Black pigment in nail OR Breadth of >3mm OR Border that is irregular/blurred.

CHANGE

Change in size or growth rate of nail band OR lack of change in irregular nail despite treatment.

DIGIT

Digit involved (nail melanoma is most common in the thumb>big toe>index finger). Pigmented band on a single digit is more suspicious than on multiple digits.

EXTENSION

Extension of brown or black pigment to the side or base of the nail.

FAMILY

Family or personal history of melanoma or irregular moles.

To help identify acral melanoma CUBED can be used

COLOUR

Coloured lesions where any part of the skin is a different colour

UNCERTAIN

Uncertain diagnosis or a lesion without a clear clinical diagnosis

BLEEDING

Bleeding lesions

ENLARGEMENT

Enlargement of a lesion

DELAY

Delay in healing beyond two months

Prevention

For ALM and SM, monthly self-exams and yearly exams by a physician are an effective strategy for early detection
Pay attention to any changes in your skin and body; if you notice anything new or different see your doctor or go to your local walk-in clinic. [i]
Advocate for yourself, if there is something concerning you about your body make sure to get checked by your family doctor or go to your local walk in clinic.

SKIN CHECK REMINDER

75% of melanomas are detected by patients themselves!

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Myths

Did you know the people with skin of colour are 4x more likely to receive a diagnosis of melanoma after the cancer has progressed to an advanced stage or spread to other parts of the body? In this video we dispel common myths and learn how to detect the early signs of acral and subungual

RISK FACTORS

Genetic factors. If your family has a history of melanoma you could be at a higher risk for developing melanoma.[i]
Late diagnosis. There is a common misconception that people with skin of colour cannot develop melanoma, so these types are often caught at a later stage compared to people with white skin[ii]
Misdiagnosis: Sometimes ALM and SM can be mistaken for a bruise but if it does not heal then this could be a sign of melanoma.[iii]

YOU ARE NOT ALONE

A skin cancer diagnosis can be overwhelming and navigating the healthcare system as a patient of colour presents unique challenges. But you don’t have to face those challenges alone. Melanoma Canada offers a wide variety of free services to support patients, families and caregivers through every step of their journey.

Contact Abigail Wiggin – Patient Care Specialist – call 905.901.5121 x112 or 1.877.560.8035 x112 or email support@melanomacanada.ca

Find Support

Acknowledgement: edits were provided by Dr. Boluwaji Ogunyemi-BSc, MD, FRCPC, FAAD

IMAGE Resources

ACL Image 1 provided by Skin of Color society skinofcolorsociety.org

ACL Images 2-4 provided by DermNet NZ https://dermnetnz.org/

REFRENCES

[i] [ii] [iii] [iv] [v] [vi] [vii] [viii] [ix]

[i] https://www.melanomanetwork.ca/types-of-melanoma/

[ii] https://www.melanomanetwork.ca/types-of-melanoma/

[iii] https://skinofcolorsociety.org/

[iv] https://www.ncbi.nlm.nih.gov/books/NBK559113/ – Cancer, Acral Lentiginous Melanoma. Hall & Rapini 2020