The darker your skin, the less you should worry about skin cancer. Right?

Dead wrong. In truth, the rates of melanoma, the deadliest form of skin cancer, are increasing regardless of skin color. And darker skin can also get basal cell or squamous cell carcinoma, the more common and more treatable kinds of skin cancer. “I want to educate women of color that skin cancer does happen in minorities,” says Los Angeles-based dermatologist Jessica Wu, M.D.

In fact, people of color are more likely to have stage III or IV melanoma at the time of diagnosis, according to Dr. Wu, which means the cancer has spread to other parts of the body. One reason may be that African-Americans, Latinos, Asians and Native peoples tend to get acral lentiginous melanoma (ALM), an aggressive form of melanoma that spreads quickly and has a lower survival rate. Often recognized in its later stages, ALM usually appears on the hands, feet, nails and mucous membranes (nose, mouth, anus). It may look like a bruise, a mole, a red patch or a stripe under the nail. Reggae icon Bob Marley died from ALM that began as a malignant tumor on his toe. He refused amputation (for religious reasons) and the cancer metastasized to his major organs.

Another factor is low awareness. “My patients with darker skin tone have a false sense of security,” says Dr. Wu. Some patients have told her they don’t need to wear sunscreen because they aren’t fair-skinned.

While it’s true that darker skin isn’t as vulnerable to sun damage, it doesn’t mean caution is unnecessary. “The melanin in skin of color offers some protection, but it is incomplete,” says Susan C. Taylor, M.D., the director of the Skin of Color Center at St. Luke’s Roosevelt Hospital Center in New York. The skin produces pigment to try to shield itself from harmful ultraviolet (UV) rays, so darker skin starts out with a little more sun protection factor (SPF), but darker skin can still burn, which can lead to blistering, scarring and keloids (thick scar tissue that grows outward).

A study done by the University of Cincinnati dermatology department found that even the darkest skin only has an SPF 13. “Therefore, we recommend applying at least an SPF of 15 which will bring you up to roughly an SPF 30,” says Dr. Taylor.

With darker skin, it’s also easier to burn before you realize it’s happening. Even if you go out unprotected by sunscreen, hats or long-sleeved clothing, the redness and pain of sunburn may not emerge on darker skin for a few hours, so you may not notice you’re burning until it’s too late. Dr. Wu once made that mistake at an outdoor event. What she thought was her dress strap simply irritating her shoulder was actually the first sign that she was starting to burn. It wasn’t until several hours later that she realized she had sunburn. The moral of that story, says Dr. Wu, is if you’re out in the sun and any area of your skin starts to feel itchy, sensitive or prickly, it means you need to cover up and retreat to the shade.

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