Skin Cancer Signs in Darker Skin: When to Check a Mole

Skin cancer is less common in Indian and other darker skin tones, but it does happen, and it is more often found at a later stage, partly because people do not expect it and partly because it tends to appear in places that get little sun. A mole or spot should be checked by a dermatologist if it is new and growing, changing in size, shape or colour, has uneven borders or several colours, bleeds or itches, or if a dark streak appears in a nail or a dark patch on the sole keeps enlarging.

Most moles and dark spots are harmless. The aim of this guide is not to worry you, but to help you know which changes deserve a closer look.

Why does skin cancer get missed in brown skin?

The American Academy of Dermatology (AAD) notes that skin cancer is often found later in people with darker skin tones, though it can be found earlier. Several reasons contribute:

• People with brown skin are often told they cannot get skin cancer.
• Spots appear in unexpected places, such as the soles of the feet or under a nail.
• A dark patch on the sole may be mistaken for a bruise, callus, corn or fungal infection.
• Many people never examine their feet, nails or the inside of their mouth.

Where does skin cancer appear in darker skin?

According to the AAD, in people with darker skin tones, skin cancer may develop in areas that receive little or no sun, including:

• Palms and soles
• Fingers and toes
• Nails
• Inside the mouth or on the lips
• Buttocks, genitals and around the anus

It can still occur on sun exposed skin such as the face and neck.

What is acral melanoma?

Acral lentiginous melanoma (ALM) is a type of melanoma that arises on the palms, soles or under the nails. A research review in Pigment Cell and Melanoma Research describes it as the most frequently diagnosed melanoma subtype in some countries in Asia, Africa and Latin America, even though it is a small proportion of melanoma in people of European descent. The same review notes that because it develops on sun shielded skin, it is not believed to be related to UV exposure.

DermNet describes how ALM can look:

• In early stages, a dark brown or black flat patch with uneven colour, often on the sole
• In advanced cases, a raised lump that may ulcerate or bleed
• Under the nail, usually a brown or black band running along the length of the nail
• Pigment spreading from the nail onto the surrounding skin fold, known as Hutchinson’s sign, which is a warning clue

ALM can grow slowly over months to years, which is one reason early checking matters.

What are the ABCDEs of melanoma?

The AAD’s ABCDE guide is a simple way to remember warning signs:

Letter	Stands for	What to look for
A	Asymmetry	One half does not match the other
B	Border	Irregular, ragged or poorly defined edges
C	Colour	Several shades, such as tan, brown, black, or areas of white, red or blue
D	Diameter	Usually larger than about 6 mm, roughly the size of a pencil eraser, though melanomas can be smaller
E	Evolving	A spot that looks different from others or is changing in size, shape or colour

Also watch for a spot that itches, bleeds, crusts or does not heal.

What is normal for moles?

The NHS explains that it is normal for:

• Babies to be born with moles
• New moles to appear, especially in children and teenagers
• Moles to fade or disappear with age
• Moles to get slightly darker during pregnancy

Moles that are a concern are usually those that are changing, uneven in shape or colour, or that bleed, itch or become crusty or raised.

What about other skin cancers?

Melanoma gets the most attention, but other skin cancers also occur in darker skin. Warning signs to take seriously include:

• A sore or wound that does not heal over several weeks
• A scaly or rough patch that keeps coming back or bleeds
• A new lump or growth that is getting bigger
• Changes in an old scar, burn mark or long standing ulcer

Many harmless growths look worrying too, such as seborrhoeic keratoses. Our article on seborrhoeic keratosis and age spots describes these, and our guide to milia, whiteheads and skin tags covers other common benign bumps. If in doubt, ask a dermatologist rather than guessing.

How do I check my skin at home?

The AAD recommends a regular skin self exam in good light:

1. Look at your body front and back in a full length mirror, then each side with arms raised.
2. Check your forearms, underarms, palms and fingernails.
3. Look at the backs of your legs, the soles of your feet, between your toes and your toenails.
4. Use a hand mirror for the back of your neck, scalp, back and buttocks.
5. Do not forget the inside of your mouth and lips.

For people with brown skin, the soles, palms and nails deserve special attention. Taking a clear photo of any spot you are unsure about makes it easier to see whether it changes.

Does sunscreen prevent skin cancer in Indian skin?

Sun protection lowers the risk of sun related skin cancers and helps prevent sunburn, dark spots and early ageing. However, acral melanoma on the soles and nails is not mainly caused by sun exposure, so regular self checks remain important even if you protect your skin well. See our sunscreen guide for India.

Should I remove a mole myself or at a salon?

No. Burning, cutting, applying acids or “mole removal” creams can scar the skin, cause infection and, most importantly, destroy the evidence a doctor needs to tell whether a spot was harmless. If a mole needs removing, a dermatologist can remove it properly and send it for testing if required.

What happens at a mole check?

A dermatologist will usually ask how long the spot has been there, whether it has changed, and about any family history of skin cancer. They will look at the spot and often at your other moles, because a mole that looks different from the rest is more suspicious. Many dermatologists use a dermatoscope, a handheld magnifier with a light, to see patterns in the skin that are not visible to the naked eye.

If a spot looks harmless, you may simply be reassured, or asked to photograph it and return if it changes. If it looks suspicious, the dermatologist may suggest a biopsy, where a small piece or the whole spot is removed under local anaesthetic and examined under a microscope. This is the only way to confirm or rule out skin cancer. Most biopsies come back as harmless.

When to see a dermatologist

Book an assessment if you notice:

• A new mole or dark spot in adulthood that is growing
• A mole that is changing in size, shape or colour
• A spot with uneven borders or several colours
• A dark patch on the sole or palm that is spreading
• A new or widening dark streak in a nail, or pigment spreading onto the nail fold
• Any spot that bleeds, itches, crusts or will not heal
• A spot that simply looks different from all your other moles

An in person examination, often with a dermatoscope, is the best way to assess a worrying spot. If you are unsure whether a spot needs urgent attention, Dr. Maria offers online consultations to review photos and advise whether you should be examined in person.