Melanoma occurs less frequently in individuals with darker skin types than in those with lighter skin types but is associated with higher rates of morbidity and mortality in this patient population. (1-7) In the cases shown here (A and B), both patients had advanced melanomas with large primary lesions and lymph node metastases.
A systematic review by Higgins et al (6) reported the following on the epidemiology of melanomas in patients with skin of color:
* African Americans have deeper tumors at the time of diagnosis, in addition to increased rates of regionally advanced and distant disease. Lesions generally are located on the lower extremities and have an increased propensity for ulceration. Acral lentiginous melanoma is the most common melanoma subtype found in African American patients. (6)
* In Hispanic individuals, superficial spreading melanoma is the most common melanoma subtype. Lower extremity lesions are more common relative to White individuals. Hispanic individuals have the highest rate of oral cavity melanomas across all ethnic groups. (6)
* In Asian individuals, acral and subungual sites are most common. Specifically, Pacific Islanders have the highest proportion of mucosal melanomas across all ethnic groups. (6)
Key clinical features in people with darker skin tones
Melanomas are found more often on the palms, soles, nail units, oral cavity, and mucosae. (6) The melanomas have the same clinical and dermoscopic features found in individuals with lighter skin tones.