Brykyta Shelton found herself standing in a checkout line of a big-box retailer, uncomfortably aware as a woman ahead of her stared at her sandaled feet.
Shelton had been taking medication for months for what her doctor said was toenail fungus, but one nail still looked gross.
After Shelton completed her purchase, the woman pulled her aside and said that, while she wasn’t a doctor, she thought Shelton was dealing with something more serious than fungus.
“She’s like: ‘I know I’m just a random stranger, but please, go get it checked out by someone else,’” said Shelton, who lives in a Maryland suburb of Washington, D.C.
Shelton, now 42, took the advice.
The initial lab work didn’t give a clear diagnosis, but her new doctor said he was confident she had acral lentiginous melanoma, a form of skin cancer. Additional testing proved him right. While rare, it is the most common subtype of melanoma in Black people, like Shelton. It is the disease that killed reggae star Bob Marley at age 36, and is most often found on skin less frequently exposed to the sun, such as the hands, the soles of the feet, and under nails. Researchers do not understand what causes acral lentiginous melanoma, and they don’t know how to prevent it. It is often overlooked in skin checks or misdiagnosed.
Skin cancer, in general, is often missed or misdiagnosed in Black patients.
Historically, Black people and those with dark skin have been left out of efforts to combat skin cancer. Long neglected by sunscreen manufacturers and a medical community lagging in diversity and cultural competency — the acknowledgment of a patient’s heritage, beliefs, and values — many have not been informed about sun safety or how to check their skin for signs of damage or cancer.
To be sure, skin cancer rates are lower for people with dark skin tones. Melanoma is more than 20 times as common in white people as in African Americans, with an overall lifetime risk of 1 in 38 for white people compared with 1 in 1,000 for Black people. Melanin does provide some protection against sun damage, so those with more of it — those with darker skin — are better protected than those with fairer skin.
But overall, Black patients are more likely to be diagnosed with various forms of skin cancer at more advanced stages and have a higher mortality rate, said Dr. Janiene Luke, with the Skin of Color Society, a nonprofit that works to educate doctors and the public on skin health.