The Washington PostDemocracy Dies in Darkness

Melanoma, often on feet and nails, more deadly in Black men, study shows

Men of color often get cancer in unexpected places, leading to late diagnoses and poorer outcomes

6 min

Melanoma is far more deadly in Black men, who may get skin cancer in unexpected places such as fingernails and the bottoms of their feet, according to a study of more than 205,000 cases.

Researchers have long known that men overall have a higher risk of being diagnosed and dying of the disease than women do. But the new study is the largest evaluation to date to explore how the location, stage and prognosis of melanoma in men varies by race.

While melanoma is far more common in White men, the study showed that Black men are 26 percent more likely to die of the disease. Although only about 2.5 percent of the more than 200,000 men in the study were Black, they had a much lower survival rate than that of White men.

“I think this is significant,” said Ali Hendi, a specialist in skin cancer surgery in Chevy Chase, Md., who did not participate in the study. “This study doesn’t give us the answer as to why, but it sheds light on the numbers.”

The study, published Tuesday in the Journal of the American Academy of Dermatology, found the following trends:

  • Among Black men with melanoma, 48.6 percent are diagnosed at late stages of the disease, when it is harder to treat, compared with 21.1 percent among White men. Late-stage diagnoses occur in 39.6 percent of Hispanic men, in 37.6 percent of Asian men and in 29.1 percent of Native American men. If detected early, the five-year survival rate for melanoma is 99 percent. But a late diagnosis changes those odds dramatically. Once melanoma has spread to distant parts of the body, the five-year relative survival rate is about 32 percent.
  • The location of melanomas on the body varied starkly by race. The data showed that 50.7 percent of Black men with melanoma have it on their lower extremities. Fewer than 10 percent of White men with the disease had it on their lower bodies. Among White men, most cases were on the trunk (35.5 percent) or head and neck (25.7 percent). By comparison, only 12.6 percent of cases in Black men were on the trunk and 9.8 percent on the head.
  • Melanoma in Black men is often found in areas not typically exposed to the sun, such as the soles of the feet, toes, toenails, fingers, fingernail beds and palms.
  • More than 75 percent of White men live five years or more after a melanoma diagnosis. Only 51.7 percent of Black men do.

The study underscores the importance of increasing public education for doctors and patients to be on the lookout for melanoma, even in Black patients where it rarely occurs, said Jeremy Brauer, physician and clinical associate professor of dermatology at NYU Langone Health, who was not connected to the study.

Brauer noted that doctors are often trained to identify skin cancers on White skin and may not know how the disease shows up differently in different races.

“This disproportionate and unfortunate rate of death means we have to try to be much more preventative,” Brauer said.

Why melanoma is so deadly for men

A more deadly form of melanoma

The study’s researchers compared diagnosis data from the National Cancer Database from 2004 to 2018 in White, Black, Asian, American Indian/Alaska Native, and Hispanic men.

“The purpose of our study was to dive deeper into why we are seeing these differences in survival rates and the factors that may be driving this,” said co-author Ashley Wysong, physician and chair of dermatology at the University of Nebraska Medical Center.

Nearly 1 in 5 Black melanoma patients have a subtype called acral lentiginous melanoma, a more deadly form of the disease. By comparison, less than 1 percent of White men had this subtype.

“It’s not related to sun exposure,” said Robert Brodell, professor of pathology and dermatology at the University of Mississippi Medical Center, who was not involved in the study. “It seems to have a different natural history, and a poorer prognosis, though late diagnosis is a component of that.”

It often appears as a black dot under the fingernail that’s growing or changing, Brodell said.

Melanomas on the fingers, toes, palms and soles of the feet are often mistaken for warts, fungus or other benign conditions, Wysong said, and ignored by patients. “They can look like flat, pink, gray, brown or black lesions.”

“Most people don’t think of skin cancers in their nails or on their hands and feet,” Wysong said. “So we see delays in diagnosis because of the location. It’s hard to see. Most people don’t know what a nail melanoma looks like.”

Late diagnosis and other factors

Late diagnosis explains only part of the reason melanoma is more deadly in Black men. Although the study controlled for factors such as income, insurance, access to health care and education level, those variables “don’t fully explain why Black men would have a 26 percent higher death rate than Whites,” Wysong said. “It does suggest that there are biological factors at work.”

Among all men, hormonal differences could explain the gender gap in melanoma, said David J. Leffell, a professor of dermatology and surgery at Yale University’s medical school and an expert in skin cancer and melanoma. He said the new research should bring needed attention to melanoma in Black men.

“There hasn’t been a focus on this, and when there isn’t that focus, there isn’t the research funding,” Leffell said. “So I think that the article is going to shine some attention on the need to fund research in that area. And who knows? By paying more attention to the less common categories within melanoma, we may come to understand melanoma better in general.”

Invasive melanoma on the rise

The number of new invasive melanoma cases diagnosed annually has increased by 27 percent in the past decade. In 2023, 97,610 cases of invasive melanoma are expected to be diagnosed in the United States; of those, 58,120 will be in men and 39,490 in women, according to the Skin Cancer Foundation. Also this year, 7,990 people are expected to die of melanoma, 5,420 of them men.

Because the majority of melanomas originate with sun damage to skin cells, dermatologists continue to stress vigilant sun protection. Wysong added that men tend to resist the very things that could save their lives — wearing hats, sun screen and protective clothing, avoiding the sun, and regularly seeing a dermatologist.

Experts advise annual skin checks at the doctor and monthly personal checks of your body. You can enlist the help of a partner or friend to look at your back and other places where you don’t have good visibility. Check the soles of your feet, palms, nail beds and between your toes. And you can ask your barber or hair stylists to speak up about any lesions or changes on your scalp.

If you notice anything new, changing, failing to heal or bleeding, see a dermatologist.

“Melanoma is totally asymptomatic,” Brodell said. “Unless you notice a changing mole, you won’t be bothered by it.”

Sign up for the Well+Being newsletter, your source of expert advice and simple tips to help you live well every day

Read more from Well+Being

Well+Being shares news and advice for living well every day. Sign up for our newsletter to get tips directly in your inbox.

Across the life span, boys and men are more likely to die than girls and women.

SuperAgers have lessons for us about longevity, cognitive health as we age

Popular keto and paleo diets aren’t helping your heart

Quiz: Are you an Ableist?

Exercise leads to sharper thinking and a healthier brain.