Many people with darker skin tones believe they’re not at risk for skin cancer, but Dr. Lilian Thomas-Harris , an oncologist with Novant Health Cancer Specialists, said that’s a dangerous misconception.

Most skin cancers are linked to ultraviolet (UV) rays from the sun or tanning beds, and these damaging UV rays can affect anyone, regardless of skin color. According to experts, knowing how skin cancer presents on darker skin is key to catching it before it reaches an advanced stage.

Everyone is at risk                                                                   

While it’s true that those with dark skin are less susceptible to UV damage thanks to the greater amount of melanin (the protective pigment that gives skin and eyes their color) their skin produces, melanin alone isn’t enough to protect against skin cancer.

The American Academy of Dermatology recommends applying a sunscreen with an SPF (sun protection factor) of 30 or higher and reapplying it every two hours or immediately after swimming or heavy sweating.

“Wearing sunscreen is not a top priority and it needs to be,” Thomas-Harris said. “Dark skin may not sunburn as easily, but there are still risks of skin damage from excessive UV exposure.”

Where you least expect

According to the Skin Cancer Foundation , m elanomas (the most deadly type of skin cancer) in African-Americans, Asians, Filipinos, Indonesians and native Hawaiians most often occur on unexposed skin where less melanin is present and skin is lighter.

Skin cancer can hide in places that get little sun, like the bottoms of your feet, palms of your hands, fingernails and toenails. Surprisingly, the bottom of the foot is where 30 to 40 percent of melanomas are diagnosed in people of color.

“Regularly check any existing moles and dark spots and look for new markings on your skin, paying special attention to areas that do not get a lot of sun exposure,” Thomas-Harris said.

Moles that are asymmetrical, more than one color, larger than a pencil eraser, have an irregular border or that have changed over time could be cause for concern, she said. If there are any changes or concerns about your skin, a dermatologist can determine if further testing is needed.

Less common, more deadly

While people of color have a lower risk of developing skin cancer, studies show that African-Americans are diagnosed with melanoma at a later stage, have the least overall survival rate and the worst prognosis.

“Close monitoring can lead to early diagnosis and treatment. If found in later stages, it’s much more difficult to cure,” said Thomas-Harris. “There needs to be more awareness in how to detect variations in the skin. When skin cancer is detected early, it’s highly treatable.”

Because 75 percent of melanoma cases in people of color appear on areas of the skin not typically exposed to the sun, it often flies under the radar. This is one reason why African-Americans are more likely to be diagnosed with skin cancer once it’s more advanced.

The estimated five-year melanoma survival rate for African-American patients between 2007 and 2013 was only 69 percent, versus 94 percent for Caucasian patients, according to the American Cancer Society .

Sun exposure isn’t the only factor

Tanned skin may be a sign of a day spent in the sun – but it’s also your body’s response to sun damage. UV exposure damages the DNA of skin cells, and our bodies produce more melanin as a defense mechanism. But sun exposure isn’t the only factor.

Family history, genetics, toxic substances and environmental factors can influence the development of cancer in areas that are not exposed to the sun.

The good news is most skin cancer is preventable, and there are steps you can take to reduce your risk:

  • Avoid the sun during the middle of the day. UV rays are strongest between 10 a.m. and 2 p.m.
  • Avoid tanning beds.
  • Take frequent breaks from the sun and seek shade when you can.
  • Always wear sunscreen with an SPF of at least 30 when outdoors.
  • Wear protective clothing, such as hats, sunglasses and long sleeve shirts.
  • Check your skin regularly and report changes to your doctor.