As a dermatologist, I’ll start by stating I’ve seen two Black patients with sunburns just this morning—so, yes, Black people are capable of developing a sunburn. Now, for a little more background. While Black and darker-skinned individuals are less sensitive to the sun, that doesn’t mean you’re immune to getting a sunburn, cumulative skin damage, or even to skin cancer. Ahead, discover everything you need to know about sunburn and skin cancer risk for dark skin tones.
The Fitzpatrick Skin Phototype Scale
The risk of a sunburn is a ubiquitous way of classifying patients among dermatologists, officially referred to as the “Fitzpatrick skin phototype scale.”
We use this scale –which broadly describes how skin responds to light–as a component of skin cancer risk factors (and when deciding laser settings). Those who only burn and never tan are on one end of the spectrum, and those who tan very easily and almost never burn exist on the other end of the spectrum.
- Skin phototype I: Always burns, never tans
- Skin phototype II: Burns easily, tans with difficulty
- Skin phototype III: Mild burns, tans gradually
- Skin phototype IV: Rarely burns, tans easily
- Skin phototype V: Very rarely burns, tans very easily
- Skin phototype VI: Almost never burns, tans very easily
Traditionally, white people of Irish decent fall into ST I, white people of Italian descent fall into ST III, those of Asian and Hispanic descent typically fall into ST IV, and Black people into ST V and VI. However, race is a social construct, and Blackness comes in many shades and ethnicities. So, for the rest of this article I will speak in more scientific terms and discuss the risk of sunburn and skin cancer in Fitzpatrick V and Fitzpatrick VI individuals.
So, Can Dark Skin Tones Still Sunburn?
In short, yes. Darker skin tones originate in parts of the world closest to the equator where UV exposure is highest. Melanin absorbs and scatters UV energy in a similar fashion to sunscreen providing Fitzpatrick V and Fitzpatrick VI individuals with a baseline estimated SPF of 7-10. This natural SPF allows darker skin tones to better tolerate UV exposure and typically results in tanning without burning. However, darker skin tones can still develop sunburns with high sun exposure, use of treatments that make the skin more sensitive to the sun (like retinoids), and/or rapid changes in UV exposure (say, winter Caribbean vacations and/or beach time.
Signs That You’re Sunburned
A typical sunburn presents with warmth, tenderness, and redness of the skin within eight hours of sun exposure. It typically occurs in areas that were missed by sunscreen and/or received higher amounts of sun exposure. The rash may stop abruptly at areas protected by clothing. The most common areas for sun burns include the nose, chest, shoulders, and back. However, a sunburn can occur anywhere. The redness associated with a sunburn may present as more burgundy in darker skin tones and may be difficult to discern.
Peeling of the burned area typically presents a few days after redness and tenderness and indicates resolution of the incident. Post-inflammatory pigmentation is uncommon with a sunburn, unlike other rashes in darker skin tones.
Severe sunburns may present with increased pain, fluid filled blisters, fevers, increased tiredness, and a general feeling of unwellness.
What About Skin Cancer?
Darker skin tones are less likely to develop sun-induced skin cancers than lighter skin tones, but less is not never.
The number of sunburns, particularly the number of childhood sunburns, appears to be an important risk factor for the development of skin cancer. In addition, darker-skinned individuals develop less UV damage from equivalent amounts of sun exposure compared to lighter skin counterparts.
However, I have diagnosed basal cell carcinomas, squamous cell carcinomas, and melanoma in darker-skinned individuals. In fact, skin cancers tend to be diagnosed at later stages with worse outcomes in darker skin tones. Remember that Fitzpatrick V and VI individuals have a baseline SPF of 7-10. This is far less than the SPF 30 that’s recommended by the American Academy of Dermatology. Although sunburns are rare, chronic, cumulative sun damage still occurs in darker skin tones. There are also other risk factors for skin cancers.
Besides Sun Exposure, What Other Factors Contribute to My Skin Cancer Risk?
- Chronic inflammation from scars, human papillomavirus, ulcers, radiation, and chronic inflammatory conditions
Early Signs of Skin Cancer in Dark Skin Tones
This is important because although skin cancer is less common in darker skin tones, it tends to be diagnosed at later stages with worse clinical outcomes.
Skin cancer can be divided into two main categories. There are skin cancers that do not fall into this list, but these are the most common:
Melanoma is the most important skin cancer to recognize, as early detection drastically changes survival rates. Melanoma may present as a dark, changing growth on the body or within the nails. On the body, it typically presents as an atypical mole. Within the nails, it typically presents as an asymmetric, wide, and/or dark streak. Because melanomas of the palms, soles, and nails are not related to sun exposure, these are the most common places for melanoma to occur in darker skin types. It’s important to have a good look at these areas (preferably now). These areas are often overlooked by patients and history is very important in accessing a pigmented lesion (it’s the E in ABCDE, broken down below). A mole that has been present for 10 years without change is different in my evaluation from a mole that’s new in a 35-year-old. The ABCDEs of melanoma are very helpful, but in general I recommend my patients follow up once a year for a routine evaluation. In-between, their job is to return sooner for a new mole that doesn’t look like the rest of their moles and/or a mole they’ve had for years that is now changing. Change in size, color, pain, and/or bleeding are red flags.
ABCDEs of Melanoma
- A: Asymmetry
- B: (irregular) Border
- C: Color– blues, white, and blacks are concerning; lesions that are more than one color are concerning
- D: Diameter – anything larger than a pencil eraser should be evaluated (that’s 6 mm for you Gen-Z Zoomers)
- E: Evolution–this is the most important factor–changing lesions should be evaluated.
Keratinocytic Skin Cancers
Keratinocytic skin cancers include basal cell carcinomas and squamous cell carcinomas. These typically present as a pimple-like or scab-like lesions that do not resolve after four weeks. Squamous cell carcinomas may present within a scar, so non-healing wounds should also be evaluated.
Of course, these are all warning signs to have a lesion evaluated by your dermatologist. It does not mean a lesion is necessarily dangerous, but it means you should have it evaluated by an expert.
Finding a sunscreen formula you enjoy makes it that much easier to wear sunscreen every single day, but keep in mind that makeup and moisturizers formulated with SPF typically don’t offer enough protection.
How to Protect Yourself From Sun Exposure
- Seek shade: Making a habit of walking on the shadier side of the street and staging picnic blankets under trees will decrease your cumulative UV exposure.
- Wear SPF daily: The American Academy of Dermatology recommends SPF 30 to all sun exposed areas of the body daily. SPF should be reapplied every two hours during prolonged sun exposure and should be reapplied after water or high sweat activities. Sun protective clothing can be beneficial for outdoor activities like running and water sports. Although UV exposure is less in the winter, it’s still present, so wear SPF everyday! Finding an elegant product that you like will make this easier. Here’s Byrdie’s list of favorites for dark skin tones.
- Avoid peak sun hours in the spring and summer: Peak UV exposure occurs between 10 am and 2 pm. It’s recommended to avoid outdoor activities, like running, during these times.
- See your dermatologist once a year: If you’re low risk for skin cancer, this exam can be wrapped into a normal follow-up to discuss skincare, eczema, or acne, for example. If you’re higher risk, this will likely need to be a separate appointment.
- Look at your skin, including your palms, soles, and nails, once a month: This will give you an idea of “what is normal.” Giving these areas a general look over once a month will help your eye narrow in on any new or changing lesions if present. This can also be reflective. I think of this as a time where I tell my skin “I see you, and I appreciate you.”
Melanin provides darker skin tones with a natural layer of protection. This layer of protection makes sunburns rare, but it does not completely block UV damage. This damage accumulates over many years to produce cumulative UV damage.
While it’s rare to develop a sunburn in darker skin tones, it happens. Abrupt increases in UV exposure and use of treatments that make the skin more sensitive to the sun increase the risk of sunburn in darker skin tones.
Darker skin tones are less likely to develop skin cancers compared to lighter skin individuals, however, when they are diagnosed, they tend to be diagnosed at later stages with worse prognosis. Monthly self-skin checks and a yearly follow-up with a dermatologist are essential for early detection. Diligent sun protection and sun protective habits are preventative.