Background/Aim:
Melanoma in individuals with skin of colour is uncommon but associated with disproportionately poorer outcomes, including increased Breslow thickness and advanced stage at diagnosis. These disparities are largely attributed to diagnostic delay and atypical clinical morphology. This review examines the clinicopathological features of melanoma in skin of colour, with a focus on diagnostic pitfalls and implications for Australian dermatology practice.
Methods:
A narrative review of the literature was conducted using PubMed and MEDLINE. Search terms included “melanoma skin of colour,” “acral lentiginous melanoma,” “amelanotic melanoma,” and “diagnostic delay ethnicity.” Articles published in English over the past 15 years were included, with emphasis on clinical, dermoscopic, and epidemiological data relevant to diagnosis.
Results:
Melanoma in skin of colour most commonly presents as acral lentiginous melanoma, involving the palms, soles, and nail apparatus. Lesions frequently demonstrate subtle or atypical pigmentation, and amelanotic variants are overrepresented. Classic ABCDE criteria are less sensitive in this population. Dermoscopic features may include parallel ridge patterns on acral skin and irregular pigmentation of the nail matrix, though these are often under-recognised. Diagnostic delay is consistently reported, with patients presenting with thicker tumours and more advanced disease. Contributing factors include lower clinical suspicion, reduced patient awareness, and limited representation of diverse skin types in educational resources and public health campaigns.
Conclusion:
Melanoma in skin of colour presents distinct diagnostic challenges, particularly in acral and amelanotic subtypes. For Australian dermatologists, heightened vigilance in examining acral sites and nail units, alongside familiarity with dermoscopic patterns in darker skin types, is critical for early detection. Greater inclusion of skin of colour in educational resources and public health initiatives is warranted. Further Australian data is needed to better define disease patterns in underrepresented populations, including Aboriginal and Torres Strait Islander communities.