Hidden Risks: Understanding Sun Damage in Skin of Colour

Irish Pharmacy News interview with Professor Desmond J. Tobin, Director of the Charles Institute of Dermatology at University College Dublin

Source: Irish Pharmacy News, May 2026, pages 30.

As Ireland’s population becomes increasingly diverse, community pharmacists are encountering a broader range of patient needs, including skin health across different skin tones. A common misconception persists that individuals with darker skin are not at risk of sun damage or skin cancer, which can lead to delayed diagnosis and poorer outcomes.

1. There is a common perception that people with darker skin tones are not at risk of sun damage or skin cancer. From a dermatological perspective, how accurate is this belief and what should healthcare professionals understand about sun risk across different skin types?

Skin tone is often characterised by level and type of melanin in the epidermis of our skin and reflects one’s ability to make brown/black eumelanin or red/yellow pheomelanin. Typically, skin protection is conferred by levels of eumelanin, which is much more photostable (and so protective) than pheomelanin. Broadly speaking skin protection from sunlight (especially ultraviolet A and -B radiation) is assessed by susceptibility to sunburn. Light skin tones are grouped into skin phototype (SPT)-I and II. While darker, more sunburn resistant skin tones are grouped into SPT-III to -VI. These are relative categories. People of darker skin tones can get sunburned, and even peel. The usual early signs of sun-burn (redness or erythema) seen in light skinned individuals are disguised in darker skin tones. Thus, we need to educate people with darker skin tones of their need to interpret how unprotected sun exposure can adversely affect their skin, especially as the warning signs can be obscured by their darker tone. Beyond acute burn/peel, darker skin tones tend to reveal photoaging signs later in their lives compared to lighter skin people, due to this relatively-protective higher eumelanin level.

2. Are there particular challenges or differences in recognising skin cancers, including melanoma, in patients with darker skin tones?

Yes, this is a key point. The evidence is already clear – skin cancers tend to be diagnosed later in people with darker skin tones (due to colour contrast differences compared to light-tone skin), when they often are more advanced and when they are often more difficult to treat. Also, black individuals may present with different subtypes of a particular skin cancer, eg. Melanoma. Here Acral Lentiginous Melanoma is more common and can appear on/around ‘hidden areas’ like nails and soles of the feet, and so not typically associated with sun exposure. While much rarer than for white skin, black skin can still develop sun-induced melanoma. In darker skin toned people Basal Cell Carcinoma often shows as a brown/black growth and not the pink patch seen in lighter skin.

3. As Ireland’s population becomes increasingly diverse, are there important considerations pharmacists should be aware of when advising patients from different ethnic backgrounds about sun protection?

Yes, that darker toned skin can still burn/peel/undergo carcinogenic changes if not protected, especially during prolonged high-UVR index exposures. That darker skin toned people can develop ALL the main skin cancers, including basal cell carcinoma, squamous cell carcinoma, and melanoma, even if they are less common.

4. What practical sun safety advice should pharmacists be giving patients with darker skin tones who may feel they do not need sun protection or who might be unaware of the dangers of UV rays in Ireland, even when it seems overcast.

While darker skin toned people have more protective melanin, this protection is not complete i.e., is not a sufficient shield against both skin photodamage and skin cancers. Pharmacists should emphasise this reality, especially for those who move from high UVR-index parts of the world to less sunny Ireland, where they may develop a false sense of security. In Ireland we all need to take sun-safety measures especially during April to September months, when UV-index can reach 3 or higher. This level of UV can still be present when overcast (up to 90% of UVR still penetrates cloud to reach our skin). Skin damage from the sun still happens, even if the darker-skin people cannot see it or feel it i.e. as they are less likely to sunburn than pale skinned individuals. Thus, these darker skinned patients are at risk of skin cancer diagnosis at a more advanced and dangerous stage, making it harder to treat.

5. Are there particular signs or symptoms pharmacists should be mindful of that would warrant referral to a GP or dermatologist?

New moles or changing moles, dark streaks under nails, and non-healing sore/ulcer or skin patches, dark spots appearing on their palms, soles, or under nails.

Scalp is also an area of attention, often ignored.

6. From a clinical perspective, are there specific presentations or anatomical sites where melanoma or other skin cancers may appear more commonly in patients with darker skin?

Yes, see above. But should also look inside mouth and genital areas to see if darker/discoloured skin appears.

7. Finally, from your perspective, what role can community pharmacists play in improving awareness and early detection of skin cancer?

Create a safe space for people with darker skin to bring their skin concerns to their attention, as they may include under-represented and marginalised groups. Have posters/flyers/handouts available to customers for casual perusal. The accessibility of pharmacies to all, and their prominence on the street, represents an ideal first-line space for engagement with this cohort. Identification of at risk/high-risk customers could facilitate triage/referral for lesions that cause concern.

Summary:

• The level of melanin in darker skin does not provide complete protection against skin photodamage and skin cancers.
• Pharmacists are positioned on the ideal and a highly accessible front-line to educate customers with skin of color and to potentially triage and refer those with suspicious lesions to the GP or dermatologist.
• Hospital clinicians in Ireland, especially of Irish geographic ancestry, need to be upskilled in the area of all pigmentary lesional and variants, given the serious consequences of delayed diagnosis to the patient.