Features of Skin of Color

Physicians need the appropriate experience to be able to reliably diagnose skin diseases in patients with skin of color.

This narrative review is based on scientific articles and book chapters about skin of color and comparative studies across skin pigmentation types or ethnic groups that were retrieved by a selective search. Publications up to 2026 were included.

Skin of color differs from the lighter skin type that is most common in northern Europe in melanin structure, content, and distribution and in other anatomical respects. Two main aspects require attention in dermatology; the distinction of malignancy from physiological types of hyperpigmentation, and the recognition and treatment of inflammatory skin diseases. Basal cell carcinoma appears to be the most common type of tumor affecting darkly pigmented as well as lighter skin types; squamous-cell carcinoma is more frequent in darker than in lighter skin. Malignant melanoma is reportedly ca. 33 times less common in persons with darker skin, but often in a more advanced stage at the time of diagnosis. Inflammatory skin diseases present differently on darker compared to lighter skin, as erythema is often barely recognizable or invisible. Sequelae such as post-inflammatory hyper-and hypopigmentation, marked scarring, and keloids are often very disturbing for those affected.

There have only been a few studies to date on patients with skin of color. Dermatological study findings must be evaluated in an inclusive manner. People with skin of color should also be screened for skin cancer and should protect themselves against the effects of ultraviolet light.