Black people absolutely get moles, though research consistently shows that darker-skinned individuals tend to develop fewer of them on most of the body compared to lighter-skinned people. What differs is not just the number but also where moles are most likely to appear, what they look like under close examination, and which changes deserve medical attention. Those differences matter more than most people realize, because the types of skin cancer that disproportionately affect Black patients often arise in spots people forget to check.
How Many Moles and Where They Show Up
A large comparative study of children and young adults found a striking gap in total mole counts between racial groups. White children had a median of 17 moles, while non-white children had a median of about 2 to 3. Among young adults, the gap persisted: white subjects had a median of 61 moles, compared to 16 in non-white subjects. The study also found a gradient, with mole counts decreasing from lighter to darker complexions across people of white, mixed-ancestry, East Asian, and Black descent.1Acta Dermato-Venereologica. Racial differences in mole proneness The reason for the difference is thought to be partly related to how melanin interacts with UV exposure: heavily pigmented skin absorbs and scatters more ultraviolet radiation before it reaches the melanocytes deeper in the skin, which may reduce some of the signals that trigger new mole formation on sun-exposed areas.
The pattern flips, however, on the palms and soles. A study of adults found that about 42% of Black participants had at least one mole on their palms or soles, compared to roughly 23% of white participants. Among those with palm moles, the distribution was remarkably similar across races: about 7 in 10 people had just one, and roughly 1 in 6 had two.2JAMA Dermatology. Acral Melanocytic Nevi: Prevalence and Distribution of Gross Morphologic Features in White and Black Adults The palms and soles have thinner pigment protection regardless of skin color, which may partly explain why moles cluster there in darker-skinned individuals even as they appear less frequently on the arms, legs, and trunk.
What Moles Actually Look Like on Dark Skin
If you have ever searched online for images of moles to compare with your own, you have probably noticed that almost every reference photo shows a light-skinned person. That is a real problem, because moles do not look the same on darker skin, and knowing the normal appearance for your skin tone is the first step in recognizing something abnormal.
Studies using dermoscopy, where a dermatologist examines moles under magnification, have found consistent differences between deeply pigmented skin and lighter skin. In people with moderately dark skin (often classified as Fitzpatrick type V), moles typically appear dark brown and show a reticular (net-like) pattern, sometimes with a darker center.3PubMed. Dermoscopy of black skin: A cross-sectional study of clinical and dermoscopic features of melanocytic lesions in individuals with type V/VI skin compared to those with type I/II skin In people with the deepest skin tones (type VI), the pattern shifts: moles are more frequently structureless under the dermatoscope and tend to appear black, blue, or gray rather than brown.4PubMed. Dermoscopic nevus patterns in skin of colour: a prospective, cross-sectional, morphological study in individuals with skin type V and VI That gray or blue tint can alarm people who associate those colors with danger, but on very dark skin it is often just the normal way melanin looks through the epidermis.
These color and pattern differences are not cosmetic trivia. They directly affect how doctors evaluate moles. A mole that would be considered unremarkable on a lighter patient might look unusual to a clinician who trained almost entirely on images of white skin, and the reverse is also true. Moles on the palms and soles of dark-skinned individuals can show patterns such as parallel furrow lines or lattice-like lines that are normal for those locations.5PubMed Central. Dermoscopic features of neoplasms in skin of color: A review When those predictable patterns break down and are replaced by irregular, multicomponent patterns, that is when a biopsy becomes important.6JAMA Dermatology. Dermoscopic Patterns of Benign Volar Melanocytic Lesions in Patients With Atypical Mole Syndrome
Dermatosis Papulosa Nigra
Many Black adults have small, dark, raised bumps on their face, neck, and upper chest that they or others casually call moles. These are very often not true moles (melanocytic nevi) but a condition called dermatosis papulosa nigra, or DPN. The distinction matters because DPN and moles behave differently, have different risk profiles, and require different approaches if you want them removed.
DPN lesions are benign growths related to seborrheic keratoses. They typically first appear after puberty, starting as tiny dark bumps on the cheeks and gradually increasing in number over the years. The bumps are usually 1 to 5 millimeters across, can be rounded or slightly thread-like in shape, and are most common on the face, neck, and trunk.7Anais Brasileiros de Dermatologia. Dermatology in black skin They run in families: more than half of affected people report relatives with the same bumps. The prevalence in Black populations ranges from about 10% to 30%.7Anais Brasileiros de Dermatologia. Dermatology in black skin Historically, these were described as noninflammatory growths characterized by a thickening of the outer skin layer.8JAMA Dermatology. DERMATOSIS PAPULOSA NIGRA (CASTELLANI) OF UNUSUAL DISTRIBUTION: (ACANTHOSIS PAPULOSA NIGRA)
DPN bumps have essentially no cancer risk, so monitoring them for changes is not medically necessary in the way that watching a true mole would be. People sometimes have them removed for cosmetic reasons, usually through light electrodesiccation or cryotherapy. If you are unsure whether a bump is a mole or DPN, a dermatologist can usually tell the difference on sight, though dermoscopy confirms it quickly.
Post-Inflammatory Dark Spots and Other Mimics
Another common source of confusion on dark skin is post-inflammatory hyperpigmentation, or PIH. Any time your skin is injured, irritated, or inflamed, whether by acne, an insect bite, a razor bump, an allergic reaction, or even a scratch, the healing process can leave behind a flat dark mark. In darker skin, the higher baseline melanin content means these marks tend to be more visible and longer-lasting than in lighter skin.9PubMed Central. Post-Inflammatory Hyperpigmentation in Dark Skin: Molecular Mechanism and Skincare Implications
PIH spots are flat, not raised, and they match the shape of the original irritation. They are not moles and carry no cancer risk. Over months, most will fade on their own, though sunscreen and certain topical treatments can speed the process. The practical issue is that people sometimes mistake a cluster of PIH marks for new moles appearing suddenly. The key giveaway is history: if you can remember a pimple, cut, or rash in that exact spot, the dark mark is almost certainly PIH.
Acral Melanoma and Why Palms, Soles, and Nails Matter
Melanoma is far less common in Black people than in white people, but the type of melanoma that does occur is disproportionately concentrated in one specific location. Acral lentiginous melanoma, which arises on the palms, soles, and under the nails, accounts for about 36% of all melanomas diagnosed in Black patients. In non-Hispanic white patients, it accounts for roughly 1%.10JAMA Dermatology. Acral Lentiginous Melanoma: Incidence and Survival Patterns in the United States, 1986-2005 That does not mean the absolute rate is higher in Black people; the overall incidence of acral melanoma is actually similar across races at about 1.8 per million person-years. But because other types of melanoma (the ones tied to sun exposure) are rare in Black patients, acral melanoma makes up a much larger share of the total.
What makes acral melanoma especially tricky is that it has little to do with sun exposure. The palms and soles receive minimal UV radiation, and research has shown that acral melanomas have distinct genetic features with fewer UV-induced mutations.11Scientific Reports. A clinicopathological analysis of 153 acral melanomas and the relevance of mechanical stress One hypothesis is that chronic mechanical stress, the repeated pressure and friction on weight-bearing areas of the foot, plays a role. A study of over 300 acral melanoma patients found that about 27% reported a significant traumatic event and about 29% reported sustained physical stress to the affected area before the melanoma developed.12PubMed Central. Frequency of Trauma, Physical Stress, and Occupation in Acral Melanoma: Analysis of 313 Acral Melanoma Patients in Korea Researchers have also pointed out that even in Black skin, the soles and palms are hypopigmented, meaning they have less melanin protection against locally generated free radicals from inflammation.11Scientific Reports. A clinicopathological analysis of 153 acral melanomas and the relevance of mechanical stress
The practical message is clear: if you have dark skin, the places you most need to check for suspicious changes are the ones you are least likely to think of, your palms, the soles of your feet, and your nail beds. A new dark streak under a fingernail or toenail, an existing mole on the sole that starts changing, or a dark spot on the palm that was not there before all warrant a dermatologist’s opinion.
Dark Lines Under the Nails
A dark longitudinal band running from the base of a nail to the tip, called longitudinal melanonychia, is common in people with dark skin and is usually harmless. In a review of nail clinic referrals over five years, about 59% of longitudinal melanonychia cases were caused by melanocyte activation rather than proliferation, and the most common triggers were friction and trauma.13British Journal of Dermatology. BH07 A retrospective review of cases of longitudinal melanonychia referred to a tertiary nail centre over a 5-year period to identify the various subtypes and outcomes Ethnic melanonychia, meaning bands that appear simply as a feature of darker pigmentation, was another frequent cause. Only a small fraction of referred cases turned out to involve melanocyte proliferation such as nail nevi or other growths, and in that particular review, only one patient was diagnosed with nail melanoma.13British Journal of Dermatology. BH07 A retrospective review of cases of longitudinal melanonychia referred to a tertiary nail centre over a 5-year period to identify the various subtypes and outcomes
In dark-skinned individuals, having a single uniform brown or black stripe in one or more nails is typically benign and may never change. The features that should prompt a visit to a doctor include a band that is widening over time, a band that is very dark or irregular in color from one edge to the other, pigment that spills over from the nail onto the surrounding skin (called the Hutchinson sign), and any band that appears suddenly in a single nail in an older adult without a history of trauma to that nail.
Why Melanoma Outcomes Are Worse for Black Patients
Even though melanoma is relatively rare in Black people, the outcomes when it does occur are disproportionately poor. Survival data show that Black patients have the shortest melanoma survival times across all racial groups studied, while white patients have the longest.14PubMed. Racial disparities in melanoma survival The gap is especially stark at early and intermediate stages: at stage I, Black patients had roughly three times the risk of dying from melanoma compared to white patients at the same stage.14PubMed. Racial disparities in melanoma survival
The driving force behind this disparity appears to be late detection. Black patients have the highest proportion of late-stage melanoma at diagnosis. One analysis found that after adjusting for stage, age, and sex, the increased risk of melanoma-specific death in Black patients essentially disappeared, suggesting the survival gap is a consequence of diagnosis happening later in the disease course rather than a biological difference in tumor aggressiveness.15PubMed Central. Racial Disparities in Patients with Melanoma: A Multivariate Survival Analysis That is both discouraging and encouraging: discouraging because the system is failing Black patients at the detection stage, encouraging because earlier detection could close much of the gap.
Several factors feed into delayed diagnosis. One is the widespread misconception, held by patients and doctors alike, that Black people do not get skin cancer. Another is that the type of melanoma most common in Black patients (acral lentiginous melanoma) shows up in locations that routine skin exams often skip. A third is a systemic gap in medical training: dermatology education materials have historically underrepresented darker skin tones, meaning clinicians may have less pattern-recognition experience with how conditions look on Black skin.16PubMed Central. Racial disparities in dermatology17Journal of the American Academy of Dermatology. Gaps in medical education curricula on skin of color in medical school, residency, and beyond: Part 1 International experts have identified this educational deficit as a critical gap that contributes to delays and inaccurate diagnoses across the board for patients with darker skin.18PubMed Central. International Expert Consensus on Knowledge Gaps in Care for Dermatologic Disorders in Skin of Color
A Practical Self-Check for Dark Skin
The classic ABCDE rule for evaluating moles (asymmetry, border irregularity, color variation, diameter, evolution) applies across all skin tones, but it needs some adjustment for dark skin. Color variation is trickier to assess when your moles are naturally very dark; a mole that is uniformly dark brown or black may be completely normal. Focus instead on whether a single mole has multiple different colors within it, such as patches of tan alongside black or areas that look blue-gray against a brown background. Evolution, meaning any change in size, shape, color, or texture over time, remains the single most reliable warning sign regardless of your skin tone.
For people with dark skin, it helps to build a few extra habits into your routine:
- Check your soles: Use a mirror or your phone camera to examine the bottoms of your feet, including between the toes. Any new spot or one that is growing deserves attention.
- Check your palms: Look at the creases and edges of your palms for new dark spots or changes to existing ones.
- Check your nails: Look for new dark streaks. A single band that is getting wider or darker over weeks to months is more concerning than multiple faint bands across several nails.
- Note what is normal for you: Because DPN, PIH, and benign moles are all common on dark skin, it helps to know your baseline. Take photos of spots you notice so you can compare them over time.
If a dermatologist dismisses a concern without examining it closely, particularly on the palms, soles, or nails, it is reasonable to push back or seek a second opinion. The evidence on diagnostic delays in Black patients suggests that advocating for yourself in that setting can matter.
Congenital Moles in Babies With Dark Skin
Moles present at birth, called congenital melanocytic nevi, occur in all races. These range from small spots a few millimeters wide to large patches that cover significant portions of the body. A review by pediatric dermatology experts noted that the overall risk of melanoma developing from a congenital mole is generally low, but it increases for children born with large or giant congenital nevi or with multiple congenital nevi.19Pediatrics. Care of Congenital Melanocytic Nevi in Newborns and Infants: Review and Management Recommendations In those higher-risk cases, screening imaging may be recommended to look for complications involving the central nervous system.
On dark-skinned newborns, congenital moles can be difficult to distinguish from Mongolian spots (dermal melanocytosis), which are blue-gray patches that are extremely common in babies of African, Asian, and Hispanic descent. Mongolian spots are harmless and typically fade on their own within the first several years of life. A congenital mole, by contrast, tends to be more sharply defined, may be slightly raised or textured, and will persist. If a dark patch on a newborn is raising questions, a pediatric dermatologist can usually differentiate the two on examination. Current expert recommendations favor a conservative approach to surgical management of congenital nevi, reserving excision for cases where the risk profile or cosmetic concern justifies it.19Pediatrics. Care of Congenital Melanocytic Nevi in Newborns and Infants: Review and Management Recommendations
Representation in Dermatology Is Slowly Improving
For decades, dermatology textbooks and teaching atlases were overwhelmingly populated with images of conditions as they appear on white skin. That meant clinicians in training had thousands of hours of pattern-recognition practice on lighter complexions and very little on darker ones. The consequences have been documented repeatedly: diagnostic delays, misdiagnoses, and a general sense among Black patients that their skin concerns are not taken seriously.17Journal of the American Academy of Dermatology. Gaps in medical education curricula on skin of color in medical school, residency, and beyond: Part 1
Recent years have brought concrete change. New dermatology atlases focused specifically on darker skin tones have been published and widely adopted in medical schools. Social media accounts and open-access journals dedicated to skin of color have given both clinicians and patients a larger reference library. International expert panels have identified dermatologic education for diverse skin tones as a priority gap and are working toward consensus guidelines for closing it.18PubMed Central. International Expert Consensus on Knowledge Gaps in Care for Dermatologic Disorders in Skin of Color The workforce itself is also slowly diversifying, though underrepresentation of minority groups in dermatology persists as a contributing factor to disparities in care.16PubMed Central. Racial disparities in dermatology
None of that erases the current reality, which is that if you have dark skin, you may need to be more proactive about skin checks than the average health recommendation assumes. Knowing what your normal moles look like, knowing where your risk zones are, and knowing that DPN and PIH are common and benign gives you a better foundation for spotting the rare thing that is not.