Jacqueline Smith was shocked when she received a stage III melanoma diagnosis at the young age of 21. As a black woman, she didn’t think it could happen to her. “Growing up, I learned that middle-aged, fair-skinned Caucasian women were at high risk for skin cancer,” Smith tells SELF. Smith, now 39, is a melanoma awareness advocate and public speaker who devotes much of her time to spreading knowledge of skin cancer risks, especially to other black women who may underestimate their chances of developing this potentially deadly disease.

Yes, black people can get skin cancer. What’s more, when they do, they’re much more likely to die from it.

“Skin cancer in [people] of color absolutely happens. It tends to be a perfect storm, which is why people who have darker skin and who develop skin cancer tend to have a much poorer prognosis,” dermatologist Brooke Jackson, M.D., who specializes in skin of color and owns a private practice in Durham, North Carolina, tells SELF.

A July 2016 study in the Journal of the American Academy of Dermatology found that of all racial groups, non-Hispanic black people had the lowest rates of melanoma diagnoses, but they were also the most likely to be diagnosed at a later stage.

The research pulled data from 96,953 patients given a melanoma diagnosis between 1992 and 2009. White people had the highest rate of skin cancer, with 45.8 diagnoses per 100,000 people, while black people had the lowest, with 1.35 diagnoses per 100,000 people. But despite the low incidence of melanoma in minority groups, these patients had significantly shorter survival rates than white patients.

According to the most recent data available from the American Cancer Society, the five-year melanoma survival rate is 93 percent for white people, but only 69 percent for their black counterparts.

There’s a whole host of complex reasons why black Americans are more likely to die from skin cancer than white Americans. To fully explore them, you first have to know a bit about what skin cancer really is.

Skin cancer happens when your skin cells grow abnormally and out of control. It’s the most common form of cancer in the United States.

Over 5 million people in the United States are diagnosed with skin cancer each year, according to the American Cancer Society’s 2017 report. The most common forms of this disease are basal cell carcinoma, squamous cell carcinoma, and melanoma.

Your skin’s outermost layer is called your epidermis, and it has three main types of cells, according to the American Cancer Society. The squamous cells in the outer part of your epidermis are flat and constantly slough off so new ones can take their place. Basal cells, which are deeper in the epidermis, divide to make new cells to replace the old squamous ones. Then there are melanocytes, which create melanin. It’s the brown pigment that, by making some people’s skin darker than others, allows for the human race to have such a beautifully diverse range in skin tones.

While everyone has a similar number of melanocytes, genetics determine how much of this pigment those cells actually make, according to the American Academy of Dermatology (AAD). The more melanin you have, the darker your skin.

The most prevalent types of skin cancer correspond with these different cells. Around 8 in 10 skin cancers in the United States are basal cell carcinomas, making this the most common form of this disease, according to the American Cancer Society. Basal cell carcinoma typically develops on areas most often exposed to the sun, like the head and neck, and grow slowly. They can present in a multitude of different ways, including as flat, firm, pale, or yellow areas, raised reddish patches, strange bumps, growths with raised edges, and open sores.