A woman thought a spot she'd had for years was a birthmark — until it started bleeding when she scratched it. It turned out to be stage 2 skin cancer.

• A Nigerian-Irish woman, 42, was diagnosed with stage 2 melanoma in 2020.
• She loved tanning in her youth, and didn't think she was at risk of cancer because of her skin color.

In 2009, Ilia J. Smith, 29, was at a spa with her friend, Tracee Blackburn.

As Smith got into the pool, Blackburn, a physician assistant who specializes in dermatology, suddenly zeroed in on a big spot on Smith's right hip.

"'Oh girl, that's a birthmark,'" Smith, now 42, reassured her.

Blackburn took a closer look and wasn't convinced, warning Smith to keep an eye on that area. To be extra cautious, Smith asked her mom and confirmed that the mark had always been there.

Over a decade later, her friend would be right: Smith's birthmark was eventually diagnosed as melanoma, considered the deadliest form of skin cancer.

Smith's birthmark started itching and bleeding

In 2020, about a year after she gave birth to her daughter, Smith's birthmark started feeling itchy. A few months later, she was in the bathroom and accidentally scraped it with her nail, causing it to bleed.

The American Academy of Dermatologists recommends that any time a mole starts to get itchy or bleeds, it should be examined by a dermatologist.

Smith immediately remembered that day at the spa and texted Blackburn a photo, who urged her to get a biopsy.

Smith booked an appointment with Dr. Dianne Davis, a dermatologist who diagnosed her with stage 2B melanoma — the more advanced level of stage two skin cancer.

"Being African-American, you don't think about skin cancer"

Smith, who is Nigerian-Irish, said she loved tanning when she was younger. "A lot of my family members are darker-skinned — I wanted to be like my family," she recalled. Plus, she said, "Being African-American, you don't think about skin cancer." Melanoma diagnoses are the lowest for Black people compared to people of all other races, occurring in 1 in 1,000 patients (it's 1 in 38 for white people).

It's not just Smith — a new survey from the American Academy of Dermatology found that the majority of Americans aren't concerned about developing skin cancer — even though many people have factors that put them at risk.

Describing herself as an outdoorsy person, Smith lived in the Philippines, California, and Texas, all of which have sunny climates. She also used tanning beds, and when she did apply sunscreen, opted for "more of a tanning lotion that had more of a 3 or 7 SPF."

One thing she wished she knew sooner was that higher SPF sunscreens don't entirely prevent tanning. While there's no such thing as a safe tan, proper sunscreen can prevent more serious skin damage.

"All this time, I could have been protecting my skin and not maybe have fallen down this route where I can't even be in the sun at all," she said.

She now has ongoing checkups and takes every precaution to avoid the sun

Because the cancer hadn't spread to her lymph nodes, Smith only needed to have the cancerous lesion surgically removed. Still, it was a fairly complicated process, requiring her oncologist to cut out 8x4 cm of tissue.

After her surgery, Smith had to have skin cancer screenings every three months for the next two years. Now, she only has them every six months.

The hardest adjustment has been avoiding the sun. "I love running and I love just being in the sun and taking my daughter to the pool," Smith, who now resides in Dallas, told Insider. Now, she wears a hat, sunscreen of at least SPF 30, and sun-protective clothing with long sleeves. If she's at the beach, she makes sure to sit in the shade.

Reflecting on her experience, Smith said it's crucial for everyone to be aware of any skin changes. "I think all ethnicities, not just pigmented people, need to just look at themselves," she said. "If you have freckles or moles, look at them and get them checked out at least once a year by a board-certified dermatologist."