Five Things You May Not Know About Bob Marley and Acral Lentiginous Melanoma

It’s an extraordinary life story: The Jamaican-born, legendary King of Reggae died at age 36 from a disease that broadly impacts people with fair complexions, not often people of color. Unfortunately, his story wasn’t fiction. Melanoma—specifically a rare subtype called acral lentiginous melanoma—tragically ended the life of the supremely talented Bob Marley. Here are five things you may not know about the life and death of Bob Marley:

1. He Tried to Fly Home to Die in May 1981

Sadly, Marley’s final days indicate that he knew every little thing was not gonna be alright. He knew he was dying.

In 1981, Marley was in Europe, where he had been receiving alternative therapies for his melanoma for months. Those treatments didn’t work, so he chartered a flight from Europe to Jamaica, where he could spend his last days on his native isle of springs and the birthplace of reggae.

The flight didn’t reach its intended destination. While thousands of feet above the ground, Marley’s vital functions plummeted, forcing an emergency landing. The plane descended to Miami, where he was admitted into Cedars of Lebanon Hospital, now the University of Miami Hospital. It was there that he succumbed to cancer on May 11, 1981.

Although he did not reach Jamaica again while alive, he received a state funeral there. A statue in Kingston commemorates his life and legacy. He eternally rests in a Jamaican chapel near where he was born.

2. His Acral Melanoma was Likely Unrelated to Radiation from the Sun

Most cases of acral lentiginous melanoma arise on the non-hair-baring surfaces of the body, such as the palms of the hands, the nails or nailbeds, fingers, toes, heels, and the soles of the feet. Acral melanoma is not thought to develop because of excessive sun exposure.

Acral melanoma is a rare type of cancer likely associated with injury from mechanical stress, pressure, or trauma. This type of melanoma can also be associated with an individual’s genetics.

During the summer of 1977, when Marley was 32 years old and on tour in Europe, his right great toe and toenail ached after a soccer game. Then, the toenail partially detached. He had received treatment months earlier for a soccer injury on that toe, and he described this site as “wounded” for years. He saw a doctor expecting treatment for a sports injury and was instead given a melanoma diagnosis.

We may never understand why his injury developed into melanoma and occurred at such a young age. Lots of amateur and professional athletes sustain repeated sports injuries without developing cancer. It’s also exceedingly rare for young people to be diagnosed with life-threatening cancer. In the US, cancer only becomes the #1 cause of death for males once they reach 60 years of age. Men in their 30s are more likely to succumb to things like accidents, intentional self-harm, assault, or heart disease.

3. Marley Refused Initial Treatment for Melanoma

There was a lack of effective treatment options for patients diagnosed with advanced melanoma in the 1970s. Ironically, the only one that might have saved or lengthened his life – surgery to remove the cancerous toe – was the one that he refused. His Rastafarian religion considered it a sin to remove any part of the body. However, he agreed to have some of the skin and tissue around his nail bed removed where the acral melanoma was found. Skin from his thigh replaced it.

Regrettably, he did not undergo routine follow-up treatments, but to be fair in the late 1970s there wasn’t much to offer. Chemotherapy was available, but it’s not usually effective against melanoma: Cancerous melanocytes, which are adept at tolerating abuse from ultraviolet radiation and environmental pathogens on the skin, do not respond to chemotherapy.

We want to assume that Marley received state-of-the-art treatment during his life. He was treated at multiple clinics specializing in cancer, including Memorial Sloan-Kettering Cancer Center in New York City. There, Marley was diagnosed with metastasized melanoma after collapsing while jogging, and there he received radiation therapy to shrink tumors in his lungs and liver.

Often, what ends the life of a person with cancer is not the primary tumor. A small tumor that remains in one spot and does not grow or travel elsewhere would not necessarily impact survival. Marley’s death is most likely attributed to the damage the metastasized cancer did to his vital organs—specifically his liver and lungs.

4. Acral Melanoma is Rare and Can Be Fatal

Bob Marley was not at high risk for melanoma. He wasn’t Australian, American, or a New Zealander; he wasn’t White, red-haired, or blue-eyed; and he wasn’t 66, the median age at diagnosis. However, these risk factors apply to the far more common types of cutaneous (meaning “skin”) melanoma, such as superficial spreading melanoma, not acral melanoma. Acral melanoma is not thought to be related to ultraviolet (UV) damage, and these risk factors are all connected to susceptibility to UV damage and actual UV damage.

Acral melanoma is often very aggressive, as evidenced by the young age of Marley at his diagnosis and death. A general lack of awareness in the 1970s about acral melanoma may have contributed to his late diagnosis, as his lesion was most likely initially viewed as a wound, not cancer. At that time, there were only a handful of medical studies describing acral melanoma. In fact, the terminology acral lentiginous melanoma was coined in 1976, one year before Marley’s diagnosis, but the government agency for tracking cancer didn’t even begin recognizing it as a different type of melanoma until 1986.

Acral melanoma generally has a worse outcome compared to other cutaneous melanomas. It also has a shorter time of survival. More patients diagnosed with acral melanoma will have their disease reach an advanced, metastatic stage than other types of melanoma.

5. His Family Carried on His Musical Legacy

Marley left behind his wife, Rita, and 11 children. His oldest son, David, who is nicknamed Ziggy, led the family reggae band, The Melody Makers, after his dad’s passing. The band formed initially upon Marley’s request and started performing when he was still alive.

Altogether, Ziggy Marley and the Melody Makers released eight albums, carrying on Marley’s musical legacy. They reached the mainstream in the mid-80s with their fourth album and the hit singles “Tomorrow People” and “Tumblin’ Down.” These hit singles rejuvenated the legacy of Bob Marley and brought reggae into popular culture for many.

The 2023 Forbes list of the world’s highest-paid non-living celebrities ranks Bob Marley number nine. He is the only Jamaican-born musician on the list. His presence is surrounded by other larger-than-life musicians like Michael Jackson (#1), Elvis Presley (#2), Prince (#6), Whitney Houston (#7), and John Lennon (#8). His 2023 earnings were reportedly $16 million.

This earnings number exemplifies how Bob Marley’s music has transcended his life. His most successful song, “One Love,” sends a message of peace and harmony. It’s been used as the theme song for the Jamaican Tourist Board to welcome tourists to his birthplace with the lyrics, Let’s get together and feel all right. Other songs like “Buffalo Soldier,” “Get Up, Stand Up,” “Jamming,” and “No Woman, No Cry” echo today with people across the globe recognizing the lyrics. And with a new motion picture about his life opening in February 2024, his legacy and music will be introduced to the next generations.

Conclusion

Beyond his musical legacy, Bob Marley’s life story stands as a tragic example of how melanoma can affect people of all races. Let’s honor his legacy and be vocal that all shades of skin are at risk for melanoma and other skin cancers, and that everyone needs to check their skin for suspicious spots. To borrow his lyrics: Let’s get together and check our skin!

---

References
Albreski D, Sloan SB. Melanoma of the feet: misdiagnosed and misunderstood. Clin Dermatol. 2009;27(6):556-563. doi: 10.1016/j.clindermatol.2008.09.014.

Bradford PT, Goldstein AM, McMaster ML et al. Acral Lentiginous Melanoma: Incidence and Survival Patterns in the United States, 1986-2005. Arch Dermatol. 2009;145(4):427-434. doi:10.1001/archdermatol.2008.609

Dellato M. The Highest-Paid Dead Celebrities of 2023. Forbes. 2023.

Flores-Fernandez A, Cassarino DS. Histopathological diagnosis of acral lentiginous melanoma in early stages. Ann Diagn Pathol. 2017;26:64-69. doi: 10.1016/j.anndiagpath.2016.08.005

Jackson KM, Jones PC, Fluke LM et al. Smoking Status and Survival in Patients With Early-Stage Primary Cutaneous Melanoma. JAMA Netw Open. 2024;7(2):e2354751. doi: 10.1001/jamanetworkopen.2023.54751.

Kyriakou G, Kyriakou A, Papanikolaou S et al. Don’t worry about a thing … every little thing gonna be all right (except for acral lentiginous melanoma). Clin Dermatol. 2022;40(5):613–616. doi: 10.1016/j.clindermatol.2020.11.011.

Siegel RL, Giaquinto AN, Jemal A. Cancer Statistics, 2024. CA: Cancer J Clin. 2024;74(1):12-49. doi: 10.3322/caac.21820.