Why is this so important for representation in dermatology
Ilia J. Smith, a 40-year-old nurse practitioner in Dallas, never suspected she would face a life-threatening health problem in her 30s. She was a health care professional. She ate well, worked regularly. Sure, she spent a lot of time basking in the sun with low SPF tanning oils, but as a black woman she didn’t care about sun protection. Several years earlier, a friend of hers, who worked as a medical assistant in a dermatology practice, reported a mole on her thigh during a day at the spa, but Smith brushed it off like a birthmark.
Fast forward to January 2021. Smith, now a mother of a young child, is lying on a plastic surgeon’s table with a gaping hole in her leg. “They had to remove a piece of tissue 8.5 centimeters wide and 4 centimeters deep from my thigh,” says Smith. She was diagnosed with skin cancer – malignant melanoma – last December. “I was stunned. I asked my dermatologist how rare this is, especially among African Americans.
Smith’s surprise is not entirely unfounded. The likelihood of women of color getting skin cancer is relatively low. According to a 2009 report in the Journal of the Dermatology Nurses’ Association, while the rates of skin cancer in the United States are around 35-45% in Caucasians, they are 5% or less for them. Hispanic and Asian patients, and between 1 and 2 percent for black patients. But two insidious factors can worsen the results: First, a relaxed attitude toward tanning in patients of color can magnify the risk. “My Latina patients have no problem getting a tan,” says Alicia Barba, MD, dermatologist in Miami. “Some of my black patients with lighter skin [also tell me] they feel prettier with a tan. Second, the disease is often diagnosed at more advanced stages in patients of color, which means it could be much more deadly by the time it’s discovered.
This is particularly concerning when it comes to skin cancer, says Jared Jagdeo, MD, associate professor of dermatology and director of the Center for Photomedicine at SUNY Downstate Medical Center. “Skin cancers usually present very differently in the skin of patients of color,” he says. “Especially basal cell cancer. It’s not just the most common skin cancer, it’s the most [frequently occurring] cancer, and often looks very different on darker skin. Miami-based dermatologist Patricia Rivas, MD, says that for Latin patients, basal cell carcinoma “can start to look like a pimple that won’t heal – they have no idea that, unfortunately, what is it?” cancer may look like. the beginning.”
The disparity in information is part of what prompted a UK-based medical student Malone Mukwende to team up with two staff from St George’s, University of London to create their own manual filled with images of clinical conditions in colored skin. “We have to start with medical schools and health care facilities,” says Mukwende. “The very first step is [these institutions] take responsibility for the lack of diversity in programming, which is part of why people are literally dying. [After that], it is very important to implement changes and see if they are working. “
In the United States, tech start-ups and skin care brands are working hard to fill the information gap. The Hued digital platform partnered with Vaseline to connect patients to local healthcare providers of color, and Vaseline also sponsored a training module on various skin care for clinician site Medscape. A new self-check microsite called Self Exam Beautifully, created by Neutrogena and the American Society for Dermatologic Surgery, identifies areas where melanoma is more likely to appear on colored skin, such as the palms of the hands and the soles.
Diversification of the medical profession will also help. “Patients of color are much more likely to wear sunscreen or get screened if a dermatologist of color tells them to,” says Mona Gohara, MD, associate clinical professor of dermatology at the Yale School of Medicine. And yet, “dermatology is one of the least diverse specialties,” she says.
According to the US Census Bureau, 13.4% of Americans identify as black or African American and 18.5% as Hispanic or Latin American. But just over 3% of dermatologists are black and less than 5% are Hispanic.
Until medical schools and mentoring programs were successful in their efforts to produce a more diverse pool of dermas to choose from (as of 2020, only 65 of 796 dermatology residency applicants were black. or African-Americans, and only 39 were Hispanic, Latino, or of Spanish descent), there are things people of color can do to improve their own results. First things first: Schedule an annual skin checkup with your dermatologist and make sure you’re scanned for skin cancer, says Karen Kagha, MD, a Harvard-trained cosmetics researcher. In addition, “reapplying SPF 30 or more every two hours is a must for all of my patients, regardless of their skin color.”
The need for greater diversity in dermatology – and in all areas of skin care – is urgent. For her part, Ilia Smith has two practitioners of color – both black – to thank for her skin cancer survival story. First, her doctor’s assistant friend, who initially alerted her to the quarter-sized mole (several years later when Smith hit her with her fingernail and a lump chipped and bled , she immediately called for help). Second, his doctor. After browsing through photos of all the dermatologists in the Dallas-Fort Worth area on Zocdoc, Smith found DiAnne Davis, MD, cosmetic dermatologist at North Dallas Dermatology Associates. Davis quickly biopsied Smith’s malignant melanoma. “I just wanted someone who looked like me,” says Smith. “Someone I can feel comfortable disclosing my tanning habits to, and someone who would understand where I’m coming from without any judgment.”
Smith’s life may have been saved, but others weren’t so lucky. “[Skin conditions] like melanoma are diagnosed too late, ”says Mukwende. “It comes down to how we are as humans. When we don’t understand something, we often go back to the original way we learned it. If the first way we learned about skin cancer involved visuals on white skin only, our natural bias is toward that perspective alone, and that bias can be the difference between life and death. ”
This article originally appeared in the May 2021 issue of ELLE magazine.
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