The dentist’s office was the last place I expected to be warned about skin cancer.
When my hygienist lifted my hair off my ears during a head and neck exam, she noticed a mole that hadn’t been present six months ago.
“I’m not an expert on skin conditions, but just to be safe, you might want to see a dermatologist to have this checked out,” she said.
The hygienist added a caveat — I should search for someone familiar with abnormalities in darker skin. She didn’t want me to see a practitioner who might immediately dismiss the mole as nothing serious.
I found a resource called the Black Dermatologists Directory and began my search. The closest Black dermatologist was 65 miles away.
My hygienist had a valid concern, since missed or incorrect diagnoses can be deadly. While skin cancer is less common in darker skin, Black patients have a 66% survival rate from melanoma, the most deadly form of skin cancer, compared to 90% for non-Hispanic white patients. People of color are also more likely to develop melanoma on the soles of their feet or their palms. Untrained practitioners could miss those areas during a skin exam or fail to recognize a spot on those areas as a warning sign of cancer.
More commonly, however, people of color can suffer for years with treatable skin conditions simply because they don’t have access to a trained dermatologist. Many Black and Hispanic patients won’t get to see a Black or Hispanic dermatologist due to sheer numbers — just 3% of all dermatologists are Black (compared to 13% of the U.S. population), and about 4% are Hispanic (compared to 16% of the U.S. population). The time and transportation needed to visit a dermatologist of color can also create barriers to care, and dermatology is among the specialties least likely to accept Medicaid, limiting access for low-income individuals.
While one small study showed that Black patients prefer to see Black dermatologists who are familiar with Black skin and hair care practices, Black leaders in the field want everyone to receive more comprehensive training so they can recognize how conditions manifest on all skin tones.
“What’s really important is that all dermatologists feel comfortable treating patients of all skin types, so if a patient isn’t able to see a Black dermatologist they can still feel comfortable with the care they are getting,” said Nada Elbuluk, M.D., a board-certified dermatologist and assistant professor at the University of Southern California Keck School of Medicine.
More inclusive training includes incorporating images of darker skin into dermatology textbooks, journals, continuing medical education content and conference material, Elbuluk said.
Numerous scenarios demonstrate the importance of this effort. When people began developing lesions on their toes following Covid infections, nearly all the images of “Covid toes” that were available for review were shown on white skin, even though the condition looked quite different on darker skin.
Other routine concerns, such as psoriasis, rosacea and eczema, also can have a different appearance on darker skin. Even with a common concern like acne, people of color are more likely to experience hyperpigmentation, a skin discoloration that occurs due to inflammation. Those suffering with hair and scalp conditions, including a type of alopecia seen almost exclusively in Black women, could also feel more comfortable with a Black dermatologist who understands Black hair textures and hair care routines.
Right now, many images of darker skin can only be found through online resources, although one study discovered images of darker skin in textbooks were often used to illustrate sexually transmitted infections.
“The lack of diverse representation and educational materials affects the training students who go on to become physicians receive,” said Elbuluk, who founded and directs the USC Skin of Color and Pigmentary Disorders Clinic and serves as the director of the school’s dermatology diversity and inclusion program. “For students and residents who may not train in areas with diverse patient populations, they may be less comfortable treating people of different skin colors if they haven’t been learning about diseases across different skin colors.”
As a society, if we want more Black dermatologists, medical programs will have to be intentional about increasing the number of students in their pipelines. Janiene Luke, M.D., a board-certified dermatologist and associate professor and residency program director at the Loma Linda University department of dermatology in California, said dermatology is one of medicine’s most competitive specialties, with fewer residencies available compared to the number of applicants.
Luke said the field is working toward more inclusive admissions processes to ensure that talented applicants from historically underrepresented backgrounds are considered. Under this type of inclusive review, leadership skills and other experiences would be considered along with test scores and grades when granting residency positions.
“We know that among those who identify as underrepresented in medicine, they’re more likely to practice in areas where healthcare disparities exist in communities that need them the most,” said Luke, who completed her residency at the first Skin of Color center in New York City with dermatology pioneer Susan C. Taylor, M.D. “That’s another reason why it’s important to have more diversity in the physician workforce.”
I contacted the Black-owned dermatology practice that was more than an hour away and was first scheduled for a virtual visit. Although the practitioner I saw was white, she was very familiar with darker skin tones and wanted to see me in person because the color and shape of the mole were unusual.
She then ordered a skin biopsy, and thankfully, the mole was benign.
While I was relieved, the experience was a real-time lesson about the importance of healthcare practitioners recognizing and treating abnormalities on darker skin — and how difficult it can be to access care.
To find dermatologists of color, Luke recommends you use social media and the internet, using search terms like “Black dermatologists in X city” to see who might be nearby. Many dermatologists also have active social media presences, and patients often find them through Instagram, Twitter and Facebook.
“We’re out there — it’s just a matter of finding us,” she said. “The ultimate goal and what I strive for as a program director is increasing the diversity in dermatology so people won’t have to drive hours to get the care they need or would feel most comfortable with.”