When it comes to diagnosing skin conditions across the human spectrum, challenges abound.
There is a rich diversity of skin types and skin colors, and it can sometimes be challenging for patients and providers to recognize issues early on.
This can be especially concerning as it applies to skin cancer and people with darker skin tones. While these cancers are less common among Black people, they are more likely fatal.
Black people who develop melanoma have a much lower five-year survival rate—about 66%, compared to 90% for non-Hispanic white patients.
And melanoma is often diagnosed later in Black patients, which can translate to worse outcomes and a shorter lifespan.
Enriched medical training will no doubt play a key role in improving diagnoses, treatment and outcomes. (One recent study found that only about 4.5% of images shown in general medical textbooks depicted darker skin.)
Among the work toward positive change is a new American Academy of Dermatology training curriculum.
Other educational campaigns focus on patient awareness, including an initiative from Vaseline, called See My Skin.
Working with a team of dermatologists, Vaseline is building an image database showing skin problems that people of color may encounter. The project aims to ease the fear and frustration of people with darker skin tones and help them find answers to a variety of questions about skin issues, such as common diaper rash, acne and cancer.
It also encourages users to upload images of their skin issues, enriching the databank.
For doctors, initial training often happens in the classroom.
“Most medical students first learn about rashes and skin problems in the first years of medical school,” Angela Oostema, MD, a family medicine expert at Corewell Health, said. “That’s followed by dermatology rotations. Students supplement images they see in textbooks with clinical practice.”
Learning to diagnose patients accurately can be a challenge, Dr. Oostema said.
There are thousands of skin disorders. Some rashes are especially subtle, including those related to rheumatalogic conditions, she said.
Sometimes adverse reactions to drugs can cause skin disorders, she said, and internal diseases can also present with dermatological symptoms.
All of these can look substantially different depending on the color of the skin.
There’s a changing awareness of these factors, especially in the last 10 years, Dr. Oostema said.
This includes stepped-up patient education, as well as efforts to debunk old myths about Black skin, especially when it comes to melanoma.
No matter what a person’s skin color, there is some risk of developing skin cancer. This is one of the most important messages the medical community can convey.
The rate of skin cancer among Black people may be 1 in 1,000, versus 1 in 38 for white people, “but that’s still a real risk,” Dr. Oostema said.
Though melanoma often occurs on areas of the body exposed to the sun, Black people are susceptible to acral lentiginous melanoma, Dr. Oostema said.
“This type of melanoma occurs most commonly on the palms, the soles of the feet and even the nails,” she said.
This type of cancer is more likely to recur—and it’s deadly. It’s what killed reggae legend Bob Marley.
Dr. Oostema advises all people to develop a relationship with a provider who makes it easy to ask questions.
“If a skin problem doesn’t resolve on its own, ask your provider to look at it,” she said. “Keep seeking treatment until it is solved.”
And for medical providers, it’s essential to continue learning, training and exploring their own hidden biases. It presents excellent opportunities for the physician community to increase awareness, using cultural humility to make it easier for individuals to present questions and receive answers.
“It’s so important to let people know we see that there are these differences, and that we care about them,” Dr. Oostema said.
“We want people to get better. And we want them to seek care whenever they think something isn’t right with their skin.”