Racial bias in the way medicine is taught means that doctors often miss melanoma and other skin disorders in Black people, writes University of Rochester dermatology professor Art Papier, MD, on the website STAT. “The skin is considered a window into health,” he writes. “But clinicians who haven’t been properly trained often fail to see conditions in patients with Black skin.”
In white skin, Papier writes, skin inflammation appears red or pink. In skin of color, it’s more likely to appear brown or violet. He describes doctors missing signs of lupus and potentially deadly drug reactions because they are only trained to identify problems in white skin.
For melanoma, a missed diagnosis can have fatal consequences. According to the Melanoma Research Alliance, studies show that Black people are four times more likely to be diagnosed with advanced-stage melanoma and 1.5 times more likely to die of melanoma than white people.
The most common form of melanoma in Black people, acral lentiginous melanoma (ALM)—the disease that killed reggae icon Bob Marley—doesn’t even appear on exposed skin. It forms on the palms, soles of the feet or under fingernails or toenails. The warning sign for ALM is a patch of discolored skin that grows over time.
Tackling systemic racism in medicine is complex, but one small step dermatologists can take is to educate themselves on how to treat skin of color and educate their patients as well, writes Papier. “Early on in my career, I recognized that showing reference images to patients that represent not only their condition but also their skin type can transform the conversation.” Racism in medicine, he concludes, “is not simply about poor access, inequitable care or hiring bias—it is also at the core of how we teach and practice medicine with people of color.”