According to research, people of color (POC) may have a higher risk of skin cancer misdiagnosis than people with lighter skin. Experts believe this problem may be attributed to shortcomings in medical education.
Specifically, researchers say POC are underrepresented in medical textbooks. As a result, physicians are inadequately trained to recognize skin cancer in POC.
Doctors Are Familiar With Skin Cancer on Light Skin
Skin cancer is the most common form of cancer in the United States. According to the Centers for Disease Control and Prevention (CDC), there are about 1.7 million new cases of melanoma skin cancer each year. The majority of those cases occur in people with light skin. Only about 300,000 cases occur in people of color.
This means doctors are far more likely to see cases of melanoma on light skin than on dark skin. To complicate matters further, medical textbooks provide few to zero examples of skin problems on dark skin.
Medical Textbooks Lack Examples of Skin Cancer in People of Color
A recent study examined racial representation in healthcare education. The researchers analyzed 4,143 images from four common medical textbooks. They hoped to learn if POC were adequately represented within the books as a whole, and within certain chapters and topics of the books.
The study came to a number of conclusions, including:
- None of the books represented light, medium and dark skin tones in proportion with the population.
- All of the books had poor representation of dark skin tones.
- One book, Atlas of Human Anatomy (2014 edition), presented 99.7% light skin tones.
At the topic level, researchers found more than 93.3% of cancer images depicted light skin tones. The remainder showed medium tones. There were no cancer depictions representative of dark skin tones.
Only one of the textbooks provided images of skin cancer. Every melanoma in the book appeared on light skin. Within the text, readers were informed of the need to check for melanoma on nails, hands and feet of dark-skinned patients. But, the book failed to include any images to illustrate melanoma in these locations on dark skin.
The researchers concluded "the complete absence of POC and underrepresentation of [darker skin tones] is clearly a problem."
Study Indicates Physicians Are More Likely to Miss Skin Cancer in Black Patients
Another study investigated physicians' tendency to correctly diagnose melanoma in light vs. dark-skinned patients. 287 physicians were shown pictures of skin conditions and asked to choose from 20 potential diagnoses. There were only four images of melanoma, evenly divided between white and black patients.
62% of physicians incorrectly diagnosed the first example of melanoma in a black patient. 31% of physicians incorrectly diagnosed the second example in a black patient. For the images of melanoma in white patients, the misdiagnosis rates were only 13% and 7%.
At best, these physicians missed melanoma about twice as often in black patients versus white patients. At worst, they missed this deadly cancer almost nine times more frequently in black versus white patients.
Medical Education Must Change to Eliminate Racial Disparities in Skin Cancer Diagnosis
Experts say medical textbooks must improve diversity within their pages at the book and topic level. They also pointed to a number of other factors that must be addressed:
- Healthcare professionals (HCPs) must be educated on minority distrust of the healthcare system.
- Race and skin tone must be diversified in other medical materials. This includes office pamphlets, posters and wall photos.
- Medical institutions must strive for better representation of minorities and POC during dermatology training.
Researchers believe these changes will play an important role in reducing health care bias. However, only time will tell if these and other changes will reduce the risk of skin cancer misdiagnosis for POC.