DermWorld Academy Insider: Skin cancer, skin of color communities, and how derms can move the needle on health equity

Jan. 20, 2022

Omolara Olowoyeye, MD, MPH, FAAD, a Black dermatologist based in Maryland, emphasizes the importance of early detection and skin cancer prevention in skin of color communities. After she uncovered a malignant legion on her sister’s scalp, she urgently pushed her sister’s physician to look deeper into the issue. Dr. Olowoyeye says cultural competency and more research into skin conditions’ impact on skin of color patients — two areas outlined in the Academy’s Diversity, Equity, and Inclusion (DEI) plan — are key to helping the specialty address health care disparities.

DermWorld: I understand that your passion for the specialty was ignited when your sister was diagnosed with and treated for melanoma. For quite some time, there has been a myth that perpetuates that people of color are not at-risk for skin cancer. Can you tell us more about why it’s important for individuals of all skin types to be aware of skin cancer detection and prevention?

Dr. Olowoyeye: In my culture, hair care is not merely a practice that accentuates beauty, but one that brings women in the community closer together. My family continued these practices after we emigrated from Nigeria to America in pursuit of a better quality of life. While grooming my younger sister’s hair one afternoon before medical school, I found a suspicious, tender, dark papule on her scalp. I had always groomed my sister’s hair and had not remembered this growth before. My family and her pediatrician assumed it was benign, but I felt it needed further evaluation. To everyone’s dismay, the pathology of the lesion was not a mere cosmetic nuance but malignant melanoma. The pathology had to be sent to an expert at Harvard at the time given it was so rare for African-Americans and patients of African descent to present with melanoma. The dermatologists, dermatopathologists, and surgeons who diagnosed and treated my 20-year-old sister’s skin cancer truly laid the foundation for my interest in dermatology. This period of my life shed light on health disparities in medicine. This experience emphasized the importance of skin cancer surveillance, detection, and prevention in all skin types. Statistically, skin cancers may present less often in skin of color patients, but studies show that when found, it is often in late stages.

DermWorld: Speaking of research and studies, what other areas are you interested in learning more about?

Dr. Olowoyeye: I am interested in furthering public health education on the importance of skin surveillance and the barriers to this effect including factors such as cultural norms, lack of awareness, training, or insufficient research in skin of color populations. What we do know, however, is early detection can save lives. Early melanoma detection saved my sister’s and I will be eternally grateful for the team of dermatologists and specialists that helped her through a very challenging period.

DermWorld: Can you tell us about your journey to becoming a board-certified dermatologist?

Dr. Olowoyeye: I can trace my interest in medicine back to my childhood in Nigeria. I remember being very troubled by the number of sick and physically deformed individuals who lived in poverty due to a very weak health care system. I constantly pestered my parents to understand what caused these various health problems. Later, I realized they were due to highly preventable diseases. In the United States, I nurtured this passion for medicine by advancing my education and providing health related services for underserved communities through volunteerism.

In high school, I was accepted into the special Health Occupations Students Program, which provided high school students with clinical exposure in hospital settings during regular school hours. It was life changing. Prior to my entrance into medical school, I decided to pursue a degree in public health to learn more about global and preventative medicine. For my preventative health final project, I created a program that educated school children about the importance of protecting their skin from the harmful effects of sun exposure and stressed being vigilant about unusual skin changes as a tribute to the early diagnosis of my sister’s melanoma.

In medical school, my interest in dermatology was solidified after a medical mission trip to Ethiopia. We tended to patients with various ailments and diseases, but I was most fascinated by those presenting with cutaneous findings. One of the most impressionable experiences of the trip was treating farmers, who suffered from a disfiguring disease called mossy foot. As one of their primary health providers, I relied on visual acuity, touch, smell, surgical instrumentation, and internal medical knowledge to care for the patients. It was great to be part of such a collaborative, multi-disciplinary effort of creating treatment options for these patients. In addition, I worked in the local factory that manufactures rubber-soled boots for to help farmers prevent future cases of mossy foot. This experience brought things full circle allowing me to be involved in both the treatment and prevention of mossy foot disease. This is a solid example of how medicine and public health can be mutually beneficial.

Dermatology specifically intrigued me because I enjoyed this aspect of medicine where a visual inspection can lead to a medical diagnosis and in turn, the formulation of a detailed treatment plan. The extra bonus of the dermatology field for me was being able to perform various surgical and minor procedures without the weight of being in an operating room. Usually in medical school, students are told to choose between medicine and surgery. As someone who was somewhat interested in surgery but preferred more one-on-one direct patient care, dermatology offered the best of both worlds. I cannot imagine being in any other profession.

DermWorld: Just one year ago, we officially launched the Academy’s Diversity, Equity, and Inclusion (DEI) work, which focuses on four areas with the intentional goal of increasing diversity among dermatologists and trainees and creating a culture of inclusivity. Of the four areas, which one resonates more with you and why?

Dr. Olowoyeye: Ensure education and research encompasses health disparities and skin of color, and advocate for Black and Latino patient representation in research.

All aspects of the diversity initiative are important and I am thrilled that the AAD is making these important strides towards cultural competency and inclusion. Of the four goals outlined in the plan, number 2 resonates with me the most: Ensure education and research encompasses health disparities and skin of color, and advocate for Black and Latino patient representation in research. My experiences with my sister’s melanoma diagnosis and as a current skin of color dermatologist are two reasons why. Various physicians had initially dismissed my sister’s abnormal growth likely due to lack of awareness about skin cancer in skin of color patients. If I had not insisted on a biopsy, her diagnosis would have never been found.

My dermatologic training was wonderful, but I would have been better equipped if I had more research and presentations of various dermatologic conditions in skin of color patients. What we often see as dermatologists in the field varies and oftentimes does not resemble the “textbook” visuals we are often taught as residents. In addition, [minority] patients yearn for cultural competency from their physicians. Most skin of color patients that have been to multiple physicians share how often they don’t feel “heard” or “seen” as it pertains to their experiences, culture, and how that may often affect their dermatologic presentation. When skin of color patients have access to dermatologists who can identify with them and provide some reassurance that they have experience dealing with diverse patients, we begin to see better outcomes and treatment compliance.

DermWorld: One year after launching the AAD DEI plan, the Academy is launching its Skin of Color curriculum to help improve patient care for people of color. How can these types of resources help the specialty be more inclusive and, ultimately, help to reduce health care disparities?

Dr. Olowoyeye: Many would argue that improved cultural competency essentially equates to improved patient outcomes and compliance. It is my impression that these implementations ultimately also result in healthier and happier patients with strong confidence in their patient care experiences.

DermWorld: The late Dr. A. Paul Kelly researched skin diseases in people of color, particularly keloidal scarring. His work was transformational, especially since research into how skin diseases impact people with skin of color wasn’t as prominent. That said, one focus area of the Academy’s DEI work includes “ensuring education and research that encompasses health disparities and skin of color, and advocating for Black and Latino patient representation in research.” In thinking through your practice and the needs of minority patients when it comes to their skin care, why is research important when seeking to reduce health care disparities?

Dr. Olowoyeye: We have to ask ourselves two key questions. Why are certain dermatologic disorders more seen in skin of color such as CCCA, AKN, and keloids? Secondly, why have there not been significant advancements in treatment options compared to other areas such as eczema or psoriasis? It is often very defeating as a dermatologist to not be able to offer better treatment options for these patients. These are all pressing examples of health care disparities. Martin Luther King Jr. once said it best: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Medical research and practice should strive to improve quality of life, morbidity, and mortality for all individuals equally and equitably.

DermWorld: What advice do you have for underrepresented minority residents seeking a career in dermatology? Why are they the next generation of physicians that marginalized communities need?

Dr. Olowoyeye: Black dermatologists make up approximately 3% of dermatologists in the United States. However, 13% of the U.S. population is Black. Similarly, Hispanics make up approximately 4% of dermatologists while 16% of the U.S. identifies as being of Hispanic descent. My advice to future underrepresented minority residents seeking a career in dermatology is to be prepared to work hard and be ready to make a positive impact. You are needed. Stay determined. You can be an important part of shifting this narrative and further opening the doorway for equality and cultural competency in our field.