Jeanine Downie, MD, is a board-certified dermatologist, and founder of image Dermatology PC in Montclair, NJ.

Jeanine Downie, MD

Skin of Color Savvy: The Art and Science of Treating Patients of Color

The latest episode of the Skin of Color Savvy podcast focused on “the sunscreen gap” in skin cancer prevention among patients with skin of color, with experts emphasizing the persistent misconceptions, delayed diagnoses, and systemic barriers contributing to poorer outcomes despite lower overall incidence rates of skin cancer in darker-skinned populations.  Hosted by Rebecca Vasquez, MD, associate professor of dermatology at UT Southwestern Medical Center, the discussion featured Jeanine Downie, MD, founder of Image Dermatology PC in Montclair, New Jersey; Henry Lim, MD, former chair of dermatology at Henry Ford Health; and Jane Yoo, MD, assistant clinical professor at the Icahn School of Medicine at Mount Sinai.  The conversation opened with Lim defining the “sunscreen gap” as both a technological and educational problem. On the formulation side, Lim highlighted limitations in currently available ultraviolet filters in the United States, particularly for long-wave UVA protection, which plays a significant role in pigmentation disorders and photoaging among patients with darker skin tones. Equally important, he said, is the widespread misconception that patients with skin of color do not require sunscreen or sun protection because of their natural melanin.  Downie strongly challenged that belief, emphasizing that “anybody with skin needs to wear sunscreen.” She explained that even darker skin tones provide only limited intrinsic SPF protection and pointed to disparities in melanoma survival rates among Black patients compared with White patients. According to Downie, these misconceptions contribute to delayed diagnoses and worse outcomes, particularly because skin cancers in Black and Asian populations may appear in less commonly examined locations such as the palms, soles, nails, genital areas, and oral mucosa.  Yoo expanded on the issue of delayed diagnosis, describing melanoma disparities in skin of color as one of the largest racial gaps seen in cancer outcomes. She noted that many patients with darker skin are diagnosed at later stages, often because both patients and clinicians underestimate skin cancer risk. Yoo stressed the importance of comprehensive skin examinations, including careful assessment of acral areas and nail pigmentation, particularly because acral lentiginous melanoma may not always present with classic pigmentation. She also pointed to continuing educational gaps among non-dermatology providers, who may incorrectly reassure patients that nail streaking or pigmented lesions are benign.  The panel also discussed how sunscreen adherence is heavily influenced by cosmetic acceptability. Yoo described how older sunscreen formulations often left noticeable white or gray residue on darker skin tones, discouraging regular use. She highlighted newer tinted mineral sunscreens containing iron oxides as an important advancement, particularly because they also provide protection against visible light, a known contributor to hyperpigmentation disorders. Yoo additionally discussed ongoing advocacy efforts to expand access to newer-generation UV filters already available internationally.  Beyond sunscreen itself, Lim emphasized that photoprotection should be viewed as a “total package” that includes shade-seeking, wide-brim hats, sunglasses, and photoprotective clothing. He also discussed emerging research into biologic photoprotection, including antioxidants and oral agents that may help suppress UV-induced skin damage.  Downie focused heavily on the importance of culturally relevant public health messaging, arguing that campaigns should better reflect diverse patient populations. She encouraged the use of skin of color models and more inclusive educational materials to improve awareness and help patients recognize that skin cancer can affect all skin tones.  Throughout the discussion, Vasquez underscored the importance of representation, clinician education, and patient-centered messaging in closing persistent gaps in skin cancer prevention and awareness for patients with skin of color.

 podcast focused on “the sunscreen gap” in skin cancer prevention among patients with skin of color, with experts emphasizing the persistent misconceptions, delayed diagnoses, and systemic barriers contributing to poorer outcomes despite lower overall incidence rates of skin cancer in darker-skinned populations.

Hosted by Rebecca Vasquez, MD, associate professor of dermatology at UT Southwestern Medical Center, the discussion featured Jeanine Downie, MD, founder of image Dermatology PC in Montclair, New Jersey; Henry Lim, MD, former chair of dermatology at Henry Ford Health; and Jane Yoo, MD, assistant clinical professor at the Icahn School of Medicine at Mount Sinai.

The conversation opened with Lim defining the “sunscreen gap” as both a technological and educational problem. On the formulation side, Lim highlighted limitations in currently available ultraviolet filters in the United States, particularly for long-wave UVA protection, which plays a significant role in pigmentation disorders and photoaging among patients with darker skin tones. Equally important, he said, is the widespread misconception that patients with skin of color do not require sunscreen or sun protection because of their natural melanin.

Downie strongly challenged that belief, emphasizing that “anybody with skin needs to wear sunscreen.” She explained that even darker skin tones provide only limited intrinsic SPF protection and pointed to disparities in melanoma survival rates among Black patients compared with White patients. According to Downie, these misconceptions contribute to delayed diagnoses and worse outcomes, particularly because skin cancers in Black and Asian populations may appear in less commonly examined locations such as the palms, soles, nails, genital areas, and oral mucosa.

Yoo expanded on the issue of delayed diagnosis, describing melanoma disparities in skin of color as one of the largest racial gaps seen in cancer outcomes. She noted that many patients with darker skin are diagnosed at later stages, often because both patients and clinicians underestimate skin cancer risk. Yoo stressed the importance of comprehensive skin examinations, including careful assessment of acral areas and nail pigmentation, particularly because acral lentiginous melanoma may not always present with classic pigmentation. She also pointed to continuing educational gaps among non-dermatology providers, who may incorrectly reassure patients that nail streaking or pigmented lesions are benign.

The panel also discussed how sunscreen adherence is heavily influenced by cosmetic acceptability. Yoo described how older sunscreen formulations often left noticeable white or gray residue on darker skin tones, discouraging regular use. She highlighted newer tinted mineral sunscreens containing iron oxides as an important advancement, particularly because they also provide protection against visible light, a known contributor to hyperpigmentation disorders. Yoo additionally discussed ongoing advocacy efforts to expand access to newer-generation UV filters already available internationally.

Beyond sunscreen itself, Lim emphasized that photoprotection should be viewed as a “total package” that includes shade-seeking, wide-brim hats, sunglasses, and photoprotective clothing. He also discussed emerging research into biologic photoprotection, including antioxidants and oral agents that may help suppress UV-induced skin damage.

Downie focused heavily on the importance of culturally relevant public health messaging, arguing that campaigns should better reflect diverse patient populations. She encouraged the use of skin of color models and more inclusive educational materials to improve awareness and help patients recognize that skin cancer can affect all skin tones.

Throughout the discussion, Vasquez underscored the importance of representation, clinician education, and patient-centered messaging in closing persistent gaps in skin cancer prevention and awareness for patients with skin of color.

Editor’s note: This episode was summarized with the help of AI tools.

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This episode highlights the importance of closing persistent gaps in skin cancer prevention and awareness for patients with skin of color.

Jeanine Downie, MD

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