Why is the 'Sunscreen Gap' Significant in Dermatology?

A recent segment of the Skin of Color Savvy podcast highlighted persistent disparities in skin cancer prevention, awareness, and diagnosis among patients with skin of color, with experts emphasizing the need for improved education, more inclusive public health messaging, and broader understanding of how skin cancers present in darker skin tones.

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

The conversation centered on what Lim described as the “sunscreen gap,” which he framed as both a technological and educational challenge. Lim explained that current sunscreen formulations in the United States still lack optimal filters for long-wave UVA radiation, which contributes not only to skin cancer and photoaging but also pigmentation disorders that disproportionately affect patients with darker skin tones. At the same time, Lim emphasized that misconceptions surrounding natural melanin protection remain widespread, leading many patients with skin of color to underestimate their need for sunscreen and other forms of photoprotection.

Downie reinforced that message, stressing that “anybody with skin needs to wear sunscreen,” regardless of ethnicity or skin tone. She explained that even deeply pigmented skin provides only limited intrinsic SPF protection and argued that patients frequently misunderstand how vulnerable they remain to skin cancer. Downie cited disparities in melanoma outcomes among Black patients, noting that although incidence rates are lower, mortality rates remain substantially worse. She attributed part of that disparity to delayed diagnoses and reduced awareness, particularly because melanomas in Black and Asian patients often appear in less expected areas such as the palms, soles, nail beds, genital areas, and oral mucosa.

Yoo described delayed diagnosis as one of the most urgent issues facing dermatology care for patients with skin of color. She highlighted the dramatic gap in 5-year melanoma survival rates between Black and White patients and pointed to several overlapping contributors, including limited patient awareness, inadequate clinician education, reduced access to dermatologic care, and the atypical presentation of acral melanomas. Yoo emphasized that many melanomas in patients with skin of color develop on acral sites that patients and even some clinicians may overlook during examinations.

The experts also stressed the importance of clinician vigilance. Yoo urged providers to perform comprehensive skin examinations that include the palms, soles, nail folds, and spaces between fingers and toes. She additionally warned clinicians not to dismiss changing nail pigmentation or longitudinal melanonychia without further evaluation, particularly in Black and Asian patients. Referencing the death of Bob Marley from acral lentiginous melanoma decades ago, Yoo argued that many of the same diagnostic gaps still persist today despite growing awareness efforts.

Throughout the discussion, the panel underscored that while skin cancer risks may differ across skin tones, the need for sunscreen use, education, and regular dermatologic evaluation applies universally.

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