Joseph E. Kerschner, MD; Olushola L. Akinshemoyin Vaughn, MD
WMJ. 2024;123(2):150-151
For the past 3 years, the Medical College of Wisconsin’s Department of Dermatology has made successful inroads to address a troubling public health disparity noted by the American Academy of Dermatology (AAD) in the first 30 years of its SPOTme Skin Cancer Screening Program (1985-2014): that 90.3% of the patients screened were White. During those 3 decades, this free program served more than 1.9 million individuals nationwide and uncovered greater than 20 000 melanomas.1
Clearly, patients of color have not benefited from this important, far-reaching skin cancer screening initiative.
The AAD’s website on skin cancer notes a number of sobering statistics:2
- Skin cancer is the most common cancer in the US.
- Current estimates are that 1 in 5 Americans will develop skin cancer in their lifetime.
- Skin cancer in patients with darker skin tones is often diagnosed in its later stages – when it is more difficult to treat.
- Research has shown that patients with darker skin tones are less likely than patients with lighter skin tones to survive melanoma.
- Twenty-one percent of melanoma cases in African American patients are diagnosed when the cancer has spread to nearby lymph nodes, while 16% are diagnosed when the cancer has spread to distant lymph nodes and other organs.
- The vast majority of skin cancer deaths are from melanoma.
According to the University of Texas’s MD Anderson Cancer Center, skin cancer in people of color tends to show up in places that are less exposed to the sun, such as the inside of the mouth, palms, groin area, and under the nails. Between 30% and 40% of cases appear on the soles of feet.3
Another challenge in treating skin cancer in people of color is that they are less represented in clinical trials that are identifying new treatment.
Olushola Akinshemoyin Vaughn, MD, assistant professor of dermatology at the Medical College of Wisconsin (MCW), understands the importance of raising awareness of skin conditions, especially via skin cancer screenings for people of color – as well as the value of community partnerships to further this goal.
To that end, on Saturday, February 17, 2024, faculty screeners, residents, and other health care providers from the MCW Department of Dermatology and the Froedtert & the Medical College of Wisconsin health network, as well as MCW medical students, successfully participated in the third annual Skin, Hair, and Nails Educational Event in collaboration with Gee’s Clippers, located at 2200 N Dr Martin Luther King Jr Drive in Milwaukee (known as the “Barber to the Bucks”), to prioritize educating patients of color about dermatology and to demonstrate MCW’s ongoing commitment to the Milwaukee community.
The screening form removed questions such as “How many blistering sunburns did you have prior to age 20?” Rather, it focused on conditions such as atopic dermatitis, dyspigmentation, alopecia, and melanoma – which are more likely to resonate in communities of color. The MCW care team handed out flyers in both English and Spanish and included a representative on site from MCW’s Saturday Clinic for the Uninsured4 so that patients without insurance could schedule follow-up visits.
More than 30 people – both adults and kids – were screened at the February event, which uncovered skin diseases across the spectrum of severity. In the past 3 years of the event, approximately 150 individuals have been screened, and several skin cancers, assorted infections, irreversible hair loss, and more have been detected.
The Gee’s Clippers events give people in the Milwaukee community a chance to see that doctors are not the enemy. “We are showing up for the community because we care so much about our community members, in the hope that they will start to have more trust in the medical system and engage with the medical system more,” Dr. Vaughn said.
Gaulien Smith, owner of Gee’s Clippers, says that these annual events are a perfect fit for his barbershop, which has long focused on being a community hub and serves a majority Black clientele. His barbers work with hair and skin all day long, and the events are a chance for even them to learn more about what signs to look out for and how to encourage people to seek medical help.5
While there is still much work that needs to be done to re-engage patients of color and to rebuild trust in our academic institutions,6 in dermatology and in all specialties we can signal our good intent through allyship and a willingness to meet patients where they are so that they can feel comfortable.
Gee’s barbershop itself is located in a beautifully renovated bank building, complete with the original steel vault door and a full basketball court. A remodeled room in the back houses Gee’s MKE Wellness Clinic – a health clinic collaboration with Network Health and Froedtert & the Medical College of Wisconsin (https://www.geesclippers.com/gees-medical-clinic). This weekly clinic offers free clinical services, such as blood pressure screening, blood glucose monitoring, and general health education. Additionally, the clinic provides health coaching in drug education, weight management, nutrition, exercise, tobacco cessation, sleep and stress, and connects clients to wellness resources.
We are very grateful to Dr Vaughn and her team for their inspiring piloting work to educate patients of color about dermatology and to demonstrate MCW’s ongoing commitment to the Milwaukee community – and for their creative partnership with Gee’s Clippers to sponsor this valuable annual skin cancer screening event. Ultimately, the goal is for MCW to model this new paradigm for screening events that will be emulated nationwide and adopted through the American Academy of Dermatology.
REFERENCES
- Okhovat JP, Beaulieu D, Tsao H, et al. The first 30 years of the American Academy of Dermatology skin cancer screening program: 1985-2014. J Am Acad Dermatol. 2018;79(5):884-891.e3.
- Skin Cancer. American Academy of Dermatology. Updated April 22, 2022. Accessed March 21, 2024. https://www.aad.org/media/stats-skin-cancer
- Underferth D. Skin color and skin cancer: 3 things to know. MD Anderson Cancer Center. June 23, 2021. Accessed March 21, 2024. https://www.mdanderson.org/cancerwise/skin-color-and-skin-cancer–do-dark-skinned-people-need-sunscreen.h00-159461634.html
- Saturday Clinic for the Uninsured. Medical College of Wisconsin. Accessed March 21, 2024. https://www.mcw.edu/departments/family-and-community-medicine/center-for-healthy-communities-and-research/saturday-clinic-for-the-uninsured
- Shastri D. Gee’s Clippers hosting second free skin cancer screening to raise awareness in people of color. Milwaukee Journal Sentinel. February 2, 2023. Accessed March 21, 2024. https://www.jsonline.com/story/news/health/2023/02/02/gees-clippers-to-host-free-skin-hair-and-nail-screening-saturday/69863797007/
- Bajaj SS, Stanford FC. Beyond Tuskegee — vaccine distrust and everyday racism. N Engl J Med. 2021;384(5):e12. doi:10.1056/NEJMpv2035827