The underrepresentation of darker skin tones highlights the lack of patient diversity in the surgical and cosmetic chapters. Our findings were similar to those who previously evaluated general dermatology textbooks and SOC representation.2,4 As skin cancer is more prevalent in people with lighter skin tones, and the bulk of dermatologic surgery is aimed at the treatment of skin cancer; the natural tendency is to overrepresent lighter tones in the depiction of those procedures.5 However, dermatologists need to be able to treat surgical skin conditions regardless of the patient’s skin color, so it is imperative to have a broad range of skin types published in educational literature utilized by students, trainees, and physicians. A lack of skin tones IV-VI in education may perpetuate gaps in proficiency, maintain disparities, and create implicit biases.3
Dermatologic training should expose physicians to a spectrum of skin tones to enhance comfort and proficiency in diagnosing and surgically treating skin conditions equally in all patients. The field of dermatology has a responsibility to eliminate these discrepancies by using photographs and anatomical schematics in our textbooks and atlases that incorporate patients with SOC.
Dermatologic training should expose physicians to a spectrum of skin tones to enhance comfort and proficiency in diagnosing and surgically treating skin conditions equally in all patients. The field of dermatology has a responsibility to eliminate these discrepancies by using photographs and anatomical schematics in our textbooks and atlases that incorporate patients with SOC.
DISCLOSURES
The authors have no conflicts of interest to declare.
REFERENCES
1. Ebede T, Papier A. Disparities in dermatology educational resources. J Am Acad Dermatol. 2006;55(4):687-690. doi:10.1016/j.jaad.2005.10.068.
2. Adelekun A, Onyekaba G, Lipoff JB. Skin color in dermatology textbooks: an updated evaluation and analysis. J Am Acad Dermatol. 2021;84(1):194-6.
3. Julius Few MD, Callender BV, Boyd EC. Myths and knowledge gaps in the aesthetic treatment of patients with skin of color. J Drugs Dermatol. 2019;18(7):616-22.
4. Lester JC, Taylor SC, Chren MM. Under-representation of skin of colour in dermatology images: not just an educa-tional issue. Br J Dermatol. 2019;180(6):1521-2.
5. Louie P, Wilkes R. Representations of race and skin tone in medical textbook imagery. Soc Sci Med. 2018;202:38-42.
2. Adelekun A, Onyekaba G, Lipoff JB. Skin color in dermatology textbooks: an updated evaluation and analysis. J Am Acad Dermatol. 2021;84(1):194-6.
3. Julius Few MD, Callender BV, Boyd EC. Myths and knowledge gaps in the aesthetic treatment of patients with skin of color. J Drugs Dermatol. 2019;18(7):616-22.
4. Lester JC, Taylor SC, Chren MM. Under-representation of skin of colour in dermatology images: not just an educa-tional issue. Br J Dermatol. 2019;180(6):1521-2.
5. Louie P, Wilkes R. Representations of race and skin tone in medical textbook imagery. Soc Sci Med. 2018;202:38-42.
AUTHOR CORRESPONDENCE
Ata S. Moshiri MD MPH amoshiri@uw.edu
