Do black people need to wear sunscreen? Do they need to be worried about skin cancer? These are both majorly important questions that seem to have created some confusion as of late – but we’re here to help clear everything up, along with California-based dermatologist, Dr. Jenna Lester.
Dr. Jenna Lester is an African-American dermatologist who works at the University of California, San Francisco. Lester is so passionate about educating people – especially people of color – about how to care for their skin and protect it from skin cancer and other harmful effects of the sun, that she created a “dermatology home” for patients of color where they feel seen and heard. She launched the “skin of color” clinic at UCSF, which is a place where they can get specialized dermatological treatment.
We spoke with Lester about the clinic, as well as what people of color should know when it comes to wearing sunscreen and protecting their skin.
Let’s talk about your “skin of color” clinic at UCSF. Why did you create it?
Among medical specialties, dermatology is the second least diverse specialty, and the percentage of dermatologists of color is in the low single digits. This certainly doesn’t reflect the population of patients we’re seeing and the diversity of our country. And in my own experience as a resident when I was training, patients of color would always be very shocked when I walked through the door and would almost always say, “I’ve always been looking for a dermatologist with the same skin tone as me…I finally feel like someone understands my skin and my concerns.”
Because of this, and because UCSF is a pioneer in addressing disparities in inequities in healthcare, my department chair and I decided that this would be a good initiative for us to pursue. While it started out as a clinic, it’s actually evolved into a facility that encompasses research and education.
That’s amazing. Let’s get into some of the misconceptions around darker skin tones and skin cancer – can you talk us through those?
A lot of what you do as a doctor is educate, and I think a lot of patients of color don’t see themselves as “at risk” when it comes to skin cancer, and just to be clear, the risks can vary for different people. Most dermatologists use the Fitzpatrick Scale, which grades skin from 1 to 6. It really started out as a functional scale, which means it assesses someone’s likelihood of getting a sunburn, but over the years, it’s been used interchangeably as a way to characterize someone’s skin color.
I like to use celebrities as references to explain the differences between the different numbers. So Emma Stone would be a skin type 1 because she has red hair and very light eyes and probably always burns and never tans. Skin type 2 would be Gwyneth Paltrow and skin type three would be Sandra Bullock. Skin type 4 would be Jennifer Lopez, 5 would be Gabrielle Union and 6 would be Lupita Nyong’o. But at the end of the day, you can’t really grade someone without asking them how easily they burn and how easily they tan.
And while, for example, skin type 4 is much more likely to get skin cancer than skin type 6, I think it’s important to teach everyone what the signs of skin cancer are, because no one is completely safe. I want to make it clear that skin of color encompasses a wide variety of skin tones and just as you would individualize everything for every patient, you have to individualize your sunscreen recommendations and your skin cancer awareness counseling for each person differently.
“I think the most important thing is educating people on the signs of skin cancer so that if something looks off, they know to get it checked. You really never know the person who is going to end up getting skin cancer.”
Dr. Jenna Lester
So how often would you recommend patients of color to get a skin check and visit a dermatologist?
I don’t think it’s unreasonable for everyone to get a baseline skin check and then your dermatologist can determine how often you’ll have to come. But I think the most important thing is educating people on the signs of skin cancer so that if something looks off, they know to get it checked. You really never know the person who is going to end up getting skin cancer.
Can you provide some clarification on why those with dark skin tones who get skin cancer are more likely to die from it?
African American patients are much less likely to get a cancer, like a melanoma, but when they do get it, they are more likely to die from it than a white patient is, and I think a lot of that has to do with the fact that they come to the doctor much later, and because there’s more education with white patients instead of black ones. Most of my patients with lighter skin tones have been worried their whole life about burning and have been educated about skin cancer and what to look for. But most of my patients with darker skin aren’t as aware or as conscious because they weren’t taught to think about it in the same way, if at all.
So, here comes the next big question: Should people of color wear sunscreen every day?
There are lots of reasons why someone would wear sunscreen, but if we’re talking about prevention of skin cancer in African Americans, I think more research needs to be done to determine exactly what is causing skin cancer in patients with darker skin, and whether or not the sun is triggering that development.
That being said, I think that patients with darker skin still have concerns with discoloration or hyperpigmentation, and while some skin cancers or pre-cancers are the way that sun damage manifests itself in someone with lighter skin, uneven skin tone is one of the ways sun damage manifests itself in patients with darker skin. Also, patients with darker skin, like everyone else, have issues with acne and hyperpigmentation as a result of acne. Sunscreen is one of the things I recommend to address all of this.
Melasma is something I also see very frequently in patients with darker skin, and evidence suggests that sunscreen with UV blockers but also with visible light blockers, like iron oxide, are essential in preventing worsening of melasma.
“It’s yet to be seen whether sunscreen is as essential in preventing cancers that are traditionally caused by sunlight for darker skin tones, but that doesn’t mean that it’s not an important part of someone’s overall regimen to improve or maintain their skin health.”
Dr. Jenna Lester
That’s great to know. What do you think the big takeaways are here?
I think it’s important for everyone to get a baseline skin check and to teach everyone what the signs of skin cancer are because no one is completely protected, which is why I have created the “skin of color” clinic at UCSF as an outlet for people of color. And it’s yet to be seen whether sunscreen is as essential in preventing cancers that are traditionally caused by sunlight for darker skin tones, but that doesn’t mean that it’s not an important part of someone’s overall regimen to improve or maintain their skin health.
Editor’s note: A sunscreen that is super popular with darker skin tones is our Unseen Sunscreen SPF 40. It’s a clean chemical formula that offers broad spectrum sun protection. The best thing about Unseen is that it goes on completely clear on every single skin tone, from the deepest to the lightest. It’s a wonderful primer for makeup that won’t leave a white cast or any flashback.
+Have more questions about darker skin tones and sunscreen? Leave them below!
