Dermatologist Brooke Jackson says that people of color are the most likely to die from melanoma. So why aren't more dark-skinned women wearing sunscreen?

As the summer sun heats up, the pasty pale among us, who have learned our lesson the hard way, scramble to the closest drugstore to stock up on salves of salvation brimming with SPF, the higher the better. Brooke Jackson, MD, wishes all of her patients would put such a priority on protecting their skin. The board-certified dermatologist and dermatological surgeon at Skin Wellness Center of Chicago specializes in lasers and cosmetic surgery procedures for ethnic skin. And yet, she finds that the majority of her darker-skinned patients don’t wear sunscreen. Many of them—and even many doctors—don’t realize just how damaging those rays are, even to the darkest of skin.  

“I have a paper coming out next month about sun protective behaviors and skin of color,” says Jackson. “I did a survey of 100 of my patients of color, and I basically asked them, ‘Do you wear sunscreen?’ ‘How often?’ and all the basics. And unless they had had a personal experience, like a family member or friend with skin cancer, most of those people were completely clueless that it could happen to them. Most of them did not wear sunscreen on a regular basis, and that’s true for most of my patients.”

We asked Jackson for the skinny on skin, and for advice on how to prepare for the summer sun. Here’s what she said.

DivineCaroline: What are the biggest misconceptions about darker skin?
Brooke Jackson: Probably the biggest misconception is that dark skin does not burn. That there is zero risk of skin cancer. And that everything is well tolerated. Quite the opposite is true. I always like to use this analogy: If you put white toast in the toaster and you put wheat toast in the toaster they will both burn. Bob Marley died of melanoma. It can happen.

DC: That lack of awareness sounds dangerous.
BJ: What that turns into is when you see that little bleeding thing or that non-healing thing, it doesn’t even occur to you that it could be skin cancer. So you’re like, oh it’s just a pimple, or I keep thinking it’s my razor. So fast forward, you never seek medical attention. Then you go to the doctor, and the doctor may also believe that that is true, that that doesn’t happen to dark skin. Then you have a delayed diagnosis that turns into poor prognosis. Statistically, the people that are most likely to die from melanoma are people from color.

DC: What are some other problems you commonly encounter with your darker skinned patients?
BJ: If you look at diseases that are statistically more common in people of color, and we’re talking about high blood pressure and diabetes, both of those diseases require medications, and those medications will often be photosensitizing or sun sensitizing. Even though you may not necessarily burn as quickly as your Irish friend, your high blood pressure medication is going to make you that much more sun sensitive. And so that may play a role in it as well.

DC: Your patients come from all backgrounds. What kinds of sun-related problems do you generally see among different skin tone groups?
BJ: When I’m waiting for my staff to put a patient in the room I’ll sort of peek out into the waiting room and see who’s there and just try to guess why they’re here. I just play this game with myself. Usually, my Irish tomatoes are always coming in for skin cancer screening. I look at all your moles and family history. Then, usually when they’re in their late 20s and early 30s, that’s when we start our cosmetic conversation: I need Botox, my wrinkles, etc.

I don’t hear a peep out of my darker skinned patients regarding cosmetic issues until usually they’re almost mid- to late-40s. So it’s about a 20-year difference. What does that mean? That means that, obviously, having darker skin protects you from photo damage. It does not alleviate it. But the flip side of that is the No. 1 complaint of my patients of color is discoloration. “I want even skin.” And my answer is I cannot do that. Even skin does not exist. No one on this earth is uniformly pigmented. So if you look at your left side, your right, your forehead, your nose, your chin, all of them are different colors. And a lot of that happens to do with how the sun hits you and light bounces off. I always tell my darker-skinned patients it is not fair for you to come in here and ask me to make your skin more even, and you are not wearing sunscreen.

DC: What skin advice can you share with all tones, from the lightest to the darkest?
BJ: When you look at the major issues for people, whether it’s premature aging, wrinkles, discoloration, the best thing and cheapest think you could ever do for yourself is wear sunscreen. Skin cancer is multi-factorial, and the reason that we as dermatologists harp so much on sun protection is really it’s the only thing we can control. We can’t control your genetics. We can’t control bad luck. We can’t control all of those other things—your immune status. All we can control is putting on sunscreen, and that’s why we harp on it so much.

The other thing I tell my patients, is just be who you are. So for my light-skinned patients who wish they were darker, or wish they could tan, I turn over the inside of their wrists, and I say this is the color that nature intends you to be. So that is the color you should be. Because if you try and do things that are not intended for you to do, you’re going to burn, and you’re going to be uncomfortable. And every time your skin burns it’s really your body trying to take care of you. Your body’s giving you a message that you can’t handle it. So listen.