Clinical decision‐making bias in darker skin types: a prospective survey study identifying diagnostic bias in decision to biopsy

Krueger, Loren; Hijab, Eman; Latkowski, Jo‐Ann; Elbuluk, Nada

doi:10.1111/ijd.16213

Cited by 3 publications

(1 citation statement)

References 5 publications

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“…Our results are congruent with a 2022 study which identified that dermatology residents are more likely to biopsy nonmalignant lesions than malignant lesions of darker skin. 10 While the national push for improved recognition and treatment for cutaneous diseases in darker skin types has improved for the average patient, such efforts may not yet translate into improved health equity nor health outcomes with regard to skin cancer. It thus remains of concern that some lesions may be misdiagnosed or delayed in diagnosis, yielding higher risk for morbidity and mortality.…”

Section: Skinmentioning

confidence: 99%

Understanding the Factors Associated with US Dermatology Resident Trainees' Diagnostic Confidence and Skill for Skin of Color Pathology

2023

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Background: Inequities in dermatologic health outcomes translate to worsened clinical outcomes for minority groups. For example, despite a lower incidence of skin cancer overall, African Americans are diagnosed at later stages with greater degrees of lymph node involvement. This has been shown to lead to disproportionate mortality when compared to lighter skinned individuals. Medical education materials contain a significantly lower percentage of skin of color (SOC) images than of lighter skin and research has indicated lower diagnostic accuracy of dermatologic conditions in darker skin by U.S. medical students. The objective of this study was to explore U.S. resident dermatologists’ ability to accurately identify skin pathology among SOC patients verus lighter skin to potentially identify gaps in training that may contribute to this disproportionate morbidity and mortality. Methods: A cross-sectional electronic REDCap survey open to all U.S. dermatology residents asked participants their basic demographics (e.g., level of training, racial and ethnic identity) and program characteristics (e.g., geographical location, proportion of patients by Fitzpatrick type, presence of a dedicated SOC clinic). This data was correlated with participant visual diagnostic accuracy on a 22-item multiple choice quiz (images selected by a senior academic dermatologist) of characteristic nonmalignant and malignant conditions in lighter skin and SOC. Results: Residents preferentially misdiagnosed malignant lesions in SOC over lighter skin (p <.0001) and preferentially misdiagnosed malignant lesions in SOC over nonmalignant lesions in SOC (p <.001). None of the residents’ basic demographic or program characteristic variables had significant relationships with any assessment of performance. Conclusion: Dermatologists should maintain a high clinical suspicion for malignant conditions in patients with darker skin types, given that these lesions are the most preferentially misdiagnosed and the fact that these lesions carry higher risks for morbidity and mortality. Dermatology residency programs should instill efforts to emphasize correct detection of malignant lesions amongst those with skin of color.

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Section: Skinmentioning

confidence: 99%