May is Skin Cancer Awareness Month, but for dermatologists, conversations about skin health extend far beyond sunscreen and annual skin checks. The field is rapidly evolving — from AI-assisted workflows and non-invasive skin cancer diagnostics to growing concerns about undertreatment, antibiotic overuse, and persistent disparities affecting Black patients.
In a conversation with BlackDoctor Pro, Adam Friedman, MD, FAAD, Professor and Chair of Dermatology at George Washington University, discussed the realities providers face in practice, the persistent gaps in care, and how dermatology is changing in real time.
When asked where providers may be over- or under-treating patients, Dr. Friedman immediately pointed to skin cancer surveillance.
“I think that it is a fine balance when it comes to skin cancer surveillance and doing it in a way that makes a difference in terms of saving lives,” he said.
He explained that while routine screenings can be beneficial, there is still limited evidence supporting universal annual skin checks for all patients.
“The United States Preventive Services Task Force says that there’s not enough evidence to support yearly skin checks for everybody,” he said. “It doesn’t mean there isn’t evidence to say you shouldn’t. We just don’t have the evidence.”
At the same time, he acknowledged that increased screenings may unintentionally lead to more biopsies.
“The more they come in, the more likely they’re probably going to get a biopsy,” he said. “Having [the patient] in front of you could possibly influence the decision to biopsy something you’re on the fence about.”
Rather than framing this as overtreatment, Dr. Friedman described it as a need for more intentional and personalized care.
While some areas may lean toward over-intervention, Dr. Friedman believes undertreatment remains widespread — particularly with advanced therapies for inflammatory skin diseases.
“There are many disease states where we have great options, yet there are many patients not getting the treatment that is appropriate for their severity,” he said. “Atopic dermatitis is a condition that affects 30 million Americans — two-thirds of them are moderate-to-severe — and only a handful are on an advanced therapeutic.”
The reasons are layered. Administrative burdens, insurance barriers, provider assumptions, and patient hesitancy all contribute to delayed or inadequate treatment.
In some cases, implicit bias may also influence prescribing decisions.
Dr. Friedman recalled participating in educational programs in which providers reviewed clinical scenarios involving patients who clearly met criteria for biologic therapies but were instead prescribed older medications due to assumptions about affordability or access.
“I’d like to believe a large piece of this is the administrative burdens of getting these medications for patients,” he said.
He added that patients with Medicaid or Medicare often face additional barriers to accessing newer therapies compared with those with commercial insurance plans.
One major shift in Dr. Friedman’s own clinical approach came from reframing how he discusses treatment risks with patients.
Because of social media, online misinformation, and platforms like TikTok and ChatGPT, many patient conversations now begin with concerns about medication side effects.
But Dr. Friedman said he often responds with a different question:
“What about the side effects of us doing nothing?”
He explained that uncontrolled chronic inflammation can contribute to a range of comorbidities, including arthritis, diabetes, hypertension, stroke, migraines, and even cancer.
Beyond the physical effects, untreated skin disease can also significantly affect quality of life, sleep, mental health, work productivity, and social functioning.
“Chronic inflammation is bad for everything,” he said. “If you have inflammation running wild throughout your body, that will cause harm to all organ systems.”
Dr. Friedman emphasized that biologic therapies are often more targeted — and in many cases safer — than medications patients may perceive as more familiar, like long-term prednisone.
Dr. Friedman acknowledged that patient behavior has changed dramatically in the digital age.
“It’s evolved from bringing the printouts from Google to having it on their phone [with] ChatGPT analyzing what we’re saying,” he said.
Still, he does not view patient research as inherently negative. Rather, he sees it as patients being actively invested in their care, creating an opportunity for discussion and education.
However, the sheer volume of unverified health information online can complicate provider-patient relationships and fuel mistrust.
He also noted that the rise of health influencers reflects broader systemic issues — particularly limited access to dermatologists and culturally competent care.
One of the most striking parts of the discussion centered on disparities in dermatologic training and diagnosis for Black patients.
Dr. Friedman emphasized that while many Black patients may prefer seeing providers who look like them, racial concordance alone does not guarantee expertise in treating darker skin tones.
“A Black doctor may not necessarily be well-trained to treat Black skin,” he said. However, he added that it’s equally unacceptable for a provider to say they don’t know how to treat darker skin.
Historically, dermatology textbooks and atlases overwhelmingly featured lighter skin, leaving generations of providers with limited exposure to how diseases present across different skin tones.
That educational gap has real consequences.
Dr. Friedman referenced research showing that Black patients with psoriasis are significantly more likely to undergo biopsies before receiving a diagnosis because providers may not recognize the disease visually on darker skin.
To address this issue, he helped develop a dermatology atlas, The Full Spectrum of Dermatology: A Diverse and Inclusive Dermatology Atlas, which displays skin conditions across a full spectrum of skin tones side by side.
“Skin of color dermatology is not a separate specialty,” he said. “It’s all dermatology.”
Looking ahead, Dr. Friedman believes dermatology is entering one of its most innovative periods yet.
In recent years, the field has seen an explosion of new therapies for conditions like hidradenitis suppurativa (HS), chronic hives, atopic dermatitis, and advanced skin cancers.
“We’re seeing new molecules, mechanisms of action, and ways of delivering therapies,” he said.
Artificial intelligence is also beginning to reshape clinical workflows.
At George Washington University, Dr. Friedman said AI-assisted documentation tools are already helping reduce time spent on charting by automatically generating clinical notes from patient visits.
“AI won’t replace US,” he said. “They’ll replace the person who’s still messing around with their VCR. It’s about taking the initiative and learning how to integrate it into your practice.”
At the same time, skin cancer diagnostics are becoming increasingly less invasive.
Emerging technologies such as confocal microscopy, tape-stripping gene analysis, and nano-biopsy techniques aim to help providers assess lesions with greater precision while reducing unnecessary biopsies — particularly in cosmetically sensitive areas like the face and chest.
As dermatology continues evolving, he believes providers must remain open to innovation while also confronting the longstanding disparities that still shape patient outcomes.
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