Beyond the SkinTok: The Black Skin Gap in TikTok’s Skin Cancer Education

To the Editor,

Skin cancer remains a major public health concern, with incidence rates continuing to rise annually in North America. ¹ Although skin cancer incidence is significantly higher in non-Hispanic Whites, it is associated with disproportionately higher morbidity and mortality rates in Black people. ² The 5-year survival rate for Black patients diagnosed with melanoma is below 60%, whereas White patients have a survival rate exceeding 80%. ² This disparity may be partly attributed to lower awareness of melanoma risk among Black individuals, as well as a lack of familiarity with Black skin presentations among healthcare providers, leading to delayed detection and diagnosis. ² For decades, Black skin has been underrepresented in dermatology educational materials. ² In the current digital world, social media has become a major source for health information, with TikTok being the fastest-growing platform. ³

We conducted a cross-sectional analysis of TikTok content to assess the representation of Black individuals in skin cancer educational videos. The keywords “skin cancer,” “melanoma,” “basal cell carcinoma,” and “squamous cell cancer” were searched up to February 4, 2025. The search was done using a public computer and an incognito browser to minimize algorithmic personalization and reduce potential biases from prior search history or user-specific recommendations. The top 200 videos per keyword based on TikTok’s algorithmic metrics were retrieved, with no date restrictions or additional filters applied. After removing duplicates and irrelevant videos, 208 videos were analyzed. Videos were considered inclusive of Black skin education if they either visually featured Black skin or used inclusive terms (eg, “black,” “skin of color,” “all skin tones,” “dark-skinned, melanin-rich”) in the spoken content or caption.

The educational quality of included videos was assessed using the Global Quality Scale, the medical accuracy score (MAS), and The Patient Education Materials Assessment Tool.^4,5 The MAS, developed specifically for this study and inspired by the JAMA Benchmark Criteria and the DISCERN instrument, evaluates key content domains, including cancer identification, risk factors, symptoms, treatment, and prevention. Independent t-tests and chi-square tests compared numerical and categorical data, respectively (Supplemental Table 1).

Only ~10% (20/208) of videos included Black skin in their educational content. However, these videos had higher educational quality and MAS compared to non-inclusive videos (Supplemental Table 1). Among videos inclusive of Black skin, 92.3% were created by dermatologists, while 7.7% came from medical organizations and 0% from influencers (Supplemental Figure 1). In comparison, among non-inclusive videos, 62.6% were created by dermatologists, while 21% were created by influencers (Supplemental Figure 2).

Notably, 85% of the black skin-inclusive videos were from recent years (2023-2024), suggesting a positive trend to improve representation. Increased efforts from dermatologists, institutions, and influencers are needed to promote inclusive health communication and improve skin cancer awareness in Black communities.