An incident in a high-end Auckland skin clinic represents a much bigger problem in dermatology, reports Alex Casey. 

An Auckland man is speaking out after a procedure at a high-end skin specialist left him with lasting marks on his face, in the hopes that the wider skin industry will become more inclusive of people with darker skin. Sam Chagani, a 42-year-old real estate advertiser, now has two long-lasting marks on his face after being recommended – and receiving – cryotherapy at The Skin Institute in Ponsonby, despite the treatment being regarded as a risk for darker skin tones. 

Chagani decided to visit Skin Institute in October after becoming concerned about two small patches of sunburn on his face. Having lived in Aotearoa for two years, he was well aware of our high skin cancer rates, and wanted his skin to be assessed at “the nicest private institution we could find”. During his appointment, the specialist told him there was a chance the patches could become skin cancer and recommended cryotherapy, a treatment where liquid nitrogen is used to freeze skin lesions, for $90. 

Having had the cryotherapy treatment explained as being “like frostbite”, Chagani said he was careful to mention that his skin is quick to scar. “I said that my skin scars very easily – cold hives and even mosquito and sandfly bites will sometimes leave a scar that will remain for months.” The dermatologist assured him it would be fine, he recalled. “It didn’t occur to me to question this when there’s a chance this is skin cancer, and this is a professional doctor who fixes things.” 

Following the treatment, Chagani was left with two prominent dark marks, one under each eye. They have yet to heal, despite the Skin Institute website stating a recovery time of approximately five days. “A month and a half later and I’ve still got these big spots on my face which are not showing signs of fading.” The Skin Institute arranged a follow-up after receiving a complaint from Chagani, where he was told the scars may remain for six months to a year and that he would not receive a refund.  

While the two scars might appear minor to some, Chagani said they have had a “horrible” impact on his life. Last month he had a work associate ask him if he had “joined a gang” during a sales meeting on Zoom. “People see a brown man and they see a little scar under his eye, so I now must be in a gang?” he said. “The baggage I carry as a brown person is very different. I do not know that any of their white employees would ever understand the impact of this.” 

Skin Institute was unable to discuss the details of this specific case due to confidentiality, but did say they have been in contact with Chagani in an attempt to resolve the issue. “As part of our strict complaints process, we work closely with external agencies and regulators, providing them access to all documentation to enable them to independently investigate the care a particular patient has received and to then act on any recommendations which may result from their investigation,” chief medical officer Dr Rajan Patel said in a statement. 

“The team at Skin Institute remain committed to providing appropriate skin screening, diagnosis and treatments for all skin types.”

The Spinoff outlined Chagani’s experience to skin cancer specialist Dr Sharad Paul, who has written multiple books about dark skin. “I would personally avoid cryotherapy in darker skin on the face due to the very risk you mentioned,” he said, adding that “ethnic or dark skin is not something we do well in New Zealand.” Paul also explained that many of the medications needed to treat vitiligo and other pigmentary skin disorders that are more noticeable on dark-skinned patients are either not funded here, or not available at all. 

Paul, who has recently returned from a lecture tour in the United States, noted that dermatology remains one of the least diverse medical specialties in the Western world. A 2021 study from the United States found that only 3% of dermatologists were Black, even though 12.8% of Americans are Black and 4.2% of dermatologists were Hispanic, despite 16.3% of Americans being Hispanic. There is no comparative data locally, but a cursory scroll of several major dermatology practices reveals an overwhelmingly white workforce. 

Representation isn’t just important in the clinics themselves, but in the educational literature. British physician Neil Singh wrote about the need to decolonise dermatology in 2020, reflecting on the fact that he can only remember seeing dark skin in a textbook on three occasions during his entire medical training. Last year, a study from the United States analysed imagery in dermatology textbooks and found that only 11.5% of examples showed dark skin. During the pandemic, literature showing the cutaneous symptoms of Covid-19 revealed the same pattern. 

Chagani said that his experience at Ponsonby’s Skin Institute has given him a deeper insight into the work that still needs to be done to meet the needs of Aotearoa’s diverse population. “My concern is for people who don’t have a voice, I’m talking about brown people who are immigrants and English is their second or third language and just wouldn’t know what to say in this situation,” he said. While he continues to check on the marks in the mirror, he hopes that dermatologists in Aotearoa will also take a hard look at themselves. 

 “This was a professional place that should treat people with dignity and with care and be very aware of their specific skin needs,” he said. “Regardless of their melanin.”