ONS Skin of Color Photo Database to Enhance Toxicity Recognition

The Oncology Nursing Society (ONS) is developing a skin of color toxicity photo repository with funding from a grant from La Roche-Posay to support oncology nurses in recognizing and treating cutaneous cancers and dermatologic toxicities of cancer treatments.

As highlighted in a news release from La Roche-Posay, about 80% of patients with cancer will experience dermatologic toxicity, but less than 5% of medical educational materials feature non-White skin tones, despite more than 40% of the US population identifying as persons of color.

Further, the images that do capture the experiences of persons of color are not broadly applicable to oncology, explained Erica Fischer-Cartlidge, DNP, RN, AOCNS, EBP-C, chief clinical officer of ONS, in an interview with Oncology Nursing News.

“Only 4.5% of medical imaging is [of] individuals of color,” said Fischer-Cartlidge. “When you look at that subset, they typically are [for] sexually transmitted infections, as opposed to other types of care…. Even within that small percentage, even less are meaningfully relevant to the oncology population.”

The database will compile photos provided directly from oncology practices by clinicians with patient consent. The University of Miami’s Sylvester Comprehensive Cancer Center in Florida was chosen as the first location for data collection.

Jessica MacIntyre, DNP, MBA, APRN, AOCNP, executive director of clinical operations at Sylvester and president of ONS, shared in an interview with Oncology Nursing News that consent forms are available in Creole and Spanish as well as English to ensure that populations whose primary language is not English are able to make informed decisions.

“We don’t want them to think we’re using their photos for purposes other than education, so we made sure that when we’re talking to patients, it’s truly about that,” said MacIntyre. “One of the nurse managers at our radiation oncology clinic told us it’s very impressive to see how patients are very eager to be a part of the photo repository because they want to be part of improving care for other patients of their skin types.”

The goal of the repository is to collect photos across skin types of a set list of diagnoses, grouped by cancers of the skin, treatment-related toxicities, and associated diagnoses — dermatologic issues that are not directly related to cancer but are seen in higher rates in patients with cancer — Fischer-Cartlidge said. Developers of the repository will use the Fitzpatrick skin phototype scale to ensure dermatologic experiences are documented for each skin type.

“The ultimate goal is [to have] each of those wish-list items across each tone on the Fitzpatrick scale,” said Fischer-Cartlidge. “We are seeking out other clinical collaborators that have patient populations that represent different [skin types] on the Fitzpatrick scale.”

Multidisciplinary Collaboration in Action

At Sylvester, the oncology team is working with dermatology to enhance the quality of data collection, MacIntyre shared.

“Many of our patients go to dermatology, especially for our immune-related toxicities,” she said. “It was very important for us to get them engaged and say, ‘Hey, if you’re looking at these [patients], can you help us build our repository?’”

MacIntyre advised that other organizations involved in data collection should employ a similar model, where possible. Further, she emphasized that the repository will be a resource for dermatology practices that don’t see the volume of patients with cancer as those in institutions with cancer centers.

“[The repository] would help, for example, dermatology centers in areas of the United States that are rural, that don’t see a lot of these, and that don’t have a lot of experience with cancer treatment toxicities of the skin.”

From Personal Experience to Meaningful Change

Toxicities may present differently in patients depending on their race or skin tone. For instance, patients with darker skin are more prone to itching rather than tingling or numbness with neuropathy, as well as skin darkening rather than reddening with hand-foot syndrome, shared Fischer-Cartlidge. However, these differences are not always included in medical education.

“No one taught me that. I didn’t learn that in nursing school,” she said. “I didn’t learn it in any type of formal education, but I knew it from seeing these patients over and over.”

As a mother of a child of mixed race, Fischer-Cartlidge’s dedication to the project is both professional and personal. When her son developed a rash where a bandage had been, it took a misdiagnosis, weeks of evaluation, and the rash spreading from his upper back to his knees for the issue to be correctly diagnosed as a contagious infection rather than an allergic reaction to the bandage.

While her son’s diagnosis was not life-threatening, the experience further highlighted the need for better educational resources to understand dermatologic profiles across skin tones in her own patient population.

“I see these differences in my clinical practice, and I just had this experience. What about the patients with cancer who have life-threatening toxicities?” said Fischer-Cartlidge.

A Historical Approach to Data Collection

Even at the data collection level, the team working on the repository draws on a multidisciplinary approach. According to Fischer-Cartlidge, the repository uses a system for data collection typically used for virtual museums, which was recommended by the ONS Connie Henke Yarbro Oncology Nursing History Center.

“They had some really wonderful experiences with metadata, search strategies, and image preservation,” she said. “We leveraged that incredible expertise to develop the platform for the repository so that we had really high-end search capabilities for individuals.”

Once oncology clinical specialists validate the information shared with ONS, the data will be employed in the system. Once a variety of skin colors is represented for each dermatologic condition, the repository will be available to anyone as a resource.

Fischer-Cartlidge shared that there are plans to preview the repository at La Roche-Posay’s table at ONS Congress in May. For those interested in sharing their experiences with ONS, Fischer-Cartlidge urges patients to reach out to their care team so that ONS can verify the patient’s diagnosis.

Reference

La Roche-Posay and the Oncology Nursing Society (ONS) announce landmark partnership to close the representation gap in cancer care for diverse skin tones. News release. La Roche-Posay. February 4, 2026. Accessed February 27, 2026. https://www.prnewswire.com/news-releases/la-roche-posay-and-the-oncology-nursing-society-ons-announce-landmark-partnership-to-close-the-representation-gap-in-cancer-care-for-diverse-skin-tones-302678633.html