Nicole A. Negbenebor, MD: Uplifting Women Clinicians

Today is International Women's Day.

Nicole Negbenebor, MD, is the current director of the Skin of Color Clinic at the University of Iowa and is also a Mohs surgeon and cutaneous oncologist. Negbenebor recently spoke with Dermatology Times to discuss her interests and passions in dermatology, her journey in the medical field, and advice for young girls and women aspiring to enter the medical or dermatology spaces.

"I think one thing that as time passes by I'm realizing, is how much of a gift it is to be in dermatology and see so many patients that we could positively affect their lives," she said. "I just want every woman in dermatology to know that her presence can make the community better."

Transcript

Nicole A. Negbenebor, MD: I'm Nicole Negebenbor, and I originally grew up in North Carolina, where I really got interested in research. There's a lot there that can have to do with disparities, so I had a research background there. Then, I went to Yale for undergrad. I majored in neuroscience, and I wasn't sure exactly what I wanted to do; I thought I was going to go into law and do patent law, but I really loved the research aspects.

I ended up becoming pre-med with neuroscience, and then I took 2 years off, and I did a research clinical trial, particularly in patients who had sickle cell disease at the National Institute of Health. I also looked at some patients with lupus and learned more about the disparities as it relates to clinical research, funding, all kinds of things. Then after that, I went to Brown for medical school, and I was in Rhode Island at Brown for 8 years as because I did my intern year there and dermatology residency. Then I ended up coming to Iowa for my Mohs and cutaneous oncology fellowship, and I have now been here for about 2 years--coming up on 2 years. I am the current director of the Skin of Color Clinic, and I also am a Mohs surgeon and cutaneous oncologist.

Dermatology Times: What are some of your research interests and passions in the dermatology field?

Negbenebor: One of the primary interests that I have is understanding some of the barriers to access for patients, particularly in dermatology. Because of my background in skin cancer: How do these barriers lead to higher morbidity and mortality for patients? Because I think, in general, we tend to not think of skin cancer as being something that leads to high morbidity and mortality. But honestly, in Iowa, I'm seeing it: a rising incidence of melanoma--patients constantly having perineural invasion of tumor. We had 2 patients the other day who had basal cell skin cancer invading their skull and their brain. What's leading to some of these outcomes, and how do we intercept them? That's something I'm interested in. That's one of my research projects.

The second I'm also interested in is hidradenitis suppurativa (HS), which is a another condition that I think is gaining more knowledge and more attention, particularly on a wider scale, and I think a lot of these patients have battled silently for a long time. Unfortunately, there's not a lot of great treatments. So from a scientific standpoint, trying to figure out a better, more tailored treatment for these patients, and also trying to mitigate some of the quality of life issues that they have to struggle with, and even acceptance, I think, from the health care system is something that I'm interested in. A lot of these patients, because of how severe their disease is, and there's no treatments, then sometimes they're fired from their jobs, or they have to miss too many days at work, and then it puts them on disability, and then they're not able to make it to their dermatology appointment during the day, or transportation issues, or even pay the copay, depending on their insurance, then getting insurance, sometimes to cover their medications, or having to do the ladder, where they fail a medication first, even though we know it's not going to work well, then there's further delays. There's a lot of complicated issues, I think, when it comes to treatment. I started and HS clinic here at the University of Iowa, and then now we are on the HS Foundation website, as well.

A third thing that I'm interested in is truly understanding, and it's kind of a little bit similar to the first one, but understanding: How do we understand more about why diseases present differently in patients of color. From an advocacy standpoint, we've done a lot of volunteer events around Iowa. One of the things that I co-started when I was in residency was the skin of color event series. We host an online series, usually about every other month, where we discuss different dermatology diseases, and we try to actually connect and host events to communities so that they can log on. We've had hundreds of people internationally, people who are able to understand about eczema, mycosis fungoides, ingrown hairs, and how this specifically affects people of color, especially if they're not able to get to a dermatologist. We've had patients or participants who've come up to us and said, "I didn't even know that dermatology treated hair conditions," or "I didn't know that spot that I had that's been changing is concerning." It's really about empowerment for different communities that may not have access to dermatology.

Dermatology Times: What inspired you to pursue a career in dermatology and skin health?

Back when I was doing research at the National Institute of Health, it was just so interesting, because sickle cell disease, I think, similar to a lot of diseases in dermatology, is kind of understudied. We have these interesting treatments, but we don't know why, and then they have a lot of side effects. One of the things was that somebody was studying the microbiome of the skin ulcers for sickle cell disease. I had never really thought of the skin as this window into what's going on under your skin. The more research I heard about it, the more I was interested in that. I wasn't completely betrothed to dermatology, and so when I was in medical school, and I did a rotation, I couldn't believe how excited people were about dermatology. The fact that people were talking about basic science, they were talking about clinic, they were talking about kids, adults, you can do pathology, you can do surgery, and there's a huge advocacy part of dermatology where access is just so limited. I thought to myself: If you can have this much joy seeing patients, and also be a part of the charge that's increasing access for these people, especially because everybody has skin.

There's not one person alive who doesn't have skin, and so everybody, I think, needs a dermatologist. I just really wasn't seeing even on my rotation a lot of people of diverse backgrounds who were coming to dermatology. Then yet, when you read about the research similar to sickle cell disease, there's high morbidity. Then unfortunately, even though patients with skin of color are less likely to get skin cancer, they're more likely to die from it, so there's a huge need for more dermatologists and more dermatologists who are trained in recognizing skin disease in different skin cones. I just love the diversity and breadth of the field.

Dermatology Times: What does it mean to you to be a woman in dermatology?

Negbenebor: One of the fields I looked at before dermatology was urology, and neurology and neurosurgery. These tend to be more male-dominated, and I think more and more women are going into dermatology. Over time, there have been more women coming into leadership positions, which I think is fantastic. But still, as a woman physician in dermatology, you have the unique opportunity to try to go for more leadership positions in a field that has a lot of women who can support each other. There's still a lot of firsts that are being made, even in 2024, talking about [American Academy of Dermatology] AAD elections, and [American Society for Dermatologic Surgery] ASDS. I think as a woman, it's a unique opportunity and privilege that we can really show what leadership in medicine looks like.

Dermatology Times: What advice would you give to young women and girls aspiring to pursue a career in medicine?

Negbenebor: The first thing that comes to my mind is: Don't give up, because dermatology is one of the most competitive fields, and as a young woman or man, you'll probably be told that it's so hard to get into, you're not probably not going get in the first time, you don't have enough research, you don't have enough this, you don't have enough that. Once you figure out the steps that you need and you find a good mentor who will believe in you and help you achieve those steps, then you can do anything. Even if you don't get in the first time, I know people who applied 3 times, and they finally got in. I do think this is a field that is worth it to try to get into, because there's just such a huge impact that you can do for people.

Even if you have other interests, dermatology, in some ways, we are kind of primary care. In a lot of ways, I'm constantly working with ENTs, surgeons, [doctors specializing in] autoimmune diseases, pathology. There's a great way to bring some of your other interests into dermatology, but I would just never give up if this is truly something that you want to do.

I think one thing that as time passes by I'm realizing, is how much of a gift it is to be in dermatology and see so many patients that we could positively affect their lives. I just want every woman in dermatology to know that her presence can make the community better.

[Transcript has been edited for clarity.]