An otherwise healthy 14 year-old boy of Somali origin presented for evaluation of hypopigmentation on the trunk. He was diagnosed with progressive macular hypomelanosis upon further workup for this concern. Unrelated to his chief complaint, a physical examination revealed multiple circular scarred plaques evenly distributed on his chest, abdomen, back, and forehead (Figures 1 and 2). These had been present since infancy, were asymptomatic, and not concerning to the patient. Further history revealed the patient underwent a Somali cultural practice called fire-burning when he was 6 months of age for therapeutic purposes. Fire-burning is a medicinal practice used by traditional healers. The technique involves heating a stick from a particular tree and applying it to the skin to cure an illness. This method is believed to cure conditions such as hepatitis, malnutrition, and pneumonia.1 Different cultures use traditional practices for religious, medicinal, or cosmetic purposes. These include coining, spooning, cupping, moxibustion, and the use of henna, among others. Some of these practices have become popular in Western countries. Cupping is one such practice adopted by professional athletes to help with muscle aches. Temporary erythema, ecchymosis, purpura, or allergic contact dermatitis may result from some of these practices.2 Burns with resultant scarring may also be observed, as in the case of fire-burning. Without the appropriate knowledge and understanding of these practices, some of these findings may be misdiagnosed as self-induced injury or abuse. Such allegations could be traumatizing to the patient and family, as well as detrimental to the patient-physician relationship. Millions of people leave their home countries every year. Some are immigrants searching for better jobs or new academic opportunities, and others are refugees or asylum seekers forced out from their countries because of war and persecution. The United States is one of the leading destinations for immigrants in the world. The top ten largest US immigrant groups in 2018 were from Mexico, China, India, the Philippines, El Salvador, Vietnam, Cuba, the Dominican Republic, Guatemala, and Korea. In 2019, the top five US states by the number of immigrants were California, Texas, Florida, New York, and New Jersey.3 As evident by the numbers and distribution of immigrants in different states, it is essential for providers to be familiar with the immigrant subpopulations of patients in their areas of practice. Providers should educate themselves about common cultural practices in these populations that would sometimes pose a diagnostic challenge without proper history or cultural context. The call for diversity and inclusion in medicine in a globalized society is fundamental. Immigrant populations are an essential group of under-represented minorities who often experience multiple barriers to adequate healthcare. Achieving cultural awareness is a crucial step for providers so they can better address and minimize health inequities.4, 5 Understanding the regional cultural makeup of populations and common practices in those populations that may affect healthcare facilitates culturally appropriate medical care. The authors would like to acknowledge Dr Asma Mobin-Uddin for the expert consultation on cultural competency and awareness.