The Skin Cancer Paradox

Recent statistics from the American Cancer Society revealed a paradox about skin cancer: While the number of skin cancer cases—specifically for melanoma—is anticipated to increase by 14 percent this year, the number of deaths is decreasing by 4 percent.1,2 How can it be that while new cases are on the rise, so is the number of survivors? We asked skin cancer experts Ivor Caro, M.D. and Josina Reddy, M.D., Ph.D., to help make sense of this puzzling statistic and point to ways that may help reduce skin cancer rates.

Ivor Caro, M.D.
Senior Medical Director
Josina Reddy, M.D., Ph.D.
Senior Group Medical Director

Sun Worshippers

Ivor Caro, M.D., Senior Medical Director, Dermatology/Oncology

We know that about 90 percent of skin cancers are caused by sun damage, so it stands to reason that about 90 percent of skin cancers could be prevented through sun protection:3,4 regularly applying a liberal amount of broad spectrum sunscreen SPF 30 or higher, wearing protective clothing and avoiding indoor tanning beds.5 Yet despite everything we know about prevention, skin cancer incidence rates are still rising. Why?

We don’t have exact answers, but years of research indicate several potential causes. The first reason for increased diagnoses is straightforward and surprisingly positive. In recent years, more people are going to the doctor when they see changes in their skin. On the other side of the spectrum, rising diagnoses can also be attributed to years of unprotected sun exposure catching up to older generations.6 But above all, despite widespread efforts to educate on the importance of prevention, skin cancer rates are rising because the vast majority of Americans fall short in protecting their skin from the sun.6 As a culture, we simply love to soak up the sun.6

But the “healthy glow” that people talk about when they purposefully set out to get a tan isn’t necessarily so healthy. Tanning is the body’s way of trying to protect itself from the harmful rays of the sun—and is itself a sign of skin damage.6 The sun’s rays are a type of radiation, which, with overexposure—especially severe sunburns—can cause skin cells to mutate.6 That sun damage can take a number of forms, from discolorations, spots and wrinkles, to varying types of skin cancers.6

Another popular, but ultimately incorrect opinion, is that only fair-skinned people need to worry about skin cancer. While those with fairer skin are at the highest risk for skin cancer, it can affect anyone.6 As you’ll see in the photos below, just because you can’t see potential sun damage, doesn’t mean it isn’t there. Thus, skin protection is essential to combating the rising rates of skin cancer diagnoses.

As the body's largest organ, the skin plays a critical role in our overall health. But because we see it everyday—the color, the finelines, the freckles, the bumps—it's easy to underestimate its impact on our well-being and, further, its true depth.

In an effort to help put this in perspective and reveal the skin's complexity beyond the surface, we conducted a photo shoot with New York-based photographer Cara Phillips using ultraviolet (UV) photography. Inspired by medical photos, Phillips uses UV photography as an artform, as it can revel skin markings that are invisible in normal light. By showing unseen spots and discolorations, including potential sun damage, these photos help people understand there is more to the skin than meets the eye.

Science Intervenes

Josina Reddy, M.D, Ph.D., Senior Group Medical Director, Oncology

As Ivor mentioned, sun protection is the best way to prevent skin cancer. But for the increasing number of people diagnosed, there are things we can do to help. In general, the most common forms of skin cancer—squamous and basal cell carcinoma—can be treated easily with surgery. This is the result of early detection, which is the first reason skin cancer mortality is dropping. Luckily, most skin cancers are slow growing when they first start forming, so there’s time to notice the change in your skin and have it checked.7,8 If it’s caught in these early stages, a simple surgical or nonsurgical procedure can typically take care of most skin cancers, which also helps with survivorship. But, just because skin cancer can often be easily treated does not mean its potential severity should be ignored. Melanoma, the most deadly form of skin cancer, can be treated if diagnosed early, but if not addressed, can penetrate the multiple layers of skin, invade the body and, in advanced stages, even spread throughout the body, making it both harder to treat and more dangerous.7,8

In instances where surgery alone can’t treat skin cancer, medicines targeting specific gene mutations that cause skin cancers are now available to patients, as well as treatments that stimulate the immune system to recognize skin cancers and mount an attack on them.9 These types of therapies used to treat advanced forms of skin cancer may slow the growth of the cancer or make it shrink.1,6

But we’re not done. Researchers around the world, including here at Genentech, continue to study skin cancer so that we can better understand the disease in all of its forms. The more we understand it, the more research we can do to find ways to treat it. In our labs we’re also working to understand more about skin cancer progression and what happens inside a skin cell when it mutates. Our clinical teams are working on research to improve the prognosis for people if they do get skin cancer. Though there’s never a one-size-fits-all solution, new treatments are good news for people with skin cancer.

For all of the scientific advancements that have happened in recent years, the best way to prevent skin cancer is still proactive sun protection and regular skin checks. And yet we can’t undo the sun damage we’ve already experienced, and it will take time to raise awareness and shift attitudes toward tanning. So in the meantime, effective treatments will continue to be a crucial tool for people facing skin cancer.

  1. Cancer Facts & Figures 2017. American Cancer Society. Accessed May 3, 2017.
  2. Cancer Facts & Figures 2016. American Cancer Society. Accessed May 3, 2017.
  3. Skin Cancer Foundation. Skin Cancer Facts. Accessed May 3. 2017.
  4. Koh HK, Geller AC, Miller DR, Grossbart TA, Lew RA. Prevention and early detection strategies for melanoma and skin cancer: Current status. Arch Dermatol 1996; 132(4):436-442.
  5. Skin Cancer Foundation. Prevention Guidelines. Accessed May 3, 2017.
  6. The Surgeon General’s Call to Action to Prevent Skin Cancer. S. Department of Health and Human Services. Accessed May 3, 2017.
  7. Neville, Julie A., Welch, Erin and Lefell, David J. Management of nonmelanoma skin cancer in 2007. Nature Clinical Practice Oncology. 2007; 8:462-469.
  8. Skin Cancer Foundation. What Is Melanoma? Accessed May 3, 2017.
  9. Skin Cancer Foundation. Treatments for Melanoma. Accessed May 3, 2017.