LIKE MANY AMERICANS, Adam Degi didn’t often think about skin cancer.
In 2019, at age 35, the Michigan-based comedian was in good health and good humor and had never been a “fun-in-the-sun” type. But he did notice a mole on his back that had been there since childhood was changing size and shape, losing its symmetry.
“Because it was on my back, it was out of sight and out of mind,” Degi says. “And because I had it since I was a child, I thought it was no big deal.”
Degi was wrong. At the behest of his wife, Degi went to a dermatologist. He was diagnosed with stage III melanoma–a deadly form of skin cancer that had spread to his lymph nodes. He underwent several surgeries to remove the mole and lymph nodes under both armpits, as well as an exhausting immunotherapy regimen.
Today, he’s in remission, the father of a one-year-old, and has even worked his experiences into his comedy act. But he’s got a straight-faced suggestion for everyone who will listen.
“See a dermatologist,” Degi says. “And definitely protect yourself from UV [ultraviolet] rays.”
After decades of work by the medical community to try to lower skin cancer rates in the United States, those rates remain stubbornly high, says Megan Trager, who is completing her dermatology residency at Columbia University Irving Medical Center. Trager says the rates are still increasing in all three kinds of skin cancer: basal cell carcinoma, squamous cell carcinoma and melanoma.
Melanoma is now the fifth-most common cancer diagnosed in the U.S., and takes the lives of about 8,000 people a year, according to the National Cancer Institute (NCI). Trager says exposure to ultraviolet radiation from the sun and tanning beds is primarily to blame, causing about 90% of nonmelanoma skin cancers and 70% of melanomas.
Despite knowing the primary cause and ways to address it, skin cancer remains a tough disease to address for reasons frustrating to doctors.
The Role of Sunscreen
Theoretically, the science behind sunscreen is solid. Its ingredients help shield the skin from UV rays, which can damage DNA and lead to the development of skin cancer even decades after exposure.
But, studies haven’t shown conclusively that sunscreen use reduces skin cancer, researchers say. The Physician Data Query, the National Cancer Institute’s comprehensive cancer information database, notes that “it is not known” whether sunscreen use lowers the risk of skin cancers but still recommends it as a tool to protect from UV rays.
Bruce Brod, a practicing dermatologist at Penn Medicine with offices in Philadelphia and Radnor, Pennsylvania, says the discrepancy is likely due to several complicating factors. People may not be applying enough sunscreen or reapplying it often enough. They might also get a false sense of security, staying out in the sun too long, a risky behavior especially if sunscreen is inadequately applied.
“Sunscreen is important, it blocks UV exposure, and we know UV exposure causes damage to the skin,” Brod says. “But there’s a lot of variability depending on how the person applies the sunscreen.”
Other challenges are cultural and may take a long time to resolve, Trager adds. In the 20th century, tan complexions became embedded in cultural ideas of health and beauty. And because most skin cancers result from sunburns suffered in youth, rates among older Americans will likely remain high even if behaviors have changed more recently.
Turning the Tide
Health experts are working to educate the public on a set of best practices to prevent skin cancer such as limiting overall exposure and wearing protective clothing in the sun, moving beyond the idea that sunscreen alone should be used as a defense.
Sunscreen is just one component of protecting your skin from cancer-causing ultraviolet rays.
Use sunscreen correctly. Sunscreen remains an important tool in fending off ultraviolet (UV) rays. Megan Trager, a dermatology resident at the Columbia University Irving Medical Center, recommends at least SPF 30, and prefers mineral-based products such as zinc oxide or titanium oxide over chemical varieties. Apply about a shot glass’s worth at a time, and reapply every few hours, she says.
Take additional measures. University of Pennsylvania dermatologist Bruce Brod stresses patients should wear protective clothing such as long-sleeved shirts, pants, and wide-brimmed hats. Clothing with SPF-rated protection is great, but any well-woven garment that visibly blocks light can also be effective in blocking out UV rays, he says. People should also limit overall sun exposure and avoid sunlight at its strongest, generally between the hours of 10 a.m. and 2 p.m.
Screen for disease. While some European nations recommend annual skin cancer screenings, U.S.-based guidelines do not. Still, Brod notes it’s a good idea to have a dermatologist visually check the skin, especially for those who are older, have spent a lot of time outdoors, have a prior personal or family history of skin cancer, had previous radiation treatment or have a compromised immune system.
Remain vigilant. Check your own skin. Be on the lookout for new, odd moles or existing ones that change shape and color. Basal cell carcinoma can present as a shiny bump, while squamous cell carcinoma can present as a dry, rough red patch on the skin.
They’re also seeking to dispel other misconceptions, including that people with Black skin or dark complexions don’t have to worry about skin cancer. Although it’s true they’re at lower risk for sunburns and therefore UV-induced skin cancers, they can still develop melanoma, particularly on their palms, soles of their feet, and nail beds. And if they aren’t on the lookout, Brod notes, that deadliest form of skin cancer may spread.
But there’s also proof that old school education can work. When Australia ran a public health campaign to lower skin cancer rates, the country saw the prevention of more than 43,000 skin cancer cases and medical savings of nearly $100 million between 1988 and 2011. Trager says similar programs are now underway in the U.S. with young children.
These efforts could take decades to bear fruit, Trager says, but she discourages despair even among those with a history of UV exposure.
“I tell people, it’s still beneficial to protect your skin now moving forward, to prevent additional skin cancers from developing,” Trager says.
Cancer Today magazine is free to cancer patients, survivors and caregivers who live in the U.S. Subscribe here to receive four issues per year.