Skin Cancer Epidemic

By: Dr. M. Christine Lee

Skin cancer rates in the United States are increasing at epidemic levels and will only worsen with time especially as the baby boomers are aging and developing skin cancers at alarming rates.  Taking the statistics we currently have and extrapolating into the future given the large cohort of aging baby boomers, the United States will not have enough dermatologists or doctors to keep up with what’s projected to be the worst skin cancer epidemic in history.  It is estimated that skin cancer incidence has more than doubled in just the last decade.

Currently, one in 55 people will be diagnosed with melanoma, the deadliest form of skin cancer, during their lifetime. This is particularly important for children because one blistering sunburn in childhood more than doubles a person’s chances of developing melanoma later in life.  Use of sunscreen has not decreased the incidence of skin cancer, in fact, it is only increasing despite the use of sunscreen.  Studies have shown than 99% of the public does not even use sunscreen properly–which is to apply ¼ inch thick,  use a shotglass (2 oz) amount with each application, and to reapply every 2 hours.  Also, sunscreen was not intended to allow people to stay out in the sun longer.  It was supposed to help prevent sunburns but unfortunately most people who would have made themselves go indoors after developing a sunburn are now staying outdoors longer because they don’t burn, and are actually exposing their skin to even more sun damage by staying out in the sun longer.

Skin cancer is already the most common form of cancer in the U.S.  1 in 5 Americans will develop skin cancer over the course of a lifetime.  80% of the sun damage that eventually leads to the development of a skin cancer later in life occurred before the age of 18.  Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.

At a recent dermatology conference, we were speaking about the skin cancer epidemic and discussing case studies of patients who have thousands of skin cancers by the time they’ve reached their 80’s.  One doctor gave an example of an 80+ year old who had more than 6,000 skin cancers.  I have had several of these patients in my practice.  I got to know one lovely 90 year old lady extremely well because she practically lived in my office during her latter years.  She was literally covered with skin cancers:  countless basal cell and squamous cell carcinomas.  There was not a single part of her skin not affected with a skin cancer or a precancer.  She had seemingly millions of lesions covering her face, scalp, body, and extremities.  She literally had more skin cancers than we could remove.  She came in on a regular basis to have the worst and most aggressive skin cancers removed so that they would not affect her vision, hearing, or cause functional damage.  She was also constantly receiving liquid nitrogen treatments and topical therapy (such as Aldara) for her diffuse actinic keratoses (precancers) that covered her entire body.

I have had numerous other patients who had hundreds to thousands of skin cancers covering their bodies and developed them faster than they could be removed.  It became a major management issue and they eventually died of other causes related to aging.  It just made me sad to see that they were having to spend so much of the latter years of their life in my office getting their skin cancers removed.  Dermatologists across the country are all seeing more patients who fit this profile.  And it is especially alarming that we are just starting to see the first wave of baby boomers who are presenting with high numbers of skin cancers well before they even approach the years when we see the largest numbers of skin cancers.

Why is this happening?  Well, we are all living longer and the longer we live, the more time we spent out in the sun.  Baby boomers make up the largest part of our population and they are now well into their 60’s.  Not only are baby boomers living longer but they are spending more of their life out in the sun.  So it turns out that the longer we live, the more time we spend out in the sun, the more skin cancers we get.  So if we don’t die of something else first, we will get a lot of skin cancers.

As Americans live longer, they will more likely develop skin cancers at some point in their lives, it’s just a matter of time.  In the old days, people would die of infection or disease or other causes before they got old enough to develop skin cancers.  As the population ages, we start to see an increasing number of people with large numbers of skin cancers develop through out the course of their lives because they are just living longer.  If someone gets their first skin cancer by age 40, they will have many more skin cancers by age 80—it’s not a matter of if but when.  The younger someone is when they get their first skin cancer, the more skin cancers they will have throughout their lifetime.  And almost everyone who lives long enough will have a much greater chance of getting a skin cancer before they die.

What can you do?  Establish a relationship with a dermatologist and learn how to protect yourself from the sun and perform regular skin exams.  Wear a broad rimmed hat, sunglasses, SFP protective clothing, sunscreen to exposed skin whenever outside.  Reapply sunscreen every 2 hours.  Perform a self skin exam monthly looking for new suspicious lesions or changes in pre-existing lesions.  If you notice something suspicious, call your dermatologist for an appointment.  If you are at higher risk for skin cancer (ie: fair skin, family history of skin cancer, lots of moles, previous history of skin cancer), have a full body skin exam with your dermatologist every 6 months.  If you don’t have any risk factors, you can probably be seen once a year.  Start your children on the right path by teaching them about proper sun avoidance and protection from an early age.

Dr. Lee is Board-certified as a Diplomate of the American Board of Dermatology. She is a guest blogger for The California Skin and Melanoma Center in Pleasant Hill, CA and she practices at The East Bay Laser& Skin Care Center, Inc. in Walnut Creek, California. She has completed her fellowship in Mohs Micrographic Surgery/Skin Cancer/Facial Plastic Reconstruction, Laser Surgery, Cosmetic Surgery, and Advanced Dermatologic Surgery.