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Skin Cancer

Dean E. Sidelinger, MD, MSEd
About the Author: 
<p>Dr. Sidelinger, pediatrician and SDCMS and CMA member since 2008, is the deputy public health officer for the County of San Diego Health and Human Services Agency. Dr. Sidelinger is also the vice president for the American Academy of Pediatrics, California Chapter 3.</p>
Published date: 
June 1, 2009
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Oftentimes when people refer to the “sun tax” in San Diego, they are referencing the fact that people are willing to receive a lower salary here and pay more for certain goods because of the beautiful weather. After all, according to the San Diego Convention and Visitors Bureau, there is sunshine here 58–75 percent of the time each month. As physicians, however, the real sun tax we should be discussing is the risk of skin cancer.

Skin cancer is the most common form of cancer in the United States. In 2008, there were over 62,000 new cases of melanoma diagnosed and more than 8,400 deaths due to melanoma. In addition, there were more than 1 million non-melanoma cases diagnosed that year resulting in fewer than 1,000 deaths.

In San Diego County, there were 1,547 cases of skin cancer (excluding basal and squamous cell cancers) diagnosed in 2006. That same year, 125 deaths occurred due to skin cancer. The death rate was 4.43 per 100,000 in San Diego County compared to a California rate of 3.43 per 100,000. In looking at just melanoma, the deadliest form of cancer, there were 1,453 cases diagnosed in San Diego County in 2006 and 97 deaths. The death rate in the county was 3.41, compared to 2.63 statewide. The Healthy People 2010 goal is to reduce the rate of melanoma cancer deaths to 2.3 per 100,000 people.

How can we help reduce the incidence and death rates from skin cancer? We need to counsel our patients to practice sun safety and work to screen for and assess skin lesions early.

Exposure to ultraviolet (UV) light is a risk factor for developing skin cancer. While everyone is at risk of developing skin cancer after exposure to UV light, those at higher risk of developing skin cancer are:

  • Those with exposure during childhood and teen years;
  • Exposure by those who burn easily, have freckles, or a lot of moles;
  • People with a personal or family history of melanoma; and
  • People with atypical moles or a large number of moles.

The following is good advice, taken from the CDC for all of our patients regarding sun safety while outdoors:

  • Seek shade, especially from 10:00 a.m. to 4:00 p.m. when the sun’s UV rays are strongest and can do the most damage;
  • Wear clothing to cover up and protect exposed skin;
  • Wear a hat with a wide brim to help protect the face, head, ears, and neck;
  • Use sunglasses that wrap around and block close to 100 percent of both UVA and UVB rays; and
  • Use sunscreen with a sun protective factor (SPF) of 15 or higher offering protection against UVA and UVB rays.

These recommendations are not mutually exclusive. In fact, using more than one method to cover up increases protection against UV rays and cancer. These tasks should occur on cloudy or hazy days (think June gloom) as well as sunny and bright days (like the local fall). Artificial UV radiation, such as that from tanning beds, should be avoided.

Children need help in protecting themselves from UV radiation. Just a few serious sunburns during childhood raise the risk of skin cancer in adulthood. Remember that children need protection while in school. Modeling healthy sun safety practices not only helps to protect you, but models healthy behavior for children, as well.

Another role as physicians is to educate patients of the importance of early detection of melanoma, and other types of skin cancer, and screen for the disease during visits. Patients should be instructed to check their skin regularly for any signs of the disease, including new moles and existing moles with a change in their outline, shape, size, color, or feel. Thorough skin exams should be done during all health maintenance visits as well as when patients present with concerns regarding skin cancer.

So, even though the sun may not be shining as bright on us in June, continue to practice sun safety. Do these things yourself: encourage your staff to protect themselves from UV radiation while outdoors; counsel all of your patients who spend any time outdoors to practice sun safety everyday. We should all work together to protect ourselves from UV radiation to prevent skin cancer and work to detect skin cancer early to prevent significant morbidity and mortality.

For more information, visit the CDC skin cancer website or the National Cancer Institute website.

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