Editor’s Note: Dr. Steven Q. Wang, one of the world’s leading experts on skin cancer prevention, diagnosis and treatment, is a dermatologist, a Mohs surgeon and the director of Dermatologic Oncology at the Hoag Family Cancer Institute. The following is an excerpt from his book “Beating Melanoma – The Ultimate Patient Guide Resource,” which was published by the Johns Hopkins University Press last summer. He has authored four other books, published over 90 scientific and medical articles and lectured around the world on skin cancer. A year ago, a Business Journal article highlighted how he won a Hoag Innovator Award to install a state-of-the-art 3D imaging system machine, the Vectra WB360, which scans a human body and turns it into an avatar to track moles.
Nothing strikes more fear in a skin cancer patient than the word “melanoma,” which is always unrelenting and can be deadly. This concern is particularly pertinent in Southern California, where the population is frequently exposed to substantial amounts of sun while enjoying beaches and various outdoor activities.
The incidence of melanoma has risen dramatically over the past 50 years; more and more people are developing melanoma. It is estimated that, in 2023, nearly 186,680 cases of melanoma were diagnosed in the United States and that about 7,990 people in this country died from it.
As a dermatologist and skin cancer specialist who worked at Memorial Sloan Kettering Cancer Center and is now at Hoag Memorial Hospital Presbyterian, I have spent over 17 years of my career focused only on the prevention, diagnosis and treatment of melanoma and other types of skin cancer.
The first edition of this book was published in 2011, and in the 13 years since then, three significant changes have taken place.
The most noteworthy change is the emergence of immunotherapies and targeted therapies, which have revolutionized the treatment of advanced melanomas. These novel medications are nothing short of miracles, as they have substantially increased the survival rate of patients with metastatic melanoma from a few months to several years. Moreover, a considerable number of patients with advanced melanoma have been cured completely, which was not possible with any treatments available at the time the first edition was published.
Secondly, I have accumulated a wealth of knowledge and insights from treating thousands of patients with melanoma and non-melanoma skin cancers. This clinical and research experience has afforded me a deeper understanding of the challenges faced by my patients, an unwavering conviction that we can beat this disease and a sense of humility over just how much we still do not know.
Third, in preparing the second edition, I conducted interviews with 25 world-renowned experts in dermatology, surgical oncology, medical oncology, radiation oncology, genetics, dermatopathology and nonprofits. These interviews are available online at beating melanoma.com
Sunscreen Shortcomings
All sunscreen products are rated using a number such as SPF 30 or SPF 55. Unfortunately, the actual degree of SPF protection provided is much less than that stated on the product label. For example, a sunscreen with SPF 30 may provide only SPF 10 in a real-life setting. How can this be? The reason is the SPF value of a sunscreen product is measured in a laboratory using human subjects. In the tests, a concentration of 2 milligrams of sunscreen per square centimeter of skin is applied to each person’s back. The test is then performed, and a SPF score is assigned to the product.
Studies have shown that in real life, most people use only one-quarter to one-half the amount of sunscreen that they should be using.
Although many brands claim that their products offer a broad spectrum of both UVB and UVA protection, the degree of UVA protection varies from one product to another.
Unfortunately, compared with sunscreens sold abroad, sunscreens in the United States may provide lower UVA protection. U.S. sunscreen manufacturers do not have all the UV filters (e.g., chemicals capable of absorbing UV rays) that are available to manufacturers elsewhere. You may be receiving good protection from UVB radiation and only limited protection from UVA rays. A sunscreen with a high SPF may prevent you from getting sunburned and thus give you a false sense of security, encouraging you to stay out in the sun longer. The result is that you may unknowingly receive a disproportionally large amount of UVA rays. Both UVB and UVA rays can cause skin cancer.
There is a part of the body that needs UV protection yet is often ignored – the scalp. Individuals with thinning hair or no hair are especially vulnerable. In fact, 10% to 15% of all skin cancers are found on the head. Despite those alarming statistics, most people do not apply sunscreen to the scalp because most sunscreens are heavy and ruin their hairstyles. In my spare time, I invented a sunscreen, ZenonLife, that also doubles as a gel.
Truths about Tanning Beds
You should not use indoor tanning beds, period. They are bad for your health. Most of their so-called health benefits are false promises. For instance, it doesn’t provide a base against sunburn – a tan generated by artificial tanning provides a paltry SPF of 2 to 3.
The industry also promotes the notion that tanning increases vitamin D synthesis. The truth is that the light sources in a tanning booth mainly emit UVA light while UVB rays are needed for vitamin D synthesis. Hence, tanning beds are not effective for producing vitamin D.
Tanning also accelerates the aging process.
More importantly, current science tells us that a tan is the body’s response to biological damage on a cellular level. Artificial tanning is associated with the development of melanoma and other skin cancers.
The Odds
In general, people with blond or red hair, a fair complexion and/or numerous freckles have a higher lifetime risk of developing melanoma than individuals with darker skin, hair and eyes.
Studies have shown that men tend to have a higher risk of developing skin cancer than women do. It may be attributed to the fact that men often do not protect themselves from UV exposure.
Traditionally, men work outdoors more commonly than women and therefore have more cumulative sun exposure. In addition, some men do not like to use sunscreen.
People over 60 years old appear to have a higher risk.
Surprise, Denial Frustration
When first diagnosed, my patients react with a range of emotions, from surprise, denial, frustration and confusion to fear and even despair. This is not the time to panic, however. Denial is not an option. You need to take action and take action fast.
Certainly, your physician will urge you to undergo treatment as soon as possible — and urgency is necessary — but some of my patients say that they feel themselves losing control as soon as the process starts. There is no doubt that you will go through an intense period from the time of diagnosis to the time you complete treatment. I call this phase the “mad rush.” Many patients find this to be a highly stressful time. They must quickly learn about the disease, find experts near their home and decide on treatment options.
I wrote this book to help those seeking answers.
