Q&A with Four Skin Cancer Experts

Meet the experts

Dr. Jedd Wolchok is a physician-scientist who runs MSK's melanoma research program, with a focus on the use of immunotherapy to treat advanced disease.

Holly E. Thaggard is brand founder and CEO of Supergoop!, a line of sunscreen products.

Dr. Allan Halpern leads MSK's dermatology program. His specialty is the detection and treatment of early-stage skin cancer.

Dr. Dennis Gross is a dermatologist, dermatologic surgeon, and founder of Dr. Dennis Gross Skincare™.

 

What is skin cancer? Why is protecting your skin from the sun so important?

Dr. Wolchok: Skin cancer is the most common cancer diagnosed each year. Basal cell and squamous cell carcinoma are the two most common forms. Melanoma accounts for a small percentage of all skin cancer diagnoses, but it is the most likely to be deadly if it spreads.

Dr. Halpern: The sun—and specifically, ultraviolet rays that come from it—cause both skin aging and cancer. We want to protect our skin from the sun to keep it younger, healthier, and especially to avoid skin cancers.

Ms. Thaggard: That’s right. Skin cancer affects one in five Americans and is more commonly diagnosed in the US than all other cancers combined. And 90 percent of aging also comes from the sun.

 

What is the difference between UVA and UVB rays?

Dr. Halpern: The sun emits both visible and invisible light across a broad spectrum of wavelengths. One part of this spectrum is ultraviolet (UV) light. UVB wavelengths are most commonly associated with sunburn. UVA rays can induce tanning without a burn. It used to be that dermatologists thought UVB were the only rays implicated in skin cancer, but we now know that UVA contributes in a big way as well.

Dr. Gross: The first thing to know is that both UVA and UVB are forms of radiation which, by definition, injures the precious DNA of our skin. That’s how these rays cause skin cancer. UVB are stronger than UVA, and causes the skin to turn red more quickly, but both team up to cause deadly melanoma. From a practical point of view, wearing sunscreens that say “broad spectrum” on the label protects against both types of rays—and is what you should use.

 

Are some people more likely to get a skin cancer than others?

Dr. Halpern: If you have a fair complexion or had a lot of sun exposure, you are at increased risk for all three forms of skin cancer. Melanoma is also associated with additional risk factors—your risk is greater if you or someone in your family had a melanoma, if you have a lot of moles, or if you have many larger irregularly colored moles known as atypical moles, or “dysplastic nevi” on your body.

 

For people at higher risk, is sunscreen enough?

Dr. Halpern: For anyone at high risk, the first line of defense should be clothing and a hat—with sunscreen as a final step for the parts of your skin not easily covered up.

 

How often do early stage melanomas turn into something more serious?

Dr. Halpern: The good news is that when caught early and removed completely, most melanomas can be cured with a simple outpatient surgery. If they are not found in that early stage, melanomas tend to keep growing, can spread throughout the body, and can be fatal.

 

Do you think the big sunscreen push in recent years has helped drive down the rates of skin cancer?

Dr. Halpern: Since the 1980s and ‘90s, when we started pushing sun protection and early detection, dermatologists have seen modest reductions in deaths related to melanoma in some segments of the population, especially younger women. This year, the number of deaths from melanoma is expected to drop by almost 20 percent—thanks to the exciting treatments for advanced disease that Dr. Wolchok and others have developed.

That said, the overall rates of people developing melanoma have continued to go up, and we need to emphasize the importance of sun protection and early detection.

Dr. Wolchok: Exactly. We need to continue constantly reminding the public about the importance of sunscreen and annual visits to the dermatologist.

Dr. Gross: Yes, I believe sunscreen has helped save lives. We know repeated sunburns increase the risk of skin cancer, and that sunscreens protect the skin. The statistics show that deaths from skin cancer are generally improving and when melanomas are detected, they are not as thick or deep as they used to be. Sun safety is important today, more than ever, and it looks like sunscreen is helping.

 

What is the fastest growing age group for melanoma?

Dr. Halpern: The fastest age group for deaths related to melanoma is men over the age of 55, probably because they are less likely to go to the doctor.

Dr. Wolchok: Yes, we still have some work to do there, but it is exciting to see progress among young women. 

 

Dr. Wolchok, your research focuses on advanced melanoma. What are the latest trends in how to treat these more dangerous cancers?

Dr. Wolchok: That’s absolutely right. Years of research conducted at Memorial Sloan Kettering and at other cancer centers has shown that there are ways to manipulate a person’s own immune system so it can seek out and kill cancer cells. We’ve had great success treating advanced melanoma with drugs known as immunotherapy. 

Now, we are working to understand why some people respond initially, but then the treatment stops working because the disease finds a way around the power of the immune system. This is the next frontier of our research.

 

Do I need to wear sunscreen year-round? What about on a cloudy day?

Dr. Halpern: Yes, you should, if your skin is exposed for significant amounts of time. Because of the angle of the sun, we get a lot of UVB rays in the summertime and in locations closest to the Equator. But remember that UVA is present in all seasons at all latitudes, so it’s a good idea to protect your face year-round—especially when participating in winter activities like skiing where you can get quite a bit of exposure due to the high altitude.

Dr. Gross: Essentially, the damage to skin by the sun is “cumulative,” meaning it all adds up. This is true for the way all forms radiation act on the human body, including UVA and UVB from the sun. Even casual exposure on colder or cloudy days leads to the sun’s rays collecting in the skin. Just ten minutes a day of unprotected sun exposure may not seem like much. But that adds up to 60 hours in a year—and that’s excessive.^TM

Ms. Thaggard: Absolutely! The sun’s UVA rays are present all year round and can penetrate through things like clouds and windows. It’s important that we continue to get the word out about the importance of wearing SPF daily—not just when you’re at the beach. SPF is the very best thing that you can do to maintain skin health Every. Single. Day.^TM

 

Do all skin tones need sunscreen or only those with fair complexions?

Dr. Halpern: We are unfortunately not all created equal when it comes to sun damage. Dermatologists think of everyone as having a “skin type” — ranging from someone who doesn’t tan and only burns, to a person with very dark skin who almost never burns, and everything in between. Everyone, however, has an ability to burn even mildly, which is why everyone should wear sunscreen.

Dr. Gross: I’ve treated over 100,000 patients over the course of my career, and have found lots of cases of skin cancer in people who are not fair skinned. As Dr. Halpern already said, a person’s risk increases if melanoma runs in their family, or if he or she has irregular moles. Many of these same people tan readily in the sun, are not fair skinned, and they don’t burn easily. Sunscreen for them is crucial because sun exposure is another risk factor that can put them over the top. Even darker skinned individuals do burn occasionally, and a single sunburn can increase the risk of skin cancer later in life.

Ms. Thaggard: All skin tones need SPF, even those who rarely burn. When it comes to sun protection, most people tend to just think about sunburns, which are only caused by UVB rays. But the truth is, you’re forgetting an entirely different type of damage. UVA rays don’t discriminate. They can penetrate an even deeper layer of your skin, causing things like skin cancer and signs of aging—wrinkles, uneven skin tone, all those little things you don’t love about your skin.

 

What does the SPF number mean and when should you use each one? i.e. SPF 15, SPF 30, SPF 50. How often do you have to reapply it?

Ms. Thaggard: The SPF number indicates the measure of protection you’re getting from the sun’s UVB rays. At Supergoop!, we believe in “broad spectrum SPF”—sunscreen that will help protect your skin from both UVB and UVA rays—and that it should be anywhere from 30 to 50. We don’t believe in SPF higher than 50, because it often gives consumers a false sense of all-day protection. It will also only protect you from less than one percent more of the sun’s UVB rays while exposing your skin to a much higher concentration of active ingredients that can be irritating.

It’s much more protective to apply your SPF generously. I often suggest that you should apply it as generously as you feel you should, and then to repeat immediately. Studies show that people apply about half as much as they ought to. That being said, the general rule of thumb is to reapply sunscreen every two hours, every single day, or more frequently if you’re swimming or sweating.

Dr. Gross: I recommend starting with an SPF 30 or higher to play it safe. If the sunscreen you are using is sufficiently protecting you, then stick with it. However, my motto for patients is, “Pink is the new red”—meaning that getting pink skin after sun exposure means your sunscreen’s SPF isn’t enough for your skin and you need to increase it. Keep in mind that you may only see pink skin in certain areas, like your ears, hairline, or scalp. Go to a higher SPF!

I recommend water-resistant sunscreens. Keep in mind that doesn’t mean it’s waterproof, so use common sense: reapply after prolonged water exposure or perspiration. Letting your skin air dry instead of toweling off will keep some sunscreen on longer. Play it safe, and reapply every two to four hours, or anytime you see signs of pink skin.

 

Ms. Thaggard, what prompted you to start your own line of sun care products?

Ms. Thaggard: A close friend of mine was diagnosed with skin cancer when we were in our early 30s. Another college friend was finishing her residency in dermatology at the time, and she explained to me that daily sun exposure starting at a young age is cumulative and damaging and that it can lead to this type of outcome—but that sunscreen was the #1 antidote.

Through research, I learned the reason why people didn’t wear it was because it didn’t feel good on their skin. So as someone who also loves to create things, I was inspired to help stop this epidemic of skin cancer by creating Supergoop!, a line of clean, feel-good, innovative SPF that everyone would want to wear all day, every day.

 

Dr. Gross, how do you know Dr. Wolchok? Why did you start your line of products?

Dr. Gross: Dr. Wolchok and I first met as medical students doing research in melanoma while at Memorial Sloan Kettering. We were both young and energetic students eager to find a cure. We still collaborate now even though we have a different focus. He has become the brilliant research head of the same lab worked in together all those years ago, and I practice dermatology in New York City, diagnosing and treating skin cancer in patients.

I started Dr. Dennis Gross Skincare™ because wanted to create better skincare products—and I knew that my background as a chemist and dermatologist would help me to make products with the most advanced ingredients and delivery systems.

 

If I wear sunscreen will I be able to get enough vitamin D?

Dr. Halpern: Studies show that people who use sunscreen regularly do have enough Vitamin D. Besides the sun, there are many sources of Vitamin D; it’s also in milk, salmon, and many other foods. Another approach for someone using a lot of sun protection is to take a Vitamin D supplement.

 

What should someone do if they have a suspicious looking mole?

Dr. Halpern: Get to a dermatologist right away if you see a mole that looks different from the others, or is changing color, shape, or size. The bottom line is to pay attention to your body. We recommend looking yourself over carefully, top to bottom, once a month.