The Skin Cancer Epidemic: Why Sun is More Helpful than Fear

“And, talking about radiation, few wonder why, after hundreds of millions of years of having our skins exposed to sun rays, we suddenly need so much protection from them—is it that our exposure is more harmful than before because of changes in the atmosphere, or populations living in an environment mismatching the pigmentation of their skin—or rather, that makers of sun protection products need to make some profits?”

― Nassim Nicholas Taleb, Antifragile: Things that Gain from Disorder

As with many of our medical epidemics—cholesterol, diabetes, osteoporosis, dementia, afib—the skin cancer epidemic has triggered a tsunami of profitable medicalization aimed at addressing the health of a fearful population.  But is our “war against skin cancer” effective, or even necessary?  My co-author Alan Roth and I discuss this in our podcast, and a more comprehensive analysis of skin cancer and the dermatology industry can be found in our book, but it is worth including it in our blog about medical myths, since our war against skin cancer is one of the most expensive and least effective myths that has been waged against patients, embraced not only by the medical community and media, but by far too many Americans.

The cost of skin cancer treatment is hardly trivial, and the profits generated by industry and doctors is a salient driver of the epidemic itself.  Based on CDC numbers, we are spending approximately $10 billion a year treating melanoma skin cancers in the US (the total cost in all other countries combined is less than $1billion) with approximately 8,000 melanoma deaths in the US a year reported out of a population over 300 million.  Just for perspective, smoking and poor eating habits are felt to cause one million Americans to die every year, and yet we invest nothing to slow those down.  More on that in a future blog!

However, the cost is likely far higher than the CDC is willing to acknowledge.  A 2016 study reported that total skin cancer treatment in the US costs $23 Billion annually, almost all of which ($22 billion) was targeted at non-lethal basal cell and minimally-lethal squamous cell cancers, a number likely far higher in 2026. The odds of dying from a basal cell cancer is near zero, while squamous cell cancer are estimated by the American Cancer Society to kill 2000 Americans a year (mostly people severely immunocompromised), or  1/100,000 of all squamous cell cancers detected.  Moh’s surgery alone—in which the over $2000 per procedure price tag is largely paid to the dermatologist surgeon performing the hour-long process—costs the system over $3 billion a year and has not been shown to be superior to cheaper methodologies of skin cancer removal, almost always being performed on nonlethal cancers. Only in the US do we invest so much to cure largely benign cancers that harm so few people.  One can argue that it is worth investing tens of billions of dollars a year, subjecting 99,999 people to interventions that won’t help them, if we prevent one death, but we have no evidence that any deaths are prevented from these procedures.

Those are only the costs of treatment.  Prevention—again never shown to be effective—is also costly.  Prevention comes in three colors: protection from the sun (with typically sunscreen), annual skin exams, and removal of pre-cancers once they are detected by screening. 

Globally, the sunscreen industry has a market of approximately $15 BILLION in 2026 based on 2023 calculations, again with most of the spending occurring in the US.  That industry feasts on skin cancer fear, and profits have skyrocketed since doctors and organizations such as the CDC, American Cancer Society (ACS), and of course the American Academy of Dermatology (ADD) raise the skin cancer alarm.  The media incessantly reminds us to wear sunscreen and get our skin cancer screening, all of which has boosted profits for not only the sunscreen industry but for dermatologists. 

There is also a high cost of skin cancer screening, since most screening is done in the dermatologist’s office and thus carries a high price tag, one that is largely paid by insurance.  There is no documentation of that cost, which is clearly in the billions of dollars, with total dermatology costs estimated to be $63 billion in 2023 and projected to double to $128 billion by 2033, much of which is geared toward the detection of non-lethal basal and squamous cell cancers, millions of which are diagnosed and treated every year.

One arena largely ignored by the media and by studies is the cost of cryotherapy (freezing treatments) performed by dermatologists a year for “pre-cancers” (actinic keratoses), a procedure that prevents no deaths and that can cause harm, especially in the elderly.  The objective of such treatment, according to the ADD, is to prevent cancer when small nodules called actinic keratoses are discovered on screening, a “fact” with absolutely no evidentiary support.  Ten years ago such costs per year in the US were $2 billion, all of which go into the pockets of dermatologists who perform them.  Given the trajectory of costs over time, the likely cost now approximates $5 billion a year.  At the time of the above study, 40 million Americans were subjected to freezing “treatment” for these benign “pre-cancers,” as the ADD labels them, more than half of whom were elderly patients with Medicare.  According to many academic dermatologists, one of whom we cite in our book Return to Healing, this procedure is low-hanging fruit, providing easy money for dermatologists, who justify the procedure through deceptive promises of cure and threats of doom if these tiny bumps are left alone.  This particular academic dermatologist studied a large practice in New England, where the rates of Medicare reimbursement for cryotherapy ranged from $10,000/year from the lowest billing dermatologist, to over $2 million a year for the highest billers, without any change in measurable outcome.

The other downstream costs, which are also not well demarcated, are the high costs of complications of skin cancer removal, the days lost of work from these dermatological procedures, and the anxiety inherent to being told you have cancer and have to undergo invasive treatments.

So, does this approximately $100 billion a year of screening, treatment, cryotherapy, advertisements to screen, and sunscreen sales translate into reduction of death from skin cancer?  The answer, as we document in our book, and which has been echoed by many conscientious academic dermatologists for years: we have not reduced skin cancer death in any verifiable way. Death from melanoma increased slightly from 1970-1990, but has not changed in the past 35 years (the period corresponding with the war against skin cancer), and while early detection of melanoma may improve outcomes (there is no evidence that this has occurred), most screening and treatment effects are aimed at nonlethal cancers. Despite all this spending and the soaring profits and media campaigns pushing people to screen and treat and bathe in sunscreen, despite the warnings and scare tactics, the dermatologic community has not reduced deaths from melanoma or non-melanoma cancers in any documented way.  All they have done is to find and remove more cancers that would never harm you if left alone.  The number of detected and treated cancers has soared, but the death rate remains the same.

It’s important to understand this important fact: we are spending billions of dollars to prevent and remove skin cancer with the result that we are discovering a plethora of nonlethal cancers that we are labeling an epidemic, subjecting tens of thousands of people to procedures for cancers that are harmless if left alone, but the same number of people are dying of such cancers, numbers that when compared to other causes of death and even other cancers are very low.  When reading ads from the skin cancer industry and the ADD/CDC/ACS about the skin cancer epidemic besetting this nation, and the need to aggressively screen/protect/treat, you will not see any mention of a reduction in deaths, only an increase in detection. It is because we are detecting so many non-lethal cancers that they declare their campaign has been successful.  This fearmongering only triggers more detection, more sunscreen, more treatment, more anxiety, and more injury, all without saving any lives, only increasing cost, complications, and profit.

As with most fabricated medical epidemics, including all the numerical epidemics we are highlighting in the blog series, this epidemic is fueled by fear; advertisements, rather than science, have triggered the epidemic’s proliferation.  Why would the CDC and ACC endorse such highly deceptive marketing and costly/injurious interventions?  Why would they partake in a costly and medically feckless campaign to scare the American public into diving into a medical abyss that will not help them? As noted in an earlier blog, both groups are highly tied to industry, which provides much of their funding and leadership.  But the ADD’s contribution to the war against skin cancer is an entirely different matter entirely.

As we explain in our book, all with prolific documentation, dermatologists sat toward the bottom of the medical food chain 40 years ago, a position occupied by primary care now.  They were among the lowest paid doctors and least respected; obtaining a dermatology residency was facile when compared to other specialties.  Now, however, dermatologists are among the highest paid doctors.  Gaining a spot in a dermatology residency program is more difficult than virtually any others.  When various medical organizations rank doctors by a ratio of earnings divided by level of difficulty, dermatology always tops the list, with primary care at the bottom.  How did this happen?  The answer is simple: the ADD stoked fear of a skin cancer epidemic and used that to increase the salaries and prestige of its member doctors.

Multiple articles, again cited in our book, explore how the ADD moved to the top of the medical food chain by exploiting fear of skin cancer.  The organization invested in a successful marketing campaign to frighten Americans about skin cancer, hired lobbyists in Congress who convinced Medicare to increase renumeration for skin cancer diagnosis and treatment, and provided free skin cancer screenings.  All of this led to a dramatic increase in skin cancer diagnosis, generating fear and a need to be proactive in preventing and treating this newly exploding cancer epidemic.  The media—also paid well by ADD ads—trumpeted the need for all Americans to screen/prevent/treat.  In fact, skin cancer numbers likely did not increase at all, only detection of skin cancer, especially as occurred through the free screenings.   But now what had once been an unrecognized and harmless problem on our skin has become an imminent danger.

What’s the danger of this expensive and self-serving war against skin cancer?  The cost alone is worrisome; if the money spent on this epidemic was used for nutrition and wellness, it is very likely the death rate would decrease.  But too, people can be injured from unnecessary procedures.  It is estimated that 20% of older individuals are harmed by skin cancer treatments, a number made all the more alarming by the fact that the majority of such treatments are performed on the elderly who are harmed the most, and that Medicare must pay both for the treatment and for the complications of treatment.  Also, such scare tactics lead to anxiety and deflect people away from something they truly need: sunshine.

The sunscreen industry, as noted, has benefited greatly from the ADD’s campaign, and the two industries work together to maintain the war against cancer.  But is sunscreen effective?  Again, not a single study demonstrates any benefit from its use.  As the SPF of sunscreen increases, less sun hits the skin, and the more our skin is deprived of sunshine.  One could argue, something buttressed by some evidence, that sunburns can increase the risk of melanoma, although no study links sunburns to melanoma deaths.  Sunscreen when used judiciously can prevent burns, which, even if not dangerous, can be painful and lead to skin damage.  But burn prevention is not enough to buttress the billions of dollars of profit that the sunscreen industry derives from people’s copious use of its products.  Due to advice from the ADD/CDC/ACS and many doctors, people use sunscreen anytime they leave the house, not merely to prevent burns, but to deflect all sun. 

A recent metanalyses of observational data (again, observational data must be interpreted cautiously, but no randomized studies have been published) shows that while burns may increase melanoma risk, gradual tanning lowers such risk.  When the skin is exposed to sun slowly it creates more melanin to block dangerous radiation, an effect over time that is protective.  By blocking sun, we are thwarting our skin’s naturally protective response to radiation (tanning), paradoxically increasing skin cancer risk.  But that’s just a small part of the danger induced by prolific use of sunscreen.

The skin is one of our body’s most important organs, and over our evolutionary history it not only protects us from external harm, but transforms sunshine into tools that enhance our health.  Of course, this is information our grandparents bestowed on us (“Go out and get some sunshine!”), but now the ADD’s scare tactics seemed to have erased this time-tested bit of wisdom.  The skin uses sun to manufacture vitamin D, which is necessary not only for bone health, as most of us have come to accept, but also for our immune system.  Without adequate Vitamin D, we are more prone to cancers and infections, as well as to other diseases of the immune system.  The skin also uses sun to create other enzymes and factors that activate Vitamin D and help our body stay healthy in many other ways, some of which are not fully understood.  For instance, during COVID, people exposed to more sunshine who had adequate Vitamin D stores were less likely to die, something quite ironic since our COVID “experts” told us to stay locked up inside.   Taking vitamin D pills did not provide the same protection, even if it raised vitamin levels in our blood.  Even if we can argue about whether we truly are being hit by a skin cancer epidemic, we do have a Vitamin D epidemic in this country from our war against skin cancer; the vast majority of Americans are depleted of it, primarily because the sun is our only source and we are blocking that.  And that epidemic has likely increased cancer risk, even as we ironically lather our bodies with sunscreen to prevent cancer.

Then why not just take Vitamin D pills/supplements?  The vitamin D supplement market has also benefited from the ADD’s war against skin cancer, since Americans now take large amounts of D to replace what they have lost by blocking their skin from the sun.  In fact, thanks to sunscreen and the ADD, Americans now spend $1.6 billion a year on vitamin D supplements to provide us with what nature would give us for free it we allowed it.  But, as we are learning from new research, and which we have summarized in an article we wrote for the American Family Physician, Vitamin D supplements only give us inactive Vitamin D, and thus they do not improve bone health or enhance our immune system, they only increase meaningless vitamin D levels we can measure.  The only way to activate D is through the sun, and the ADD has made sure we don’t do that.

Thus, the ADD’s marketing campaign—and the increasing “awareness” of our skin cancer epidemic disseminated by doctors and the media—has not reduced deaths, has not reduced disability, but has led to harm, profits, and deception.  This is quite common in all our health myths and numerical epidemics.  By convincing Americans they will die unless they submit to measurements and treatments for something whose prevention/detection/treatment does not lead to better outcomes, we have indeed increased profits for a group of doctors and for industry, but at what cost?  It is easy for the medical industrial complex to invent illness through measurements, it is equally easy to convince insurance companies and the media (as well as far too many frightened Americans) to advocate and finance preventive and treatment strategies that cause more harm than good with the misperception that they are beneficial, but it is not easy to dismantle a system that preys on trust and generates such harmful myths.

As a disclaimer, I am being investigated by the Maryland Board of Physicians due to a complaint by Dr. Michael Silverman, a cardiologist in Columbia MD, that claims that I spread misinformation. His allegations point to my practice newsletters, which provide studies and data that he believes are not consistent with industry and specialty society protocols and are thus dangerous. He notes of the newsletters, "The highlighted information [all peer reviewed studies and other articles from peer reviewed journals] is either false patient advice that does not follow American College of Cardiology use guidelines or is otherwise misleading information... If some patients follow this advice it will result in significant patient harm." This is to note that, as with my other blogs and my newsletters, I am not providing patient advice but rather using data and studies to expose often deceptive and self-serving messaging by the medical community and industry to give all people a broader look at medical issues. When I see patients I discuss all issues through a lens of objectivity and science, showing multiple sides of every issue rather than the dogmatic protocol-based approach that doctors like Dr. Silverman prefer. Thus while this and other blogs may upset the sensibilities of Dr. Silverman who believes that censorship and protocol-based care are necessary to protect patients from what he believes to be false, all patients have a right to make their own decisions and can explore not only the articles I highlight in this blog, but other sides of this issue that are available through medical investigation and from their doctors, including their specialist doctors. This blog is meant to educate and provide a unique scientific viewpoint that verges from industry messaging, but is not meant to change patient behavior without a discussion with his or her doctor.