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Skin Cancer and Sun Protection city, state

by Evan R. Ransom, January 2014 issue of MarinaTimes

It’s a new year, and with every January, we make resolutions. In many cases, these resolutions involve our health and physical fitness. And in a beautiful place like the Bay Area, that can mean getting outside more — to walk, run, hike, ride, ski, or climb. As a physician, I strongly encourage this … and I want to remind you not to forget the sunscreen!


Skin cancers are the most common malignancy in the United States, with around 3.5 million new cases each year. Skin cancers come in three main types: basal cell, squamous cell and malignant melanoma. Basal cell (BCC) is the most common and tends to look like a pearly papule — a slightly raised, shiny patch, sometimes with a little blood vessel on top. The next most common is squamous cell (SCC), which presents as a rough spot or a scab that never heals completely. The least common, but by far the most serious, is melanoma. This can have a broad range of appearances but generally looks like an oddly shaped, overly dark, or ulcerated freckle or mole.

Nonmelanoma skin cancer rates are similar for men and women, though some variability exists in their location on the body. The majority occur in areas with the greatest sun exposure, such as the face, scalp (men more than women), forearms, shoulder region, and upper chest (women more than men). Though it is very uncommon to die from nonmelanoma skin cancer, melanoma claims the lives of nearly 10,000 Americans each year, including on average two Californians each day. Almost twice as many men than women die from melanoma, a fact that is often attributed to less attention to sun protection and delays in diagnosis or seeking treatment. Warning signs include changes in size, shape or color; bleeding or ulceration; and localized pain or swelling.


The best way to diagnose a skin cancer early on, particularly if you are fair-skinned, prone to burns, or have a history of sun exposure, is a regular skin check with your dermatologist. The good news is that most skin cancers are treatable, and the success rates for treatment of non-melanoma skin cancer is nearly 99 percent. In many cases, treatment includes a specific technique called Mohs micrographic surgery. In this procedure, named after early 20th century dermatologist Frederick E. Mohs, very thin layers of skin are meticulously removed, stained, and sequentially examined under a microscope. By taking layers of tissue in such an incremental manner, the physician can be sure that all tumor tissue is excised, and can simultaneously spare as much nearby normal tissue as possible. Frequently, skin cancers affect the delicate and complex facial structures. In these cases, the Mohs surgeon will often refer patients for reconstruction to a plastic surgeon. This helps to ensure the best possible outcome, both in terms of cancer care and cosmetic appearance — especially in highly visible and functional areas, such as the nose, eyelids, lips, and ears.


Most skin cancers are related to sun exposure, specifically, the ultraviolet radiation (UV) that filters through the Earth’s atmosphere. This comes in two forms, UVA and UVB, which have some different effects based on their wavelengths. In the aesthetics field, we often say that UVA contributes to aging (wrinkles, “sun spots,” and the changes in texture and elasticity of the skin), while UVB causes burns. The distinction is not exact and the truth is a little more complicated, but the take-home message is this: Both types are damaging to the skin and can contribute to skin cancer formation; therefore, your sun protection regimen needs to address both UVA and UVB. This is just as true on overcast and cold days as when it’s sunny and warm. To help you prepare, the UV Index is calculated daily and can be found on many local weather websites.

By now, you may be asking, what do I do with this information? First, congratulations on your resolution to get outside and enjoy the beauty of Northern California! Second, take a closer look at the label on your sunscreen. In my practice, I recommend sunscreens that specifically protect from UVA and UVB, and prefer products that contain a physical blocker and an SPF rating of at least 30. These sunscreens actually reflect the UV radiation away from the skin with tiny particles of zinc or titanium, rather than using chemicals to absorb it. Also, when you’re sweating it out or if you’re doing water sports, waterproof sunscreens can be very helpful. Regardless of the type or brand, however, make sure to reapply regularly. And finally, have a happy, healthy 2014!

Our Patient Reviews

San Francisco Center for Facial Plastic, Reconstructive & Laser Surgery

5 / 5.0

Based on 23 reviews

Christina G.

I had several nasal/sinus issues including a severely deviated septum and a dorsal hump, which I wasn't crazy about. Dr Ransom did both the medical and aesthetic parts of my surgery and he did a wonderful job! While I did have some swelling, I didn't experience much bruising at all. I loved that he left the natural look of my nose just making small corrections. My breathing has GREATLY improved. His office staff was super helpful in scheduling and making sure payment and everything was very clear. I am very, very, very pleased with my results!!

Tk I.

I had a terrible surf accident in Bali and needed to get 50 stitches to repair what the reef did to my face. I had emergency cosmetic surgery in Bali the day of the accident. Immediately when i got back to the states i was introduced to Dr Ransom through some mutual friends. I was searching for the best cosmetic surgeon in San Francisco to help in my recovery. He and his team have been amazing! he helped establish a plan for my post-op wound care/treatment and administered some initial laser treatments. Dr Ransom and his team are extremely knowledgeable and very patient / helpful. I am very grateful for their help and support. I am finally looking normal again!

Joey B.

I had three issues with my nose - which inhibited my breathing: 1- broken nose, 2 - narrow nostrils that collapsed when I inhaled through my nose, 3 - deviated septum. When I was living in New York, I went to see a doctor about my breathing issues, and he said my skin was too thin and there was likely nothing he could do to rectify the problem. Dr. Ransom was recommended by an ENT I saw through One Medical. As soon as he saw him, he said he could easily fix my nose, and remove the bump that had formed from the trauma. His confidence and strong sense of self immediately put me at ease, and I had little doubt that he could accomplish exactly what he promised. He showed me a modified picture of my nose , and really liked what he proposed. The end result very closely matched what he promised. Not only can I now breath much more easily through my nose, it looks much better. He managed to make it look like an improved version of itself, however I still look like me, and unless I tell anyone I had it done, it's not overly noticeable, which I prefer. I'm pretty vain and very critical, and I can say that Dr. Ransom is great, and comes highly recommended.

Edward T.

Doctor Evan Ransom took my surgery on relatively short order and did a wonderful job. He is very talented and has a nice friendly professional support staff. I can not thank him enough, he was calm, caring, professional and interested in the follow results of his work . He seemed to bring a certain artistry to the profession.

Lisa C.

Dr. Ransom is a talented physician. He is knowledgeable, professional and goes the extra mile to make you feel comfortable during your treatments. He has been blessed with an artistic eye which brings wonderful results. I highly recommend Dr. Ransom and would refer all of my friends and family members to choose him as their physician.

Cheryl H.

Dr Ransom is very kind, honest, and conscience doctor. I was referred by my best friend, she is also Doctor Ransom patient. She has so much good things said about Doctor Ransom. So I had a face lift done by Doctor Ransom on July 2015. He did a wonderful job on my face and I have a lot of compliments on my face. So if anyone want to get their face done. I would highly recommended Doctor Ransom to you. I give Doctor Ransom a five stars.

Jill P.

I have currently been getting botox regularly with Dr. Ransom and he does a fantastic job. My previous doctor's office moved to another location where it was no longer convenient. I didn't realize what I was missing until I went to Dr. Ransom. I felt really comfortable, but most important he did a terrific job blowing my previous doctor out of the park. (Sometimes it's good switch it up a bit to make sure you are getting the best treatment.) On top of that, Dee the office manager is an incredible asset to the office. She personalizes your visit and relationship with the office to an extent I have never experienced before. I even get follow up calls to see how I am doing after a treatment. I highly recommend Dr. Ransom for his great work, and his team's impeccable customer service.

Arielle C.

Dr. Ransom and Dee are the BEST! Whether it's aesthetic or reconstructive, I'd trust him over and over again with my face.