Family History and Skin Cancer: Are You at Risk?

Your skin is your body’s first line of defense. Taking care of it is essential, especially when it comes to skin cancer. In our bi-monthly series, “Psst! Here’s What You Should be Asking Your Dermatologist,” we dive into questions you should be asking your dermatologist. Find the answers you’ve been seeking and make informed decisions about your skin health.

This month, we chatted with Dr. Laura Ferris, MD, PhD and Director of the University of Pittsburgh Department of Dermatology Clinical Trials Unit in Pittsburgh, PA. A common concern is the risk for basal cell carcinoma or squamous cell skin cancer if one or both parents had nonmelanoma skin cancer. Read on to gain some valuable insights from a renowned expert in the field.

Am I at high risk if one or both of my parents had basal cell carcinoma or squamous cell skin cancer?

Patients often ask me about this. For the vast majority of patients, having a family history of basal or squamous cell carcinoma is not really a risk factor. Basal cell carcinoma and squamous cell skin cancer are very common cancers, and they are extremely related to ultraviolet (UV) damage. That’s the most important risk factor: whether you’ve sustained UV damage. So for the most part, no, you’re not at high risk if one or both of your parents had basal cell carcinoma or squamous cell skin cancer.

That said, if your parents have red hair, blue eyes, or very light, easily freckled skin, you might, too, and it’s these characteristics that put you at higher risk for basal cell carcinoma and squamous cell skin cancer, because people with these skin, eye, and hair characteristics are more susceptible to skin cancers. Additionally, families tend to have similar sun exposure history. If you are a family that spent a lot of time at the beach and that didn’t use a lot of sunscreen, for example, your shared history puts you at similar risk.  

Which group of people are at the highest risk for developing nonmelanoma skin cancer?

The people with the fairest skin have the highest risk for developing skin cancer. The people who burn and do not tan or the people who may burn and then tan a little bit – these groups are at the highest risk. However, anybody who has had a lot of cumulative sun damage is also at high risk. Finally, immunosuppressed people are also at risk. Those are the biggest groups in terms of risk for nonmelanoma skin cancer.

What type of skin cancer is hereditary?

Melanoma is the main type of skin cancer associated with hereditary risk factor. There are, however, exceptionally rare syndromes where people get mostly basal cell carcinoma and sometimes squamous cell skin cancer—but again, these are exceptionally rare.

How do genetics and family history contribute to someone developing skin cancer?

The main way is through susceptibility to damage from UV light. This goes back to what I noted in the earlier question about skin color and sun sensitivity issues.

Are there genetic tests for nonmelanoma skin cancer?

There are lots of different ways to think about genetic tests. One way to think about these tests includes looking for germline mutations, which answers the question, “Do you carry a gene that makes you more likely to get skin cancer?” We do this kind of testing very selectively. It is mostly in patients that have a very strong history or family history of melanoma. We may do germline testing to see if you carry a gene that puts you at a high risk for melanoma.

For basal cell carcinoma or squamous cell carcinoma, genetic testing occurs only if your doctor suspects that your DNA carries genes for the syndrome that makes you more likely to get lots of basal cells or squamous cells. This suspicion would not be based only on family history, but a constellation of lots of different findings. This germline mutation testing answers the question, “Do I carry an inherited gene that makes me more likely to get this type of cancer?”

A second kind of genetic testing that is available is what we call gene expression profiling, and that is available for squamous cell skin cancer. If you have been diagnosed with squamous cell skin cancer, there are tests that can look at the genes that are expressed within your squamous cell skin cancer to determine how high risk that tumor is. In other words, how likely is it that your tumor might spread? Can your squamous cell skin cancer be cured by a simple surgery in the dermatologist’s office or is it more aggressive? Is it more likely to cause future harm? Specifically, that test is not looking for a mutation that the patient carries, like germline mutations, but that test is looking for genetic changes within the tumor. Most squamous cell carcinomas, however, are low risk, and this type of testing would not be informative or appropriate for most cases, but may be useful in some cases.

What can people do to reduce their risk of skin cancer?

The most important thing is to assess what are the things that you can change and what are the things that you cannot change. You can’t change your genetics or your skin color. What you can change is your exposure to ultraviolet light. The easiest thing to do is to NOT use tanning beds. Don’t go out in the sun looking to tan. I certainly encourage people to go outdoors for the mental health and fitness benefits, but to do so safely. That means wearing sunscreen, at least SPF 30 or higher, if you are going to be outdoors. On a day-to-day basis, get a facial moisturizer that contains SPF 30 so that you have chronic protection of the areas that get commonly exposed. Wear a hat. Wear sun protective clothing when you are going to be outside. Sit in the shade when you can. Those are important things that you can do to reduce your risk of getting skin cancer.

If you have had a lot of sun damage and have had some skin cancers, talk with your dermatologist about what else you could be doing to decrease your risk of skin cancer. For example, there are some blood pressure medications that put you at higher risk for skin cancer.  Another example is that there are topical treatments for patients that have extensive sun damage, specifically pre-cancerous lesions called actinic keratoses. These medications aim to get rid of more genetically damaged cells that are precursors to skin cancer. If you have had actinic keratoses, your dermatologist can tell you if a topical treatment for your lesions may be a good option for you.

Laura Ferris, MD, PhD, is a Professor of Dermatology at the University of Pittsburgh. Dr. Ferris is also the Director of the Clinical Trials Unit in the Department of Dermatology and has been the principal investigator for over 30 trials thus far. Her practice includes medical dermatology with a focus on skin cancer. Although Dr. Ferris has authored over 100 publications on skin conditions, in 2023 she published, “Clinical Utility of an AI-powered, Handheld Elastic Scattering Spectroscopy Device on the Diagnosis and Management of Skin Cancer by Primary Care Physicians,” as senior author. This publication highlights a medical device recently approved by the FDA in 2024 aimed to improve skin cancer diagnosis when patients present with suspicious lesions.