Many who, like Ratcliff, spent their youth soaking up the sun — long before the risks of UV exposure were widely known — are facing skin cancer as they age. In the U.S., the incidence of melanoma has more than tripled since 1975.

Fortunately, survival rates for patients have also risen dramatically, thanks to advances in immunotherapy and other treatments. It’s giving hope to patients like Ratcliff, who have many more options than they did even a decade ago.

As a Northern California teen in the late 1970s, her social life revolved around sunbathing: She and her mother would lay out in their courtyard most weekends and, during the summer, she and her friends would spend six hours a day at the beach, slathered in tanning oil or even margarine. Sometimes, they used aluminum foil to concentrate the sun’s rays. No one applied high-SPF sunscreen, which wasn’t widely available — or known about — at the time.

“Even when my skin would bubble up, the next day I’d go right back out there,” Ratcliff said. “It was a bonding thing … and you felt so much cuter if you had a tan.”

Using sun protection later in life

Ratcliff didn’t start using sunscreen until her early 30s, when conversation about the danger of UV rays had filtered into the mainstream. In her case, that was too late: In 2010, when she was 46, Ratcliff’s husband, a Stanford physician, noticed a chocolate chip-sized mole on the back of her thigh.

A dermatologist diagnosed her with stage 0 malignant melanoma and cut out the lesion during the appointment. “I left her office feeling as though I’d dodged a bullet,” Ratcliff later wrote in an account of her experience.

Ratcliff began using SPF 50 sunscreen, stayed in the shade, wore long sleeves and hats and underwent yearly skin checks. “I thought I was safe,” she wrote.

Then in December 2023, just before her 60th birthday, she felt a pea-sized lump in her groin while showering. A biopsy revealed that she had stage III metastatic melanoma that had spread to a lymph node. “I thought, ‘Oh my gosh, is this going to be a death sentence?’” she recalled. “I was just so scared.”

One source of solace was Funchain, Ratcliff’s oncologist at Stanford Medicine, and like Swetter, a member of the Stanford Cancer Institute. “She’s been my ace in the hole this entire journey,” Ratcliff said. “She’s so personable, warm and really encouraging.”

Funchain explained that Ratcliff was experiencing a late recurrence, a rare situation in which melanoma returns significantly later than the original diagnosis. “Any recurrence pulls the rug out from under you,” Funchain said. “As an oncologist, you're there when that happens and have to help patients fully grasp that — to put it all in context and provide the big picture.”

Funchain explained a new treatment approach she and her colleagues adopted in recent years: starting immunotherapy before surgery. Several studies showed that doing so could make treatment more effective by shrinking tumors or giving the immune system a clearer “memory” of cancer cells to target.

The strategy also allows doctors to see whether a patient’s tumor responds to immunotherapy. “Dr. Funchain is tapped into the latest research,” Ratcliff said. “She has been so knowledgeable about all the treatments and what is good for my particular case.”

Being regularly monitored

Ratcliff received four treatments of an immunotherapy drug before her surgery, but her tumor shrank by less than 10%. Still, the surgery was deemed successful. In April 2024, Kirane, her surgical oncologist, removed eight lymph nodes, with cancer only detected in one.

Ratcliff was told she was cancer-free, but there was no way of knowing whether rogue cells remained in her body. She and Funchain discussed whether she should pursue preventative therapy to lower the risk of her melanoma recurring.

Funchain often compares this approach to an insurance policy: Few people benefit, but some appreciate the peace of mind. Others, meanwhile, would rather avoid unpleasant side effects. “It’s a very personal decision,” Funchain said. “It requires a lot of teamwork between the oncologist and the patient to talk about what makes sense and their values.”

Together, they decided that Ratcliff would pursue targeted therapy, a preventative treatment aimed at lowering the risk of recurrence by blocking any remaining cancer cells from multiplying. In her case, that involved taking five pills daily for a year. Ratcliff’s side effects were severe. “It was pretty brutal,” she said. “I had bad chills and fever when sleeping. Every part of my body was spasming.”

Funchain advised Ratcliff to pause the treatment, then adjusted the dose. “We’re going to find a titration that will allow you to live and have a quality life,” Ratcliff recalled her saying.

In May, Ratcliff took her final dose of medication. “You’ve gone through so much, and I’m really proud of you,” Funchain told her.

Now, Ratcliff sees Funchain every three months to review her blood tests and results from PET or CT scans. Four times a year, she sees Swetter or another dermatologist for a full body exam.

Living life one scan at a time

Ratcliff appreciates that her Stanford Medicine providers meet regularly to review her case. “I feel that they’re all on the same page, and everything gets discussed so well,” she said.

While no outcome is guaranteed, there’s no evidence that Ratcliff’s melanoma has returned. “I don’t want to live my life thinking, ‘What if something else is brewing?’” she said. “I’ve chosen to live my life one scan at a time and not live a fear-based existence.”

Now, Ratcliff is on a mission to share her story to help others. In August 2024, she penned an op-ed for the San Francisco Chronicle with the aim of offering hope to people dealing with a scary diagnosis, and countering misinformation. Influencers on TikTok and other social media sites have claimed that sunscreen causes cancer, hormonal imbalances and other ailments, and tanning is becoming more popular among Gen Z. Cancer rates for young people are rising, and melanoma ranks among the top cancers diagnosed in those ages 15 to 39.

“I want young people to understand that they’re not invincible and that what we do when we’re young can have repercussions later in life,” Ratcliff said.

She also hopes to continue speaking at events like Steps Against Melanoma to raise money for melanoma research and patient support.

Watching Ratcliff take the stage last fall was a meaningful moment for Funchain. “Kim is a kind and bright individual who’s full of life and joy,” she said. “She came into her own as a survivor and grasped her power as a patient. …The whole experience became a foundation she could stand on instead of a towering shadow she had to crouch from.”

Accompanying patients like Ratcliff on their treatment journeys can be rewarding despite the challenges involved, Funchain said. “The special thing about being an oncologist is you’re with people in very scary times,” she said. “Whether it’s the good moments or the bad moments, it’s really an honor and beautiful to share that.”