Written by Josephine Fagan

Health

Skin cancer – why all the fuss?

To mark Sun Awareness Week, we asked Dr Josephine Fagan to give Standard Issue readers the skin cancer facts.

SunflowerWhats the big deal?

Melanoma is the most serious type of skin cancer and there are 9000 new cases each year in the UK.

It is the second most common cancer in people aged 15 to 34 years, and is more than twice as common in young women as it is in young men.

Melanoma is particularly dangerous because it can spread to other parts of the body.

Getting painful sunburn just once every two years can triple the risk of melanoma.

What about other (non-melanoma) types of skin cancer?

More common in the over-70s, if caught early these can be treated effectively and do not usually spread. The two main types are basal-cell carcinomas and squamous-cell carcinomas.

What causes skin cancer?

Excessive exposure to the sun is thought to be responsible for 90 per cent of non-melanoma skin cancers and 60 per cent of melanomas.

Ultra violet radiation (UV) from sunshine (and sunbeds) damages the genetic material in skin cells. UVB is responsible for most sunBurn. UVA tends to Age the skin.

The body’s attempt to repair sun damage is what makes sunburn painful. But skin only has to appear red to be damaged. It doesn’t have to blister or peel.

And remember, you cannot feel UV rays. The sun’s warmth comes from infrared rays, which cannot burn you. That’s why people can get sunburnt on bright cold days.

Who is most at risk of getting skin cancer?

• Fair-skinned people who burn in the sun, especially redheads with pale eye colour
• People who have lots of moles and freckles
• Those with a family history of skin cancer
• Those with a weakened immune system (e.g. from HIV infection, or from taking immunosuppressant drugs following organ transplant)
• Getting painful sunburn. This doesn’t only happen while abroad, on holiday. In a recent survey, a third of respondents admitted that the last time they were sunburnt was here in the UK.

Can dark-skinned people get skin cancer?

Yes, generally in areas not exposed to the sun, such as the soles of the feet. But black/brown skin colouring is a protective factor.

How do I check to see if a mole is showing signs of melanoma?

The British Association of Dermatologists advises an ABCDE approach:

Asymmetry: does the outline look irregular?
Border: do the edges look blurred?
Colour: is the pigment patchy, uneven, variable, changing?
Diameter: is your mole getting bigger?
Expert: if in doubt, consult your doctor.

Are melanomas always dark in colour?

No. Some are not typical in appearance. But, as they grow, they may crust, itch, bleed or ulcerate. This is also true for non-melanoma types of skin cancer and, if these symptoms develop, you should seek medical advice immediately.

What is the best protection against sun damage?

• Cover up and wear a hat
• Wear sunglasses that protect against UV
• Spend time in the shade, especially between 11am and 3pm when the sun is strongest (in the UK)
• Use sunscreen with at least SPF 15 (to protect against UVB) and a high star rating (to protect against UVA) and reapply regularly.

What about sunbeds, fake tan and tanning products?

Sunbed use damages and ages the skin, (the same as sun-tanning). They cannot safely ‘build-up a tan’, or protect against subsequent sun damage.

Fake tanning products appear to be safer than sun-tanning or sunbeds, but they do not offer much protection from UV, and more work needs to be done on the effects of long-term usage.

Melanotan is a synthetic hormone that increases the levels of melanin (a natural dark skin pigment). It is unlicensed in the UK and it is illegal to sell Melanotan injections because its safety is still under scrutiny.

UV level meterWhats the upside to sunshine?

Vitamin D is vital for good health and is made in the skin with the help of sunlight. It’s estimated that we need two to three 30-minute sun exposures (bare arms and face) per week during the summer months to prevent deficiency.

Sunlight also makes us happier because it boosts the levels of a neurotransmitter called serotonin.

Whats the take-home message?

Enjoy the sunshine. But stay safe.

Useful websites:
http://www.bad.org.uk/for-the-public/sun-awareness-campaign/sun-awareness-week
http://sunsmart.org.uk/
http://www.dermis.net

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Written by Josephine Fagan

Josephine works as a doctor in urgent and primary care. She’s also a bit of a globetrotter, is working on her first novel, and loves the colour purple.