Although we’ve had a very mixed summer, there have been some days when it was like being in Australia at the height of their summer – around 30 degrees and incredibly hot! Because our weather is so unpredictable, we often forget to use sunscreen or take it with us when we’re out and about. Often we don’t believe it’s necessary and only associate it with being on holiday. You might be surprised to learn that skin cancer is the most common form of cancer in the UK, and rates continue to rise. At least 100,000 new cases are now diagnosed each year, and the disease kills over 2,500 people each year in the UK – that’s seven people every day. On average, someone who dies from skin cancer typically loses 20 years of their life, and rates of malignant melanoma are rising faster than any other type of common cancer.
There are three main types of skin cancer – basal-cell skin cancer (BCC), squamous-cell skin cancer (SCC) and melanoma. The first two together along with a number of less common skin cancers are known as non-melanoma skin cancer (NMSC).
How skin cancer has affected me
This subject is personal to me as my Mum has skin cancer. When she was younger she spent every spare moment in the garden trying to get as tanned as possible, even though she was fair skinned, blonde and blue-eyed. She’s had several operations to remove skin cancer from her hand, nose and ears, including having skin grafts to rebuild her ears, but she has been lucky compared to some skin cancer patients. She has basal-cell skin cancer which is sometimes called “rodent ulcer” and it is rare for it to spread to other parts of the body. I have also put myself at risk as, like many others in the 80s, I had a sunbed at home and would languish under it for hours every night. Although, at the time, my only concern was having a healthy glow and lovely brown legs, the damage it has done to my skin is now visible. It was more fashionable back then to be tanned all year round. Now there are better tanning products available and people are much more aware of the dangers of being exposed to the sun without adequate sun protection. My daughter is fair-skinned, blonde and blue-eyed like my mother and chooses to avoid the sun and doesn’t mind being fair! The wisdom of youth!
Now we know that sunburn during childhood can be disastrous in later life. My son-in-law is 23 but when he was a child, he spent every summer in Turkey on the beach and was always very tanned. Now he has several suspicious moles on his back that need to be checked on a regular basis. This illustrates the importance of always using a high sun protection factor on children and limiting their time in the sun as this can greatly reduce the risk of skin cancer in later life.
Melanomas are the most aggressive type of skin cancer. Around 13,500 people are diagnosed with melanoma in the UK each year. It is the 5th most common cancer overall in the UK, excluding non melanoma skin cancer. Skin cancer rates are more than 4 times higher than they were in the late 1970’s in Great Britain. Above the age of 20 to 24, the incidence steadily rises with age. It is now the second most common cancer in people under the age of 50. The diagnosis rate of melanoma is said to have increased as doctors are now better at recognizing it and more people are taking holidays abroad.
Causes/Risk Factors of Melanoma
* Exposure to Ultraviolet light (the sun/sunbeds)
* Having fair skin/freckling (fair skinned people have less protection than darker skinned people)
* Being born in a hot country e.g Australia (you may have had more exposure to the sun as a baby or young child when the skin is most delicate)
* Irregular exposure to strong sunlight on holiday and in the UK (as opposed to regular exposure all year round)
* If you’ve been sunburned several times
* Sunbed use (especially before the age of 35)
* Higher number of moles on the body, especially large ones (moles of over 5mm in diameter)
* Rare birthmarks (giant congenital melanocytic naves can develop into a melanoma if it is larger than 20cm) which should be checked regularly
* If there is a history of melanoma in the family – familial atypical multiple mole melanoma syndrome (FAMMM) which means having at least 50 moles and at least one close relative has been diagnosed with a melanoma.
* Having melanoma or cancer in the past (8 to 15 times higher risk than other people)
* Those that suffer from Parkinson’s Disease
* Lowered immunity
* Women are more at risk than men
* A mole that has changed in size, shape, colour, has irregular edges, has more than one colour, is itchy or bleeds.
* Moles with three different shades of black or brown
* A dark area under a nail that is getting bigger without any injury
* An enlarged lymph gland close to a mole
* A dark spot in the eye
* Avoid the sun at its hottest (between 11am and 3pm)
* Cover up – T-shirt, hat, sunglasses
* Use at least SPF 15 sunscreen with a high UVA protection
* Avoid sunburn
* Check your own skin regularly for changes
Right now there is no general screening programme in the UK for malignant melanoma. Melanoma is not a common cancer. If your GP is worried that you may have a melanoma, they will refer you to a skin specialist. Depending on local NHS services, they may refer you to a rapid access suspected skin cancer clinic. There are private walk in skin clinics in the UK, but some staff are not medically qualified and the screening may not be reliable. If you want a skin change checked, it is best to see your GP. If you are high risk your doctor can refer you to a dermatologist who can show you how to check your skin each month for abnormal moles. (Some people have a much higher than normal risk of melanoma and should have regular checks by a skin cancer specialist).
The treatment for early stage and advanced melanoma is different. Surgery is the main treatment for early stage melanoma. If your cancer has spread (advanced melanoma) you may have a type of biological therapy, or chemotherapy/radiotherapy. There are four different stages, and the stage signifies how deeply the melanoma has grown into the skin, and whether it has spread. Stage 1 and 2 are localised melanomas where the cancer has not spread. Usually a mole is removed first, then if melanoma is diagnosed, you have a second operation to remove a larger area of healthy tissue around the melanoma. Normally you won’t need any further treatment. Stage 3 melanoma means that the cancer cells have spread, usually to the lymph nodes. Surgery may be needed to remove the affected lymph nodes. Radiotherapy may be prescribed for more advanced stage 3 melanoma. You may also be offered biological therapy, normally in a clinical trial. Stage 4 melanoma (advanced melanoma) is when the cancer has spread to another part of the body, such as the lungs, liver, bones or brain. There are a wide range of treatment options (biological therapy, immunotherapy, chemotherapy, radiotherapy and surgery). You may also be asked to take part in a clinical trial to find out what treatment works best.
Coping with melanoma
Coping with a diagnosis of cancer can be tough. However, it’s encouraging to know that most melanomas in the UK are diagnosed at a very early stage and are curable. Many people just have the melanoma removed and need no further treatment but it can still be a very worrying time. At first, you are likely to feel very upset, frightened or confused. It is essential to get the right information about your type of melanoma and the most suitable treatment, as this makes it easier to cope.
Physical affects of melanoma
You may have only a minor physical change after treatment for melanoma, such as a small scar where the melanoma was removed. However you may have a skin graft or a scar on a very visible part of the body. These changes can be very difficult to cope with and may affect your self-esteem. If you have treatment such as biological therapy or chemotherapy for advanced melanoma you may sometimes feel very tired and lethargic.
Coping with melanoma
Having cancer brings up practical challenges – you may need financial support if you can’t work. This can be stressful, especially if you have a family to support. It’s important to ask for help and try to deal with one issue at a time. Your medical team will put you in touch with a support network of trained professionals, e.g. a physiotherapist or social worker. Social workers may be able to help you with information about your entitlement to sick pay and benefits. If you live alone, a social worker may be able to help by organising someone to look after you when you leave hospital, if necessary.