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Staying safe in the sun

Summer is here, which is typically the time when people start to become more conscious of their skin. Dr Genevieve Osborne, a Consultant Dermatologist at Nuffield Health Bristol Hospital, gives advice on the sort of things we should be aware of when spending time in the sun.

Skin cancer is the most common form of cancer in the UK – but most is curable if caught early. Sun is the primary cause of skin cancer; the sun’s ultra violet (UV) rays – both UVA and UVB – can cause genetic and immune changes in the skin that can lead to skin cancer in the future.

The two main categories of skin cancer are melanoma and non-melanoma skin cancer. Melanoma skin cancer can be a serious form which can spread more rapidly internally if not treated early. Over the last 20 years, it has become the fastest increasing cancer, probably reflecting changes in people’s sun exposure habits, and in particular can affect a younger population – although all forms of skin cancer become more common with advancing years. Non-melanoma skin cancer includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

The reactions that immediate sun exposure can cause are redness (‘sunburn’), tanning (caused by an increased amount of the pigment melanin) and freckling (where the melanin occurs in clumps). All these changes can be risk factors for the development of skin cancer, but sunburn is particularly risky, especially in children. Use of sunscreen at least SPF 30 with 5* UVA cover, protective clothing and wide-brimmed hats helps prevent sunburn, as does avoiding exposure to the most intense sun between 11am – 3pm. Individuals who are more light-skinned, with fair or red hair, who have a freckling tendency, or those with a lot of moles are all more prone to skin cancer.

Moles are common ordinary skin spots that represent clumps of pigment-making cells called melanocytes. They’re usually brown, sometimes pink and can be flat or raised. They start to appear in early childhood, more so in response to sun exposure, but they can also occur spontaneously at non-sun exposed sites and may be hereditary. When moles become cancerous, they’re called ‘melanoma’. A change in a mole, such as enlargement, change in colour, shape or size may be signs that it has become a melanoma. Less often, melanoma may cause bleeding, irritation and itching.

Melanoma can also develop on normal skin, where there was no mole present before. Many people aren’t in the habit of checking their moles for change but this does help to pick up melanoma early. A typical melanoma is a brown, irregular-shaped mark that may show several shades of colour and have a fuzzy border; occasionally a melanoma can be pink.

As most melanomas develop silently, it can be helpful to have your moles assessed by a Dermatologist, particularly if you have risk factors such as fair skin, many moles, a family history or have had considerable sun exposure or used a sun bed. If a suspicious mole is seen, it may be surgically removed and sent for analysis, and early detection of melanoma can be life-saving. The Dermatology team at Nuffield Health Bristol Hospital can make a risk assessment of your skin, photographically map suspicious moles for surveillance purposes, treat pre-cancerous changes and surgically treat many skin cancers where present.

People who have accumulated much sun-exposure over the years are prone to pre-cancerous skin conditions that can turn into SCC, and they are at greater risk of BCC too. These skin cancers are usually managed surgically. Individuals who have had a non-melanoma skin cancer are more prone to further such cancers in the future and therefore benefit from regular skin surveillance by a Dermatologist for early diagnosis.

Dermatologists would never view a sun tan as ‘healthy’ because it is a sign that there has been damage which may later lead to skin cancer. Some exposure to the sun is required to maintain Vitamin D levels, so we don’t need to avoid it completely, and Vitamin D can still be made in the body when a sunscreen is applied. Certain skin conditions, such as psoriasis, are actually improved by UV exposure from the sun, so the important message is to avoid sunburn and prolonged exposure, and know your own risk factors, regularly inspecting your skin for changes.

If you would like to book an appointment with Dr Osborne, or one of the other Consultant Dermatologists at Nuffield Health Bristol Hospital, Dr Helen Audrain and Dr Adam Bray, call 0117 911 5339, or visit our website: www.nuffieldhealth.com/hospitals/bristol.