BRITISH BROADCASTING CORPORATIONÌý
RADIO SCIENCE UNITÌý
CHECK UP 1. - Skin CancerÌýÌýÌý
RADIO 4Ìý
THURSDAY 05/08/04 1500-1530Ìý
PRESENTER:
BARBARA MYERSÌý
CONTRIBUTORS:
JANE MCGREGORÌý
PRODUCER:
HELEN SHARPÌýÌýÌý
NOT CHECKED AS BROADCAST
MYERS
Hello again. Like smoking and overeating sunbathing is a lifestyle choice with health consequences. Sunburn, even suntan, is the first visible sign of skin damage, it may be years before the effects present as skin cancer and not everyone gets problems of course, your skin type makes a big difference. Skin cancer can be treated if the superficial growth is removed before it has chance to spread but if you don't keep a close eye on abnormal looking blemishes it may be too late for treatment - 2,000 people die every year from skin cancer in Britain. Curiously enough that's more than in Australia , even though they have more cases over there. So what should we be looking for and what minimal precautions should we be taking if we do choose to lie in the sun or if our work takes us outdoors? Well call us now with your questions for my guest today, she's consultant dermatologist Dr Jane McGregor. The number to ring: 08700 100 444.Ìý
Jane, at your clinic at the Royal London Hospital , I know you see plenty of patients with skin cancer at various stages, I wonder if that makes you personally run for cover, seek deep shade?Ìý
MCGREGOR
Well I think it is a worrying problem and certainly skin cancer is something we need to take seriously. Patients don't like the look of it, they don't like the surgery and of course patients can die from it. I think what we're trying to put over is to have a sensible approach to sun exposure and particularly I think we feel that we should be educating parents to educate their children, if we can start sensible behaviour - exposure patterns - in childhood, hopefully that will go through into adult life.Ìý
MYERS
The trick is of course to know what is sensible and what is common sense because everyone has their own idea about these things. Let's go to our first caller, I think she, Jill Campbell in Derby , would consider herself to be quite sensible and for good reason because you're a fair skinned person aren't you Jill.Ìý
CAMPBELL
Yes that's right. I had red hair when I was young and several sunburning episodes before people were aware of how dangerous that was.Ìý
MYERS
So now where does that leave you?Ìý
CAMPBELL
Watching every freckle with great fear.Ìý
MYERS
So as I said quite sensible but of course that's also rather worrisome I guess, if you feel that there's a potential there for those freckles to develop into something more serious. Let me put that thought to our guest today. Jane, I mean if you are freckly, light skinned and one way or another have had a certain amount of sun exposure, as you might have, over the years I mean are you necessarily at risk?Ìý
MCGREGOR
I think yes you are at risk. You're at risk, one, because you've got the fair skin and freckles and the red hair, which is exactly the sort of type of patient that burns very easily. Now often we hear in the clinic people say - Well of course we didn't know about that back then and our mothers covered us in olive oil and we went out and burnt like lobsters and we were all fine. There is no doubt that that sort of treat - behaviour in the past does lead you now to be at risk of skin cancer. There's a balance between fearing it to the extent that it's ruining your life and taking a sensible approach to looking for the sort of changes that might be worrying.Ìý
MYERS
So how assiduous then should Jill be, I mean you say you keep an eye on them, is there something more that you might want to do or need to do Jill, do you think, to feel comfortable with your skin?Ìý
CAMPBELL
Well I assume I watch for changes, that seems to be what - the advice that everyone's giving but apart from that no I don't know anything else.Ìý
MYERS
Okay, so maybe help us with the idea of watching for changes - what changes are an indication that things are going wrong, that a freckle may be turning into a mole, a mole maybe turning into an abnormal growth - maybe a cancer?Ìý
MCGREGOR
Okay. I think at this point it would be helpful to say there are different kinds of skin cancer. There are melanoma type skin cancers which really are tumours that arise predominantly from moles. And so the sort of changes that you would look for in a mole are the appearance of a mole that you are certain you haven't had there before, an enlargement of a pre-existing mole, a change in the shape or the colour of a pre-existing mole. What I say to my patients is that moles when you look at them generally look like they all belong to the same family and if one of them just catches your eye and you think that just doesn't like it belongs to my family of moles that's the sort of mole that you should hot foot it along to your general practitioner and see what he says about it and if he's concerned about it or even if you're concerned and he's not he will often then refer you on to a dermatologist for a specialist opinion. Ìý
MYERS
Okay Jill thanks very much for starting our programme, keep watching the freckles. Of course freckles are not moles, that's the other complication - do you just want to add in to that finally before we leave Jill?Ìý
MCGREGOR
Yes freckles tend to be the sort of little irregular pigmentation that occurs on the face if you go out in the sun or some people have them constituitively on their skin and they aren't moles, they're not comprised of melanocytes, which are the mole cells that are in the skin. So freckles and moles are quite different pathologically although they can be very, very difficult to tell apart just looking at them actually.Ìý
MYERS
Okay thank you very much. And we'll go to another caller - Bob is waiting patiently in Dunstable, hello Bob.Ìý
BOB
Hello.Ìý
MYERS
Hello, your question please for our dermatologist expert today.Ìý
BOB
Yes well, just before Christmas last year I had to go to the local hospital and the doctor there told me that I'd got solar keratosis. Then on top of my head because I've got very thin hair and give me some cream to put on twice a day for over a period of a few weeks and then to go back about three months later. And it seems that they have cleared up but I'm a little bit worried because I'm very fair skinned that these might return and I have been told that they can turn cancerous if they're not treated and I don't know how I stand on this.Ìý
MYERS
Okay, well not everyone will understand the term - solar keratosis - I think you got it exactly right though but Jane just fill us in, what actually is solar keratosis and is Bob right to be concerned that they may come back or somehow grow anyway and turn into a cancer?Ìý
MCGREGOR
Well solar keratosis are the different kind of skin cancer - they are not the melanoma type, they are the non-melanoma group. Now solar keratosis is often just a little red scaly thing, lots and lots of people have them, up to perhaps 30% even 50% of people over the age of 70 will have one or more of these things, usually on chronically sun exposed skin like the face, the backs of the hands or in gentlemen who've got thin hair - as Bob says he has - on the scalp. And they are what we call pre-malignant lesions. And what that really means is that they aren't skin cancer in themselves. The information that we have from research suggests that only about one in a thousand of these solar keratosis will ever go on to become a squamous cell carcinoma or a skin cancer. The vast majority of them will either stay exactly as they, in fact some of them may even disappear of their own accord. Now the fact that you've had your cream, which can be used to clear them, is good news and they can reappear, in fact often they will reappear, but the risk of them individually turning into skin cancers is pretty low.Ìý
MYERS
I suppose the advantage Bob, at least you know that this is a problem, I guess you'll recognise them in future if they come back, if the cream is needed again. I'm just wondering Jane I guess cosmetically you'd want them to be cleared up, so there's a perfectly good cream that can do this is there?Ìý
MCGREGOR
Yes I mean a lot of people don't even bother to go to their doctors with them and certainly if we see them in patients who we're treating for other conditions we wouldn't necessarily volunteer to treat individual solar keratosis, they're so common and they have such a low risk of anything going wrong with them we don't routinely treat. But if people come to us wanting treatment, either because they don't look very nice or because they're concerned about them then yes there is a cream available for treating them or we can treat them with something called cryotherapy, which freezes them and clears them.Ìý
MYERS
Bob thank you very much for sharing that with us. We've had one or two e-mails either about or from men and I think there's a bit of a theme emerging which is that a lot of men don't feel that they are sun sensitive or vulnerable to the sun. Maybe it's a macho thing that they like to go out without shirts on in the hot weather or without a cap or a hat and yet if you've got thinning hair the scalp certainly can be vulnerable. Clare in particular says she's worried about her husband but he says, well he feels that he tans so easily it's certainly not necessary to take cover or to protect himself. What about this business of feeling or looking as though you tan easily - does that actually mean that you're not doing some damage - skin damage?Ìý
MCGREGOR
Well different skins clearly do tan with differing degrees of redness and that goes from Afro Caribbean skin which is constituitively black through Asian skin which is sort of coffee coloured and tanning easily, right down to Jill, our first caller, who had red hair and freckles and probably doesn't tan at all. If you tan easily that is what we call a tanning skin type. The fact that you tan is still a response to injury, it just means that you need more of the sunlight to get the same degree of tan. Now black skinned and Asian skinned people really tend not to get skin cancer, so most of the sun smart campaign, for example, that's run by Cancer Research UK , is aimed at white skinned people. Now it sounds to me as if Clare's husband tans easily but it still means that while he's getting his tan he is doing damage to his skin because the tanning is a response to that injury.Ìý
MYERS
Another e-mail, picking up what we've just been talking about, Santu Chatajee has written to us that he's an Indian man, lives in the UK , he assumes that his skin pigments would protect him from skin cancer. Am I right, he says? But he goes on to say that his sons - whose mother is Scottish - are fairer skinned and they really don't know whether they should be protecting themselves from the sun. So double question there from Santu, what's the answer?Ìý
MCGREGOR
Well Asian skin types are pretty well protected against the sun. We do very occasionally see certain types of cancer in Asian people but there's no doubt that the incidence is far, far less in darker skinned people than in white skinned people. Now it is interesting that the colour mix between his son - who's married a Scottish woman who's likely to have very fair skin - their children are going to be somewhere in the middle. Now it's very variable, sometimes they'll have much more of the Asian skin type, sometimes much more towards the white skin type and it really is - it's not a matter of ethnicity or racial type, it's absolutely to do with skin type. So if you burn then you are going to be at risk of skin cancer and if you don't burn, because you're much more towards the Asian type, you'll be protected from it to some extent.
MYERS
That also has been echoed I think in one or two e-mails that I've seen where within one family you tend to get a child who burns easily and another who can be out in the sun all day and just has a nice healthy glow. And I think that's quite confusing for parents because these are children from the same family in the same environmental conditions but you're making the point that they have different genetic backgrounds even so.Ìý
MCGREGOR
Absolutely, absolutely. I think within a family it's probably quite helpful to instil good behaviour patterns in the sun throughout the family rather than respond to each individual skin type otherwise it's going to be rather a confusing message for the children.Ìý
MYERS
So slap on the sun cream?
MCGREGOR
I think so, I would say so.
MYERS
Alright, let's move to another caller now though. Jacqueline is waiting patiently and she's in Guildford . Hello Jacqueline.Ìý
JACQUELINE
Hello.Ìý
MYERS
And your question please for Jane McGregor.Ìý
JACQUELINE
Hello. I've had two rodent ulcers treated in January, which have cleared up beautifully. And on my check up they spotted another ulcer which was operated on last week and having done it they said oh in fact this was different, it was a Bowers [sic.] Disease. And I was just wondering what that is because I hadn't been able to find much information on that.Ìý
MYERS
Well thank you you've introduced us to two new terms there - rodent ulcers and Bowers - start with rodent ulcers, it sounds awful - it sounds like you had a rat bite or something. Jane what's that about?Ìý
MCGREGOR
Right, well both Bowens Disease actually and rodent ulcers fall into the non-melanoma skin group, so they're not melanoma kind of skin cancer.Ìý
MYERS
Again you make that distinction quite meaningfully because non-melanoma is not so dangerous, melanoma is potentially more dangerous.Ìý
MCGREGOR
Yes. From the pathological point of view melanoma comes from melanocytes, so it looks like a mole and it's from moles. The non-melanoma is all the rest actually - solar keratosis, squamous cell cancers, basal cell cancers - which is the same thing as a rodent ulcer. And then Bowens Disease, which is a bit like a large solar keratosis actually. So they're all the non-melanoma skin cancers. And the reason we separate them out actually is because they're far less aggressive, they behave in a different way, the outlook is different for them. So it's useful, it's relevant, to separate them out apart from anything else. Now Bowens Disease, as I say, is a bit like a large solar keratosis and so it has a similar sort of outlook. On the whole they tend to be benign, rather indolent things, once you treat them they tend to stay away even if they recur you can just go back in and treat them again.Ìý
MYERS
Is that reassuring Jacqueline?Ìý
JACQUELINE
Very, thank you very much indeed.Ìý
MYERS
Good, thank you very much indeed for your question. We'll move to Aberdeen and Pam, Pam Morton, hello.Ìý
MORTON
Hello, hello Jane.Ìý
MYERS
Go ahead with your question please Pam.
MORTON
Yes, I'm 59 and like your first caller I have fair skin, freckles and lots of moles. I recently returned from Spain where despite sitting under a tree for shade I burnt my chest and shoulders very badly and I was wondering how long does it take for the effects of sun damage to develop into skin cancer usually, or I presume it's variable but is there a guidance on this?Ìý
MCGREGOR
Okay, well Pam I don't think you need to be too terrified by this single episode of sunburn, certainly I'm sure it was very uncomfortable at the time and most of us want to avoid that feeling. Sunburn does increase your risk of both melanoma and probably non-melanoma skin cancer as well. There's a long delay usually between a sunburn episode and the sort of long term effects that we see in terms of skin cancer, usually in the order of 30, 40, maybe even 50 years, so what tends to be more important is the sort of sunburn episodes and cumulative sun exposure that children get that adds up over the years into being - into determining their skin cancer risk. So if this was your first ever sunburn then I wouldn't worry too much. If this sunburn has been on a long standing background of lots of sunburns and lots of sun exposure then your risk is higher.Ìý
MYERS
And so you should look out for any warning symptoms - is that the simple message? Let's hope that nothing comes of this but you put - as you say inadvertently - put yourself at risk and so Pam you need to keep an eye.Ìý
MORTON
Yes I certainly do, yes I have had episodes of sunburn in the past but I just wondered now being older my skin's obviously thinner.Ìý
MCGREGOR
Yes it's the build up of sun exposure and the number of sunburn episodes over the years I think that determines your risk. Ìý
MORTON
Right.Ìý
MYERS
Can we use your question as a basis for talking a little bit briefly about suntan creams or sun creams - sun protection creams? I think you said you didn't realise you were getting sunburnt and of course there's a big question mark over how effective sun creams are in stopping sunburn. Is there a simple message that you would give, Jane, about the sun protection factor, for example, in a sun cream that you might use, particularly for children but for anyone? Ìý
MCGREGOR
Well I - I think our message is not just about sun creams or sun blocks. The message that we try to put over through all of our campaigns and when we speak to our patients is to behave sensibly in the sun. So there are certain hours of the day when the sun is much more intense - the UVB levels are much higher ... Ìý
MYERS
That's the ultraviolet B.Ìý
MCGREGOR
B - which is the burning rays ...Ìý
MYERS
B for burning.Ìý
MCGREGOR
That's B for burning. A for ageing apparently but in fact probably both UVB and UVA cause both problems - sunburn, skin cancer and ageing. Keep out of the sun when the UVB levels at their highest. Simply put if your shadow is smaller than you then you shouldn't be out in the sun, that's usually two hours on either side of midday . Really that's very hot, very burning type rays. Cover up - hats, close weave clothing, T-shirts if you go into the sea, shoulders and bare heads are terribly exposed because they're flat surfaces for the sun to beam down. Now the last leg of our message really is the sun block because that's - if you have to be out there, if you're not covered up, then the sun block is the last refuge really.Ìý
MYERS
So that might be relevant for people who find themselves working outdoors and can't avoid the midday sun possibly.Ìý
MCGREGOR
Although builders are notorious for just stripping of their T-shirts, whatever the weather, certainly we've had builders and no amount of me nagging about a sun block makes the slightest bit of difference. But yes if you are unavoidably outside for any length of time then it probably is a good idea to wear your sun block on your face, your hands, the v of your neck - anything that isn't covered to prevent you sunburning.Ìý
MYERS
Okay thank you very much indeed. We'll go to Lucia - Lucia Leyton hello.Ìý
LEYTON
Oh hello.Ìý
MYERS
Hello.Ìý
LEYTON
My question is if you have a mole that's never actually been exposed to the sun is that still in danger - I mean it's years since I wore a brief bikini but even then this mole I'm thinking about has always been covered up, what do you think?Ìý
MYERS
What does your mole look like? Is it sort of any significant size? Is it on your midriff you say somewhere?Ìý
LEYTON
Well it's sort of on my front hip. It's only very small, not very big and hasn't grown much but it's something I'm always wondering about.Ìý
MYERS
So do your moles have to see the sun in order to grow is the question - to change and become sinister?Ìý
LEYTON
Well the first thing I would say is that if you are concerned about this mole you really should go and see your GP, don't sit at home and be concerned all alone, go and see your GP to discuss that with him. The answer to your specific question is that no ironically moles probably don't need to see the sun in order to turn malignant. There's no doubt that sunlight is closely related to the development of melanoma across a population, that is to say the higher the amount of sunlight a population gets the higher the incidence of melanoma. But melanoma's quite a complicated tumour and the genetics of melanoma plays quite a large part in determining your risk factors. So apart from skin type the genetic factors include how moley you are, whether your moles look completely normal or whether they're what we call atypical looking moles, have you got a family history of funny moles, is there a family history of melanoma - all these things add up to provide your personal risk factor - or factors. If you then go out into the sun that puts your risk even higher but moles can occur on non-sun exposed sites. So it isn't as straightforward as just sun makes moles go malignant, there's your genetics to take into account as well.Ìý
MYERS
And is this going to be a simple procedure to go to your GP, say have a look at this, what do you think and will he or she know or is this going to be a case of going to a dermatologist and having special investigations?Ìý
MCGREGOR
Well almost inevitably it will involve going to the GP first, who will then either reassure you that it's absolutely benign or I think if you give a history that a mole is changing it's a very important thing to listen to and most GPs would then refer on for a dermatologist to take a view and we also listen to the history, it's not just the appearance and very, very early melanomas can be quite subtle, so if the history of change is there then we would probably excise it.Ìý
MYERS
And this removal of these malignant - the melanoma cancers - straightforward, successful?Ìý
MCGREGOR
Very straightforward.Ìý
MYERS
As long as you're there quickly enough.Ìý
MCGREGOR
Early melanomas - very straightforward procedure, very good outlook.Ìý
MYERS
Alright let's go on, if we may, we're running out of time already but Lorna is waiting in Crewe and I think she's had a mole removed. How did that go and have you got any concerns arising Lorna?Ìý
LORNA
Hi, yes it was a very smooth procedure. There was hardly any pain involved or anything like that - just to reassure anybody that's listening. My question though really is in respect of this melanoma - my melanoma was malignant and I had to go back and have more skin removed - I'm just confused as to what I should do now, how this is going to change my life, I've heard different stories as to whether I'm allowed in the sun, whether I can go on holiday, just basic care of myself now from now on, I just wondered if you could clarify that for me?Ìý
MYERS
Right we've got 30 seconds or so in which we can get some clarification.Ìý
MCGREGOR
Okay, not - it depends very much how early your melanoma was excised, if it was excised early enough and you've been effectively cured - and for most people, I have to say, it will be a curative procedure - then sensible precautions in the sun, pertain just as to everybody else.Ìý
MYERS
Okay thank you very much indeed. I'm so sorry we will have to stop there, more questions, more answers. Thanks very much to our expert though, Dr Jane McGregor, thanks for all your calls and all your e-mails today. If you would like more information on our topic on skin cancer you can phone our help line - the number 0800 044 044. You can, of course, check the 91Èȱ¬ website and follow the trail for Check Up. And I hope you will join me again at the same time next week when in the run up to the Olympics we'll be getting fit, even if you're very unfit.Ìý
ENDS
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