Cancer

Hello, and thank you for joining us on this mythbusting session on all things skin cancer.

So Petra to start off with what are the different types of skin cancer?

Well, Zoe, we broadly define them into two groups, melanoma, skin cancer and non melanoma skin cancer.

Most people have heard about melanoma skin cancer, these are the types that we talk to people about looking for changes in moles or new moles,

but actually the much more common skin cancers are the non melanoma skin cancers, such as basal cell carcinomas, and squamous cell carcinomas.

So three types that can be grouped into those two groups.

Okay, and what sort of symptoms should people be looking out for when it comes to skin cancer?

So you mentioned the mole and I think people tend to be aware of that, but what else is there?

So in addition to changes in moles, which I think people are very aware of, I think people are much less aware of the symptoms that you might see with the other two skin cancers, which make up the vast majority of skin cancers we see.

So things like new skin growth, so flesh coloured growths, particularly on the face, head and neck, that develop over weeks and months, they may get little blood vessels on them, they look kind of pearly.

Those are things that need to get checked out and the other things are skin lesions, ulcers, scratches, that don't heal.

So we're looking at things that change over weeks and months, and things that don't heal after three or four weeks, that's not common and probably needs to get checked out.

Brilliant, and then lifestyle factors.

So what are the things that might increase the risk of somebody getting skin cancer, we know that obviously genetics play a role with can't do anything about our genetics.

But what are the lifestyle factors that we can adjust?

Well, the main one is exposure to sunlight.

All skin cancers have a relationship to sunlight, sunlight is UV light and UV light damages the skin.

So we know that sunlight is the major factor.

So for that, that's two things really the amount of time you spend in the sun, which actually can be reflected on how brown your skin goes and whether you've had periods of sunburn.

These are two factors when it comes to sun exposure that increase your risk of skin cancer.

There are other things such as genetics, so if you've got a family history of skin cancer, that can make you more likely to get it especially if there's a family history of melanoma.

and for some people, if they're on certain medications that can make you more likely to have some of these non melanoma skin cancers.

And what types of medications would they be?

So things that affect your immune system, so immunosuppressants are the ones we need to be most cautious about.

Okay. So you mentioned that about genetics.

The next question we can probably do quite quickly is.

Is skin cancer hereditary?

In most cases, it isn't.

However, if you have had someone in the family, particularly with melanoma, it is worth mentioning that especially if you have a change in a mole or a new pigmented mole type lesion that you need checked out. I guess another reason to be really, really careful about protecting yourself from the sun.

Here's one, quick one to deal with, probably.

You can only develop skin cancer by sunbathing? True or false.

I guess the answer is false but also a little bit true.

So sunbathing is exposure to the sun but it's not just lying on a sunbed.

Is that the thing that makes you get skin cancer?

Not at all, it's any exposure to the sun.

So I think people need to change their mindset.

So there are lots of people that work outdoors and they feel that because they're outdoors and they get a base tan, they're protected.

They're actually much more at risk than someone that might spend just one week, a year on a sunbed.

So it's the amount of sun you get and not in what position you are when you get that sun exposure.

And I'm sure you're the same in GP, often the type of patient we will see who's affected by skin cancer will be often men who've worked outdoors. Who've never sunbathed so they think fit they're fine and it's places that the tops of the ears, the nose, those places that are pointing up towards the sun for many, many hours.

Yeah absolutely and if you've not got much hair, so the top of your head, so you haven't noticed it, the chest area shoulders. So really common those kind of areas and you're absolutely right people think because they've not been sunbathers that they're immune from those problems but actually they've they've still got the same risks.

So here's another one. Something I often get asked.

People with dark skin do not develop skin cancer.

Is that true or false?

You know what I wish that was true.

Certainly it's much less common to get melanoma type skin cancers and all skin cancers and people with dark skin because the melanin they have in their skin is a protective factor.

It's the thing your skin produces to protect the skin from the UV rays.

Which is why we do get a tan when we are in the sun because the skins desperately trying to protect itself.

Absolutely but it doesn't mean you're protected and we still get skin cancers if we have pigmented skin and it can be harder to pick them up.

And for some reason, and we don't know why it seems that for people that do get melanoma, particularly in pigmented skin, they tend to have worse outcomes.

So we picked them up later and they're more aggressive.

So it's even more important to keep an eye on your skin and no reason not to use some protection if you have pigmented skin.

And it also protects the skin from other things like ageing as well.

And Bob Marley, not a lot of people know, but Bob Marley actually died of skin cancer.

So he had a type of skin cancer that affected the sole of his foot, we call that area if you get skin cancer, acral skin cancer, and that's what he got.

And really unusual and people perhaps if they see a pigmented lesion on the palm of their hand or sole of their foot it wouldn't occur to them, that this could be a skin cancer but I think if that happens then you know, get to see your GP.

And also on the nail, you can get a melanoma in the skin underneath the nail so worth getting that checked out as well.

Next question.

Tanning beds don't pose a skin cancer risk, true or false?

I mean, I hope this is a well known fact that tanning beds are directly linked to skin cancer risk.

There is no doubt about that the scientific community are really clear, I think there are lots of dermatologists and oncologists would love to see tanning beds entirely banned.

And there are very strict rules around who can use it and how long and the risks are clearly explained to people.

But unfortunately, there are still lots of people using them and the link is very clear.

There should be no doubt about that.

I mean I think in the last couple of decades, we've seen a huge shift haven't we away from tanning beds, to using fake tan and you know, hopefully that will continue and eventually tanning beds will be a thing of the past.

There is no reason there is no health benefit from using a tanning bed and no real reason why you should ever need to use one.

Absolutely.

If your skin tans and you don't burn so you go out in the sun and you turn lovely, beautiful brown without any burning, then you don't need to wear some protection, true or false?

False, false again, So yeah, tanning is a sign of sun damage and we know that UV light causes DNA changes in skin that actually pre makes you predisposed to skin cancer.

So the brown or you are the more sun damage your skin has got.

So unfortunately, a tan, if it's come from sunlight means you're damaging your skin and, you know, premature ageing and wrinkles.

Definitely one of the outcomes but increased risk of skin cancers.

So unfortunately, also false.

But if you are somebody who so, whether you tan beautifully or whether you burn to a crisp, you know, the fact that you're exposing your skin to the sun and seeing changes is a sign that you're damaging your skin.

But if you're somebody who does burn easily, is that damage more significant than somebody who tans?

Well, there's two groups of people I think, we know that people that burn or have had episodes of burning even if you're don't burn easily.

We know that causes significant DNA damage to the skin and will make you more likely to have a skin cancer but people that have long exposure also have increased risk of skin cancers, different skin cancers, admittedly but still problems in the future.

If you are someone with very fair skin and you do burn easily however, your overall risk of skin cancer is higher than if you're someone who tans easily.

So I think that may be where this information might be misunderstood.

I can easily therefore it's protective, not true.

You can easily maybe your risks are lower than someone who burns easier, but it doesn't mean it's protecting you.

Brilliant. Great.

Then what about choosing the SPF the number so the question Is a higher SPF means you can spend more time in the sun?

SPF have been designed and explained in such a way that the higher the SPF, the longer you can stay in the sun before you burn.

However, truthfully the higher the SPF, the better protection you're giving your skin from sun damage.

I mean that's the simplest way so really you should use the highest SPF you can get your hands on for the best protection from the sun. And actually if you do want to go a slightly brown colour and those people do when they've been on holiday you will still tan through SPF 30 or SPF 50.

You are just less likely to burn and there'll be less damage to your skin so the higher the better.

So continue with some creams then the next question is.

My kids don't need some cream a cotton t-shirt in the sea or pool is fine.

True or false?

Oh false, I wish it was true because putting sunscreen on children is a giant hassle.

But no it that's not enough some protection there are some clothes that have SPF and that's great. But my tips are put tonnes of sunscreen on but do really early so before you even leave the house or when you're getting your kids dressed to go to the beach. I used to get my kids are gonna hate this pretty much naked and cover them in sun cream and then put their swimmers on and then you've covered all the areas. So sun cream early before you leave the house and then put it on really frequently and really liberally.

I mean the temptation as a family is to try and eke out but you need plenty on. So plenty on nice and early in the day and reapply frequently, All the more reason actually then to buy the higher factor because they cost the same price whether you get in fact 15, or factor 50, and you're getting better protection with the factor 50.

Okay, next question. This is an interesting one.

Do you need to put a sunblock or higher sunscreen on moles?

Should you be spotting yourself.

Common misconception so although some people with lots of moles, a higher risk of skin cancer, it's not necessarily that it's the moles that will be affected?

It's the whole skin and actually most skin cancers don't originate in a mole.

So put your suncream everywhere.

Same thickness all over you don't need to l ook like you've put your calamine on chickenpox.

Next one that is about moles.

What signs should people be looking out for?

What is the sign of concern?

When should you go and see your doctor?

So the things we're worried about as doctors are changing moles and changing over a short period of time over days and weeks many people's moles might change over years.

That's not to be concerned about its changes in shape, colour and size. Any crusting or bleeding and if the colour appears to be bleeding out of the mole or suddenly looking very dark and different some people call it the ugly duckling mole. It looks completely different to any other mole that you've had before or currently have.

And I think a good tip as well is if you're not sure, take a photograph of it. You know cameras just phone cameras now zoom in take a photograph in good light and take you know do that weekly, monitor it and then you can look at it see if it's changing if in doubt.

It's so helpful for a doctor if you come with this was a picture three weeks ago this now and if you can put something next to it for kind of size comparison a ruler or tape measure. And especially with all the virtual consultations it can really mean that you can have a mole safely assessed if you've taken those pictures. So completely agree it's What you do even if you have to wait for your appointment is send an E consult with the pictures and as a GP you love that. This is brilliant.

I've got all the information I need and if there is concern we're probably going to bring you in sooner.

Thank you so much for joining us.

I hope you found that both interesting and useful.

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