Most of us assume skin cancer is confined to hot countries, but it affects thousands here each year. Sylvia Thompson reports
Elizabeth Kirwan was at a family wedding in the summer of 2000 when her mother noticed a spot on her arm. "It wasn't itchy or oozing, but it had gradually become dark brown over the years. I wasn't worried about it but decided to have it checked out nonetheless," says Kirwan, who is 43. Her GP immediately made an appointment with a dermatologist, and within a week she had the spot removed. Biopsy results revealed that she had malignant melanoma, a potentially deadly form of skin cancer. "I was deeply shocked and stayed out of the sun completely for at least a year after the diagnosis."
She went on to have exploratory surgery four weeks later. Fortunately, the cancer had progressed no further. "My consultant told me that had I not had it seen to when I did, I would have been dead within a year. We hear so much about other forms of cancer, but we rarely hear about melanomas. There is a profound ignorance of the whole area of skin cancer. We think that skin cancer only happens to the Irish in Australia."
That Irish people don't take skin cancer seriously enough is borne out by new research by the Irish Cancer Society. Only 9 per cent of the people it surveyed thought skin cancer was Ireland's most common type of cancer. Thirty-nine per centt thought it was lung cancer and 33 per cent breast cancer. And skin cancer is the most common cancer not only in Ireland, where 5,500 cases are diagnosed each year, but also worldwide.
"People don't think of it as a killer and therefore don't think about it as a problem," says Dr Gillian Murphy, a consultant dermatologist at Beaumont Hospital in Dublin. The survey also reveals other misconceptions. Everybody knows that the sun causes skin cancer, but only 2 per cent of respondents regarded childhood sunburn as the main cause of skin cancer.
"Sun exposure in childhood sets the stage for a lifetime risk of skin cancer, especially for basal-cell and malignant melanomas," says Dr Murphy, referring to two of the three main types of skin cancer. "Children up to the age of five should be completely protected from the sun. There is also a false belief that if you tan rather than burn from the sun you won't get skin cancer. Yet those who never get sunburn can also get skin cancer."
Another misconception is that you need to be in a hot climate to get skin cancer. "The survey clearly shows that Irish people perceive the Mediterranean sun to be a lot more dangerous than the Irish sun, yet you can get sunburn and blistering sunburn in Ireland. The danger in Ireland is that we often miscalculate the risk because of our changeable weather. It can be freezing cold and cloudy at 9 a.m. and roasting hot and sunny by 11 a.m. In fact, we are paradoxically at a higher risk in Ireland because of the unexpected nature of our weather. When you go to the Mediterranean, you plan ahead for your two weeks in the sun."
Not that a few hours on a sunbed should be part of your plans. The radiation from sunbeds is even more dangerous than that from the sun, as most sunbeds filter out UVB light to prevent sunburn but allow through UVA light, which damages the skin without the warning of sunburn.
The Irish Cancer Society has been using its SunSmart campaign to highlight the false sense of security that sunscreen gives us. "Most people choose sunscreen as the preferred method of protection, yet you must consider that in a 60g tube there is only enough for two applications. If you were adequately protecting yourself every two hours for two weeks in the sun, it would be very expensive," says Dr Murphy.
"In practice, people don't do that at all. They make their sunscreen last a week, and such inadequate use of sunscreen means people aren't getting anything like the protection factor that is on the bottle. By spreading it out and making it look non-greasy, the average person is putting on about a third of what is required, even for children. A visible amount of sunscreen would feel greasy."
Dermatologists have suggested that sunscreen manufacturers change the sun-protection factors marked on bottles to reflect reality. "We've been asking them to do this for years," says Dr Murphy. "We believe that it is very important to highlight that the protection factor is determined by the amount of the product used."
SunSmart points out that sunscreen should not be your first or only choice for protecting yourself against skin cancer. Nor should you use it as a way of staying in the sun for longer or as a substitute for clothing on areas that are usually covered up, such as your torso and buttocks.
The lower legs are the most common place for women to develop skin cancer; the back is the most common place for men. As with most health matters, women tend to have any unusually shaped or coloured mole checked out earlier than men do (see right). "The majority of cases just need surgery, but the long-term prognosis probably reflects the time the skin cancer was detected, with 85 per cent of women but only 68 per cent of men alive five years later," says Dr Murphy.
Elizabeth Kirwan says she now only goes out in the sun if she is completely covered up. "I've never been a sun worshipper, and I now know that the damage was probably done between the ages of eight and 14. I can remember getting sunburn and sunstroke as a child, growing up on a farm in Co Waterford.
"Getting skin cancer led to a total life change for me, and I am fully aware of the potential danger of the sun. When I'm out mountain-walking now, I cover up completely and wear total sunblock on any exposed areas, such as my hands and my face.
"I continue to go for check-ups and am very lucky that there haven't been any recurrences. But it is vital for everyone to have their skin thoroughly checked at their annual medical."
- You can get more information on skin cancer and the Irish Cancer Society's SunSmart campaign from 1800-200700 or www.irishcancer.ie
Be SunSmart
- Avoid the sun at its strongest, between 11 a.m. and 3 p.m.
- Wear T-shirts with sleeves and high collars and long shorts made from closely woven fabric.
- Wear a wide-brimmed hat to protect your ears, your nose and the back of your neck.
- Apply a high-protection sunscreen (at least SPF15) 20 minutes before going out and reapply it at least every two hours -- more often if swimming or perspiring.
- Wear wrap-around sunglasses to protect your eyes (European Standard EN1836 or British Standard BS 2724:1987).
Easy as A to E
Look out for new lumps or growths, a sore that does not heal or scaling red areas that bleed easily. It is particularly important to watch for changes in moles, as they can indicate malignant melanomas. The A to E rule is a convenient guide to signs that you should have checked out by a doctor.
A is for asymmetry - when one half of a mole is unlike the other.
B is for border irregularity - a spot or mole with rough or poorly defined edges.
C is for colour variation - with areas of tan and brown, black and sometimes patches of white, red or blue.
D is for diameter - when a mole is more than 6 mm wide (bigger than a shirt button) or is growing bigger.
E is for an elevated mole.