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Programme 3. - Sun Damage
RADIO 4
THURSDAY 16/08/07 1500-1530
PRESENTER:
BARBARA MYERS
CONTRIBUTORS:
RINO CERIO
PRODUCER:
JOHN WATKINS
NOT CHECKED AS BROADCASTbr />
MYERS
Hello. Well here's the fact of the matter - sun tanned skin is sun damaged skin. And you don't have to sit on a hot beach to catch the rays, even dull cloudy days, like today, can allow enough ultraviolet light through to cause skin ageing, however young you are. So apart from staying out of the sun altogether what can we do to prevent wrinkling, blotchiness and worse. Skin cancer is on the increase. But how can we tell if those brown spots or rough patches are an early sign of cancer? And if it is how can it be treated?
Well put your questions about sun damage to our expert today, he's Professor Rino Cerio, consultant dermatologist at Barts and the London and a man with scarcely a tan. So you keep out of the sun as a dermatologist do you Rino?
CERIO
I don't seek it Barbara but I must say I still go on holiday and the sun makes you feel good doesn't it, so I wouldn't say to anybody not to do that.
MYERS
Well it does make you feel good and that may be part of the problem. Ed Kinge has phoned us and he's actually suggesting that the sun is good for us, that's what you hear I gather Ed.
KINGE
Yes I've read of research which indicates that the - exposing the skin to sun creates vitamin D which can act as a protection against some cancers, in particular prostate cancer and as a 70-year-old man obviously is of interest to me. So I'd like to ask the professor about the balance - how much exposure is good and how much is bad.
MYERS
And the word balance is an interesting one.
CERIO
I think that's the point. Cancer Research UK are saying all the things that people know now - not to get sunburnt - but they say have a little casual sunshine, I'd say 20, 30 minutes a day to get your vitamin D, you don't need much sun to get the vitamin D and of course it's in quite a few foods - fish oils and vegetable oils etc. So you're absolutely right sir but the thing is that those that are at a risk - and that's very fair people, people who are also getting older who travel a lot and have a family history of course can get themselves in trouble with a lot of skin cancers that can be sometimes even worse than prostate problems.
KINGE
Yes, yes I see.
MYERS
Thank you very much, that's a very good point to start with. We'll move to another caller though - Yvonne is waiting to speak to us, Yvonne who's fair skinned and has got some sun damage, where is the sun damage Yvonne?
YVONNE
It's on my face and it's sort of underneath my eye - on my cheek really, the top of my cheek and I also get it on the - it's worse on the left hand side but I also get some on the right.
MYERS
What does it look like - a brown blotchy patch?
YVONNE
No it's - it was red and it was a spot - a big sort of - well I suppose about half an inch across which I had for months and months and months and months and eventually the doctor sent me to see a specialist who gave me some cream which I had to put on and then it brought it out, extremely red - I mean I was going to a wedding and she said don't put it on before you go to the wedding.
MYERS
But you did.
YVONNE
No I didn't, I didn't do it till afterwards ...
MYERS
Just as well.
YVONNE
Yeah it really - and it takes ages and she said it may never turn to cancer but it may.
MYERS
So you want some more information about the outlook?
YVONNE
Yeah because I still get a very red face and I'm using factor 50 sun cream and I wear a hat and try avoid going in the sun you know.
CERIO
I mean I think what this lady's talking about is what's called actinic keratosis or solar keratosis. The Americans have a very good term for it called sun warts and I think that's quite nice because it takes away the fear that in fact it is life threatening. Certainly it's not life threatening for you. However, the damage which has been accumulated over the years has now resulted in some skin that I'm afraid doesn't grow very well and gets inflamed. And I think what the doctors have done is given you some quite strong treatment to sort of destroy the bad bits, if you know what I mean, and that's why you reacted. Now you've now got to be careful in the future, I assume you're going to live a long time, you're going to enjoy going out in the sunshine, but you know once you've got this, this is a risk, this is telling you that you're very vulnerable to more of this solar keratosis. And although you can have some treatment there's no substitute for avoiding as much damage in the future. To sort of turn the clock back would be very difficult and this isn't the type of damage that even responds terribly well to what you see as anti-ageing type creams that you hear so much about on all these TV programmes and the magazines.
MYERS
Thanks for your question Yvonne. So it sounds as though unfortunately the damage is done. I wonder if I could take this on with another question that I've had e-mailed from Susan Graham who says that while on holiday I got sunburn on my face, it cleared up, but she says that ever since she's had a small patch of skin on the face which is red, sore and itchy - about the size of a 5p piece. Is this as a result of the sunburn?
CERIO
Absolutely and it sounds exactly what this other lady had and I always say to my patients this is actually a risk factor for you now and while you can treat it - and we're quite good at treating those things - but the thing is they do tend to reappear elsewhere on other sun exposed sites. And of course the more risk you are, i.e. if you're fair skinned, if you have a lot of sun exposure and of course the older you are the more of these you get. And those that get multiple ones they are also higher risk of developing a more serious skin cancer like a non-melanoma or even a melanoma skin cancer.
MYERS
And I think Yvonne mentioned a high factor sun protection cream, is that helpful?
CERIO
I'd say yes but it's part of doing the whole - you have to do a little more than that, you mustn't rely totally on a sunscreen, remember a sunscreen is not completely a blocker and it's only a ratio to reduce the penetration of sunlight and it's a bit like a cloudy day that you mentioned earlier on - you can still get UV light through. So you know there's no substitute for a hat, somehow we've lost the fashion, haven't we, where ladies where large broad brimmed hat, we sort of survive on those baseball caps now that expose our ears and things. But you know a good Panama, I say to the gents, a nice broad brimmed hat and then of course make sure that your back's not exposed by putting a T-shirt on, sunglasses and then being careful not to go during the highest exposure times, i.e. over, you know, 11.00 till 3.00.
MYERS
We've got Andrew Price waiting to speak to us who's I think interested in what kind of sun creams to use, sun blocks and so on. Andrew, do you try to protect your skin when you're out and about?
PRICE
Oh absolutely I always do. I don't go brown, I mean I can go out in the sun for hours and I come back kind of jaundiced and I then go white again, so it's absolutely pointless. But you know I used to get sort of what I call patches underneath my eyes which are little brown patches so that if I haven't put anything on my face they then appear. But you see all these different kind of sun creams and that sort of thing and you see information on the chemical sunscreens and the physical sun blocks, on the back of some of the sun creams there's a whole list of chemicals and of course you're absorbing them into your skin, I'm sure some of these chemicals are not good because what they're doing is they're absorbing the energy from the sun and dispersing it within the skin rather than reflecting it, which is what a physical sun block does. So what is your advice, I mean is that just sort of industry jargon that I've picked up or what kind of information can we have?
MYERS
You made a very good point - you're between a rock and a hard place - if you put these creams on your face you might be doing damage from the chemicals in them.
CERIO
And you take that a little bit further - there are some people that sort of use so many sunscreens that in fact then in a way encourage them to expose more sunshine and you can get a reverse statistic showing that those that use a lot of sunscreens get more skin cancer. So we're in a very complicated situation here to sort out. But I would say again that sunscreens as such are helpful. Now the physical ones are a lot - you know the ones cricketers wear...
MYERS
These are the white ones that you see on.
CERIO
The white ones that are sort of physically based probably are safe. The chemical ones - you're right, you know years - in years time maybe some of these are shown to be possibly problematic...
PRICE
My sister when she puts on - well when she used to put on the sun cream she would come out in the most terrible rash, whatever sun cream it was, even if it was hypoallergenic.
CERIO
Yeah, yeah well hypoallergenic really doesn't mean anything if you're allergic to it and people do increasingly present with allergies, contact allergies, to sunscreen and particularly those that are encouraged to use it. So it is awkward this, it's difficult.
MYERS
Is it a matter of trying out various ones to see what suits you best?
CERIO
I think always remember that the highest number you can tolerate is best, that looks pretty good, it doesn't have to be expensive, people are tricked into thinking that the more expensive the better. The other thing is to remember to use also a combined UVA and UVB because sunscreens can be one or the other or indeed not necessarily the two together. So you want a broad sunscreen and remember that one application isn't enough, if you're out all day, particularly if you're swimming or sweating etc., you need them. But again going back to covering - being aware - a lot of the Australian publicity now is about sun awareness and sun avoidance, so remember the trees, remember the umbrella, remember the hat.
MYERS
And what's a sun protection factor, as it were, it's not worth bothering below, is there a ...
CERIO
Oh absolutely I mean you know people say well I start with an 8, well you know you've wasted your money there, you might as well have a little bit of just moisturiser. So I think you know don't buy anything less than probably a 15-20.
MYERS
Okay, thanks very much. We'll go to another caller and we've got Rupert Henley waiting to speak to us with spots on the head which bleed, doesn't sound very good Rupert, can you say a bit more?
HENLEY
Hello.
MYERS
Hello. Tell us a little bit more about the problem you're having.
HENLEY
Yes I'm 84 and I have fair and dry skin and on top of my head for quite a long time now I've got these patches of light brown and reddish marks and I always wear a hat, if I leave it off for two minutes I get trouble, I'm just - a few questions on this if I may.
MYERS
You choose a main question if you will.
HENLEY
Yes, yes right. Should I ever wear sunscreen, I only at the moment use [name] moisturiser?
CERIO
Right hello. Well your scalp's 84 years old sir isn't it and it's had a - although you're very fair you obviously can't take much sun. But as I said at the beginning this is all cumulative. I wouldn't be too worried about the brown ones, they're probably very large freckles, some cruel doctors will call them age spots but you can see them in even 35-40 year olds. But the red - the red scaly ones, they're a little bit like our earlier caller, I think was Yvonne, that remember these are sun warts or actinic keratosis and solar keratosis and I think if you went to your doctor there are now a couple of preparations that you can use to try and dampen these down to control them, some are a lot stronger - I think our earlier caller had something quite strong perhaps because she was a little younger. But your moisturiser, your [name] is still not a bad thing but if you wanted to shift them a little bit. What you must look out for really is if any - if a lump developed, in other words if you've got something that's appeared about the size of a pea or a grape then that would be very worrying because this area obviously is at risk.
HENLEY
I had a large red area and I saw the doctor 10 days ago and he gave me - can I mention the name?
MYERS
Go ahead.
HENLEY
Solaraze.
CERIO
That was one that I was - that's one that's available yes.
MYERS
So you'd approve of that.
HENLEY
And that has formed a white scab and I'm just wondering whether I should continue using that, it irritates quite a lot using it but should I continue?
CERIO
Well you know when you've got something that's not normal skin and it's already inflamed sadly anything that's going to try and get rid of that will also irritate a little bit, so you have to persevere a little bit. It does take a long time - solaraze - you need to put it on sometimes up to twice a day and they say up to 90 days. I always say pace it the way you - the way you can. It's an interesting product because it originally started life as something they used for joint pains and they noticed that when they used it in Australia the Australian pale skin - they say tennis players - got better. So I would say that that would be worth persevering a bit sir.
MYERS
Thanks for that call and is that a reassurance that it won't go anywhere beyond the keratosis that it is, it's not going to develop into something more serious is it?
CERIO
It's a good question, I think that the company would like to - and they're doing long term studies on it to see if you can actually reduce the risk - but I think that that's still out for .. you know. But clearly it seems a sensible way to go. You don't have to treat these unless they've become symptomatic and indeed some of them do improve, some people say well look they only appear, like that gentleman, when he's exposed to the sun, they get worse. But in the winter they can actually dampen down a little bit and some can disappear but they will reappear.
MYERS
Let's take a call from Penny Dowell who I think has had a brush with skin cancer. Penny, your question for our dermatologist today.
DOWELL
Yes that's true. Good afternoon. I've just had a melanoma diagnosed and removed from my face. It was a painful operation and it needed a reconstruction skin graft. But I love the outdoors - gardening, sailing, walking - so my questions are does my skin remember that there has been a cancer there and how can I reduce the risk of any recurrence of it?
CERIO
Well certainly a melanoma statistically is going to behave according to the depth it's already grown to, so you know every melanoma I say to patients is unique to that person. And I think with regard to one on the face I suspect it was a lentigo malignant melanoma - is that correct?
DOWELL
It was a coal coloured one which they diagnosed purely by colour.
CERIO
Right, well the thing about - if they didn't tell you how deep it was then very often the depth will give you statistically how - the chances of it coming back. I assume that you're going to be followed up, the normal practice is that depending on the depth you come back three to four monthly, sometimes six monthly if it's not too big. And then - but you certainly have to be followed for five years.
MYERS
Penny what I'm hearing in part of your question was that you do like to be out in the skin, are you wondering whether it's safe to go out in the sun or whether indeed that would possibly exacerbate matters, is that part of what you're asking?
DOWELL
Yes I wonder if I'm a greater risk.
MYERS
No, he's shaking his head I'm afraid.
CERIO
I think that without being a spoilsport and I think you should enjoy the sunshine but you know people who have a lot of sunshine you can show that it dampens the immunity, the thing that actually protects you against cancer, so I would say that having had a malignant melanoma the one thing you should do is to certainly enjoy your garden but with all things we've been talking about.
MYERS
Thanks for that question. We've got a caller, Uche's on the line, and I think has got a Nigerian background and of course we tend to think that perhaps it's only people like me with that sort of fair sandy sort of hair and skin that suffer but that may not be the case. Anyway Uche what's your question?
UCHE
Hello. Hi, yes I just wanted to know what kind of advice you provide for someone of my complexion. I would probably describe my complexion as being just slightly lighter than Beyonce and as you said we usually just tend to think that skin cancer is not a problem that tends to affect black people because we've got high levels of melanin in our skin. But I was quite shocked recently to find that I'd burnt when sitting in the park.
MYERS
Did you feel it or did you see it or both?
UCHE
I felt it the next day because I was sitting there and enjoying myself, having a chat and then it was the next day when I was taking a shower and putting on some cream that I saw I was red and I was stinging all over, across my shoulders in particular.
CERIO
I'm glad for this question because you're absolutely right all skin types are vulnerable to skin cancers and there's no doubt that even darker people can get sunburnt. I think some figures have been worked out that even some Asian to black skin is really a pf protective factor of no more than 8-10.
MYERS
You mean the natural protection within the skin.
CERIO
The natural protection - the amount of melanin which is quite low. Now if you look - if you're like Beyonce ...
MYERS
In every way.
CERIO
I would have said - I would have said that would be pretty - you know you'd be very vulnerable. So you have to be careful and also remember that the darker the skin the less it ages but that's also because a lot of individuals from these hotter countries know how to treat the sun with respect and of course you know if you look at darker older - perhaps some of your relatives - you'll see that they age very well than maybe some of your whiter paler friends older relatives. So ..
MYERS
Because it is only mad dogs and Englishmen that go out in the midday sun isn't it?
CERIO
And it's those that get burnt, it's short sharp sun - because every sun exposure will always give you a certain degree of damage - DNA damage.
UCHE
Does it?
MYERS
Thanks very much for that call. Another one now from Hexham, Julia Grint is waiting to speak to us and again has had a melanoma removed and this is a serious skin cancer. So your point or question please Julie.
GRINT
Hello, yes it's really a point and it's sort of bearing on what the gentleman was saying just before though which is that I have a skin that tans very naturally and easily and I don't burn at all easily, I've got to be in ferocious sun before I burn. But I did get this melanoma, this is about 15 years ago now, and it was on my forearm, which I would have thought was fairly sort of strong and robust and it had gone - this is the other thing, bearing on what you were saying, it was actually quite deep before - it was my mother who sort of forced me to go to the doctors and it already had - I had a 20% chance of it having spread to my lymph glands. So it was a horrible experience, it was really ghastly. And I just wanted to say you know that people who think that they're safe because they tan easily it's not so, not so.
MYERS
Thank you, very salutary words. And can we just get a sort of little thumbnail sketch, Professor Cerio, of the - what you should be looking for if in fact you're worried that a spot - because we've all got spots, I've got lots of them - moles and so on - but when should I be worried about any one of them as possibly indicative of an early melanoma?
CERIO
Okay. Of course freckles are not moles in the strictest sense because they're not - they consist of colour and only - and not cells. And usually if you've got multiple freckles, it's usually relatively easy to tell the difference. But if you have moles which can raise they're very easy to identify. Remember a good rule of thumb: It's the odd one out that you need to be aware of, not necessarily the one that bleeds and itches because they're very difficult symptoms, you know if you catch it etc. But anything that's - if you can't - if it's bigger - if you can't cover it with the end of the rubber on a pencil, which is seven millimetres, if it's asymmetrical with a ragged border not a sharp border, it's not one colour. So we've got asymmetry A; B for border; C colour and then diameter for D. If those things - and I always encourage patients to take a photo and see what happens over the next few months because these things are not quick, they can take a year, they can take 18 months even two years to evolve. And so the thing is that if they've got a little documentation now, everyone's got those mobile phones and things, they can see with a tape measure, that's a good way to monitor.
MYERS
And can these moles be out of sight, as it were, in places where you wouldn't expect the sun to shine?
CERIO
Yes we mentioned the earlier caller, with very dark skin of course they get - it's hands and feet, around the nails. But in general 50% of melanomas occur on the back in males and these are individuals who say they don't sunbathe but of course they all take their shirt off and outside work etc. And ladies, it's no surprise, it's on the legs. So the forearm in that lady is down to exposure and I'm sure it was on the sun exposed side. Very rarely do you get a birthmark but that can happen if it's a particularly large birthmark.
MYERS
We're going to Biggin Hill in Kent for another caller Phillip Tussill is waiting to speak to us, I don't know if it's sunny there but apparently you - you don't get sunburn, Phillip is that right?
TUSSILL
Well I tan very easily and I don't generally get burnt unless I've abused myself which generally speaking I don't sunbathe I just enjoy the sun. So my question really is because it's a little bit frightening listening to some of this advice because it's almost as if we shouldn't be out in the sun almost at all and I don't tend to use sun cream lotions and things because they're messy and oily and horrible. So what should I be doing, should I be always covering up which I don't really like or is a small amount of exposure a day okay?
CERIO
Without being alarmist I think we've got to remember that our world's getting hotter, we travel more, we actually have more leisure time and I think the thing is, as we've heard right at the beginning, the number of skin cancers is going up. The non-melanoma skin cancers, the type that are much, much commoner, you've got a 7 out of 10 chance of getting one of those after the age of 60. With regard to melanomas now the - there are 2,000 deaths a year in this country, which is more than the deaths in Australia and there are 6,000 new cases every year. So this is a problem that has evolved and has got worse and worse over the last couple of decades.
MYERS
There is no hiding from it. Thank you very much, we finish there I'm afraid. Thanks to the many people who have phoned in today, thanks to our guest Professor Rino Cerio. If you want more information you can always go to our website and listen again. You can call the Radio 4 action line 0800 044 044.
And join me again the same time next week, if you will, when we'll be taking questions on overactive or do I mean hyperactive children?
ENDS
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