Dr Dan Coit of Memorial Sloane Kettering Cancer Center in New York gave a fantastic talk on the evolution of node dissection and sentinel node biopsy as a technique in the treatment and staging of melanoma at the recent Focus on Melanoma Meeting held at the Royal College of Physicians, London. Recent trials (DeCOG-SLT and MSLT-2) demonstrate avoiding a lymph node dissection after identifying a positive sentinel node is safe, and can spare patients the morbidity associated.
Mr Myles Smith and his colleague Mr Asif Chaudry, a Consultant Upper GI/Oesophagogastric Surgeon based at the Royal Marsden Hospital, appeared in the BBC documentary One Day That Changed My Life. The series follows people that go through dramatic life-changing moments and, in the case of Mark, it was undergoing the first robotic oesophagectomy in the UK using the Da Vinci Surgical Robot. The operation was a success and Mark recently celebrated the two-year anniversary of his surgery.
Whether it’s due to the trend for looking super tanned or a lack of awareness about how dangerous excessive sun exposure can be even here in less sunny Britain, the latest figures show that we are worryingly complacent when it comes to looking after our skin.
Cases of malignant melanoma have increased sevenfold since the 70s and between 2007 and 2016, it killed 26,807 Britons compared to 19,839 Australians. It is now the fifth most common deadly cancer in the UK and there are now more than 140,000 new skin cancer cases diagnosed and 3,000 deaths from the disease every year in Britain.
As well as not protecting ourselves adequately, another issue is that we do not spend enough time checking for any skin irregularities such as a mole changing in shape or colour or new dark spots developing. The British Skin Foundation has joined with skin tracking app Miiskin to analyse attitudes to skin cancer in the UK and in Australia.
It found that almost one in four adults in Australia regularly take photographs to document any skin changes, compared to only 11% of Brits.
Jon Friis, founder of Miiskin, said: “The importance of self-examining your skin is more commonplace in some countries than others and many in Britain are unaware that they should regularly look out for changes.
“Spotting warning signs early can be vital, and a routine of self-examination can help – particularly for those with an increased risk of developing skin cancer, due to their complexion, over-exposure to the sun or use of UV tanning beds.”
Any new moles or marks on your skin should be checked out. If an existing mole changes size or shape, develops new colours or starts to bleed or crust and becomes painful or itchy, then visit a specialist for an immediate medical assessment.
The research that appeared in JCI Insight, the peer-reviewed journal published by the American Society for Clinical Investigation, concluded that increased susceptibility to cancers of the breast, colon, prostate and blood among others, is likely related to mutations in a panel of proteins that repair DNA damage.
As the study’s senior author Kavita Sarin, assistant professor of dermatology at Stanford University, explains: “We discovered that people who develop six or more basal cell carcinomas during a 10-year period are about three times more likely than the general population to develop other, unrelated cancers.
“We’re hopeful that this finding could be a way to identify people at an increased risk for a life-threatening malignancy before those cancers develop.”
Sixty-one people that had been treated for unusually frequent basal cell carcinomas were studied to see if they had genetic mutations in the code for those proteins that repair DNA damage. The research team found that 20% of the group had a mutation compared to approximately 3% of the general population. They were also more likely to have suffered from additional cancers.
This analysis was then applied to a large medical insurance database and found that the more basal cell carcinomas reported, the more likely the person was to have had other cancers.
Basal cell carcinoma is a very common form of skin cancer and about one in three Caucasians will develop it at some point in their lifetime and this research doesn’t mean that you have an increased risk of developing other cancers. However, for those patients that have been diagnosed with several basal cell carcinomas over a short period, it does raise the question of increased screening.
After such a long glorious summer, we probably all suspect that we might have had a bit more sun exposure than is safe. Although getting your daily dose of vitamin D is important, most of us are unsure exactly how much sun you need to generate enough of this essential nutrient while at the same time balancing skin cancer risk.
Attempting to answer this question is Professor Lesley Rhodes of the University of Manchester in a recently published Cancer Research funded study.
Rhodes and her team analysed the impact of exposing different skin types to low levels of UV, in terms of generating vitamin D and assessing DNA damage. Understanding the differences in skin types was important as Rhodes explains: “Quite a lot of information has been gathered on white-skinned people, but there’s been very little for people with darker skin. We needed to firm up our knowledge by looking at the major benefit and the major harm of sunlight at the same time in each person.”
The study found that for darker skin types DNA damage wasn’t detected at the lower level of the dermis where damage is most likely to result in skin cancer. In lighter skin types, DNA damage occurs throughout the layers of the skin, increasing the skin cancer risk.
The other aim of the study was to define a formula for how much sunlight you actually need in the UK to produce enough vitamin D. She teamed up with Professor Ann Webb, a physicist with expertise in the atmosphere and sunlight, and they estimated that we require nine minutes of lunchtime sun throughout the summer months to produce enough vitamin D throughout the winter when production declines drastically.
After those nine minutes, sun protection is key, so don’t forget to protect yourself with sunscreen that is suitable for your skin type and amount of exposure.