Believe it or not, it is now summer!
We were just talking in the dermatology department at Orpington about the unpredictability of the weather.
That day, one of the team had turned up to work in a summer dress, thick opaque tights, wellington boots and a raincoat!
However, despite the weather, it is still that time of year when we all try and opt for lighter, summery dresses and short sleeve tops if we can – and start thinking about our summer holidays.
Because of this, a lot more of our skin is on show, so to speak, and moles and spots that have been hidden for the great majority of the year are now evident for all to see.
It is important, even in a British summer like this one, to be careful in the sun and this is especially important if you have fair skin, fair hair and with lots of moles – and especially if you have a family history of skin cancer.
You can get sunburnt at home, let alone on holiday. The ultraviolet (UV) index is a way of describing the strength of the sun’s rays at the Earth’s surface – and the higher the value, the greater the damage from the sun and the less time it takes to damage your skin.
You can check the global solar ultraviolet index, or UV index for different parts of the UK and Europe at the Met Office website, www.metoffice.gov.uk. In the UK in the summer, the UV index might reach 7.
Between October and March in the UK, it is normally less than 3 and at this level, even people with fair skin do not need to protect themselves.
Summer Sun = higher risk
From April to September it’s a different story.
The strongest sun is from 11am to 3pm. Dermatologists advise you to avoid the mid-day sun, especially for children. High factor (at least SpF 15), broad spectrum (ie 5-star UVA rated) sunscreens are recommended when in the sun and these should be applied regularly and liberally.
Simply wearing clothes, eg swimming with a swim-top or t-shirt can be more protective than the highest factor sunscreen. Avoidance is best, so sit in the shade, wear a broad-rimmed hat that covers your ears and neck, plus long-sleeved cool linen tops and baggy long trousers.
What about sunbeds?
Some of you may be thinking about trying for a sunbed tan before going on holiday.
There is a myth that a tan before you go on holiday protects you from the stronger sun whilst on holiday. In fact, a tan only offers you a benefit equivalent to a sunscreen of SpF 2 or 4 which is definitely not enough to protect you from strong sun.
Plus, the ultraviolet rays from a sunbed are some 10 to 15 times stronger than that of the sun and so are far more damaging.
Don’t be mean with sunscreen!
I do also sometimes hear patients say that they are very good at putting sunscreen on; when pressed, they actually mean that they put it religiously only on their face daily or only on their moles.
It is wrong to assume a skin cancer such as melanoma will only arise in a mole. Melanomas can arise from a mole, but in the majority of cases, a melanoma develops from normal skin, so it is very important to put sunscreen all over and not just on worrisome moles.
Can sunscreens increase the risk of skin cancer?
Some patients say that they have heard that sunscreens can increase their risk of skin cancer and are not good for their health. This is not true; it is more often that wearing a sunscreen makes the person feel as if they can stay out in the sun for longer and do not re-apply the sunscreen frequently enough, rather than the sunscreen being at fault.
Also, we all need the sun for Vitamin D but around 20 minutes of sun per day (before 11am or after 3pm) should be enough. The amount of sun you need to keep your Vitamin D levels healthy is never an amount that would redden or burn the skin.
How exactly does the sun damage your skin?
Even if you do not burn in the sun, the UVA rays from the sun (which are a type of UV radiation) cause damage to the DNA in skin cells. Repeated damage gives rise to the skin changes which in time will lead to skin cancer.
When the skin tans, it is a response by the pigment producing cells in the skin to produce more melanin or brown pigment. Tans are never permanent, but with time, irreversible changes can occur in skin that is exposed to a lot of sun.
Firstly, there is premature skin wrinkling.
Also, permanent brown spots can occur on the skin. These are called “lentigos” (or colloquially, ‘liver spots’.)
White spots and pink scaly spots can also develop called actinic keratoses. With time, these could theoretically develop into another form of skin cancer called “squamous cell carcinomata” (SCCs) and these can also spread to involve other organs.
Another form of skin cancer, called “basal cell carcinomata” (BCCs) can also develop in skin that has been exposed to lots of sun.
BCCs do not spread to internal organs, but grow slowly on the skin. They tend to cause little bother and so some people do not go to their doctor until they are quite large. The only treatment is surgical and depending on where they are, may need plastic reconstructive work.
Protect and Enjoy!
A lot of scary talk! And us dermatologists do sometimes feel as if we are telling people off a lot, especially if they turn up for an appointment excessively tanned or even burnt!
We are saying that it is perfectly okay to enjoy the sun and go on holiday to sunny places, but do be responsible in the sun. Often the damage to your skin from the sun lasts far longer than your tan.
Dr Sandy Flann, Consultant Dermatologist