Have fun in the sun – but ensure you wear sunscreen

Simone Laube. BGH consultant dermatologist. Skin cancer specialist uses a dematoscope to inspect a mole for signs of cancer.
Simone Laube. BGH consultant dermatologist. Skin cancer specialist uses a dematoscope to inspect a mole for signs of cancer.

OUR love of the sun is killing some of us. And unless we learn to treat it with greater respect, it will kill more of us.

It is a strange contradiction – our bodies need a certain amount of sunlight to stimulate their natural production of Vitamin D, which has several important functions.

For example, it helps regulate the amount of calcium and phosphate in the body. These substances are needed to keep bones and teeth healthy.

And, according to some studies, Vitamin D can help lower the risk of some cancers. However, on the other hand, too much exposure to the sun and we run the risk of developing skin cancer.

TheSouthern recently published an article in which claims had been made as part of a medical research project that the Borders was one of three ‘hot spots’ for skin cancer rates in the UK.

While a controversial claim as far as experts in the Borders were concerned, it does focus attention on the issue of skin cancer – rates of which across Scotland, including the Borders, are rising as a whole.

One person who knows all about the sun and its risks is consultant dermatologist, Dr Simone Laube, who joined the staff of the Borders General Hospital in September.

She studied medicine at the University of Leipzig, in Germany, and, after qualifying, she continued her postgraduate training in the UK and gained a wide general medical experience before undertaking specialist training in dermatology.

Dr Laube received training in all aspects of dermatology, including skin cancer, skin surgery and lasers, and worked as a consultant dermatologist at Aberdeen Royal Infirmary before moving to the Borders.

She is also a member of the British Association of Dermatologists, The British Society for Dermatological Surgery and Scottish Dermatological Society, and has written in excess of 20 publications.

So when it comes to the sun, tans and the question of skin cancer, she is someone well worth listening to.

“There is no doubt that the numbers of melanoma [the most serious form of skin cancer] cases in Scotland are going up, and we are following that trend in the Borders,” Dr Laube told TheSouthern.

“What may come into it for the Borders is that we do seem to have a slighly more older population when compared to other areas. Melanoma tends to become more common the older you get.”

And Dr Laube says our love of the sun is the main culprit.

“It is about exposure to the sun over a lifetime. The older you get, the more sun you have had on your skin. Obviously there can be other factors, but sun exposure is still the most common cause of skin cancer,” Dr Laube explained.

“But it is now more complex than people thought. For example, it may be that sunburn in childhood is a significant risk factor, hence the reason people should make sure children don’t burn, and the advice nowadays is to avoid sunbeds.

“Also periods of intermittent high exposure to sunshine, such as going on holiday to Spain for two weeks a year. Basically skin that isn’t used to coping with intense sunlight is suddenly is exposed and that seems to be relevant.

“But it is also important to state that if you spend a significant amount of time outdoors normally – if you do gardening or walking for two hours – take appropriate precautions. It doesn’t need to be sunny. It could be a day like today, a bit cloudy.

“People shouldn’t forget that there is a risk in the winter also. If you go skiing for example, as the reflection off the snow is significant, or if you are on the water, as water can also reflect asignificant amount of UV (ultra violet) radiation.

“The advice is to use either clothing, such as hat or top with long sleeves and long trousers and consider sunscreen.”

However, Dr Laube pointed out there is also some concern about Vitamin D, which the body produces naturally, thanks to stimulation from sunlight on the skin.

“If people are too restricted, then the body may not be able to produce enough Vitamin D which is important for other body functions. So if you are going outdoors for just short periods, such as from the car to your office, or to the shops, then you don’t need any precautions.

“Those five or 10 minutes of sunshine on hands or face are important for the body to produce Vitamin D.

“But if you do spend significant time outdoors, especially if you have higher risk factors, then you should protect yourselves.”

So what about sun creams and sprays? Dr Laube says it does not matter which type you use. The all important thing is the SPF rating – sun protection factor.

“The SPF is the measure of UVB protecion it gives you and generally the higher, the more effective. Anything below 15 is not much use at all and there are some efforts to actually get those products off the market.

“These creams and lotions are all tested in the lab – something you cannot reproduce in daily life. You will never put a cream or spray on as thickly or as evenly as is done in the lab, so you will never get 15.

“And, if you have risk factors or are going on holiday, aim for at least an SPF of 30. That will also give you protection against UVA and that’s a star rating system which is also on the bottle. You should look at that too and that’s either a four or a five-star rating.

“For children I would go for at least 30 and for UVA, the highest rating.”

Dr Laube explained that there are three main types of skin cancer. Melanoma is the only one which is generally pigmented and is the rarest and most serious.

“Basically, if you have a lesion which is not healing, you should go and see your GP. If you have a new mole or an existing mole which starts changing shape, size or colour and is progressive change, then see your GP,” she said.

Only half of all melanomas start life as a mole. The other 50 per cent appear in normal skin. Dr Laube said it was vitally important to stress one thing about melanomas.

“A diagnosis of melanoma is not an automatic death sentence – that must be stressed. Three quarters of patients are cured by treatment.

“It is also especially important to say the earlier they are caught, the thinner they are. That means the risk of them having spread is lower, so that gives people overall a better prognosis.”

Such skin cancers are more common. In women, they appear mostly on the legs, while on men it is the trunk – areas often exposed most to the sun. And in men it is the older ones that present with most cases.

Dr Laube says lifestyle factors such as the use of sunbeds can play a role in skin cancers.

“In certain areas sunbeds are still popular, especially among teenage girls for whom it is a bit of a fashion statement.

“Tanning salons that use spray-on tans are fine, but some people have started buying melatonin in the form of an injection over the internet to give themselves a tan and we don’t really know what its doing. There have been reports of some people developing large numbers of moles.”

Dr Laube says those at higher risk of developing skin cancer include those with more than 100 moles, more atypical moles, a strong family history of melanoma with two or more first degree relatives affected, or people with red hair, freckles and sun sensitive skin.

She explained: “A mole is a collection of pigment cells. Most people have a few moles – that is quite normal – and they can be blue or light brown.

“We recommend people check their skin once a month.”

Dr Laube says it was in the 1960s and 70s that tans really became popular as people felt it made them look healthy from an outdoor lifestyle.

“In Victorian times, people wanted to look pale because the only ones who had sun tans were manual workers. They got the idea right, just for the wrong reasons.”

However, Dr Laube says she does not want people to avoid foreign holidays to sunny climes or to become recluses.

“But people need to be sensible and take adequate precautions,” she added. “In England, many cricketers who are outdoors for long periods are now being screened for skin cancer. People need to be sensible about the sun.”