skin cancer risk

May is Skin Cancer Awareness month! Everyone is at risk of developing skin cancer, but some people are at an increased risk.

If you include yourself in any of the below-listed groups, please be extra vigilant to check your skin.

  • Fair skin and get sunburnt easily
  • Previous history of lots of sun exposure and especially blistering sunburns
  • Lots of moles (>50)
  • Unusual looking moles
  • Family history of skin cancer
  • Personal history of skin cancer
  • Previous sunbed use
  • Immunosuppressed people
  • Outdoor workers

If you are worried about a skin lesion, mole or spot please consult your GP or Consultant Dermatologist immediately

Leading London dermatologist

Congratulations to Andrea Maurichi for publication of his paper, ‘Factors Affecting Sentinel Node Metastasis in Thin Cutaneous Melanomas’, in the current issue of Journal of Clinical Oncology! I am thrilled to be a co-author.

This paper provides a nomogram that assists the clinician in determining the likelihood of positive results of sentinel lymph node biopsy (SNB) for thin melanoma (T1, ≤1 mm).  https://ascopubs.org/doi/abs/10.1200/JCO.19.01902. We propose the nomogram as a decision aid in patients with T1 melanoma being considered for SNB.

The development cohort included 3,666 patients with T1 disease treated at the Istituto Nazionale Tumori (Milan, Italy) between 2001 and 2018. Patients treated at 13 other European centres formed the validation cohort (4,227 patients with T1 disease).

Within the development cohort, 1,635 underwent SNB; 108 patients (6.6%) were SN positive. Age, growth phase, Breslow thickness, ulceration, mitotic rate, regression, and lymphovascular invasion were significantly associated with SN status by univariable analysis. The random forest procedure selected 6 variables (not growth phase) for inclusion in the logistic model and nomogram. The nomogram proved well-calibrated and had good discriminative ability in both cohorts.

London mole check

May is Melanoma Awareness Month and all this lovely weather means it’s time to check your moles! The ABCDEs of melanoma is a guide to help you check your moles. Early detection of melanoma is key.

Mole Check: A is for asymmetry

Check that both halves of your moles are the same and match each other

Mole Check: B is for border

Are the borders or outlines of your moles irregular?

Mole Check: C is for colour

Is the colour pattern regular or are there varying shades of browns, tans, white, red or blue visible?

Mole Check: D is for diameter

Melanomas are usually greater than 6mm in diameter –  bigger than a pencil eraser

Mole Check: E is for evolution

Is your mole or spot changing over time?

If any of your moles are showing any of these signs please consult your GP or Consultant Dermatologist immediately

physical vs chemical sunscreen

What is a mineral or physical sunscreen?

Physical sunscreens consist of mineral ingredients namely, zinc oxide and titanium dioxide. They work by sitting on top of the skin and they reflect and scatter light in a similar way to clothing.

Zinc oxide protects against a wide range of UVA including UVA 1 (340 to 400 nm). It is very photo-stable and does not react with other UV filters. It is more effective than titanium dioxide in regards to UVA protection however, it is less efficient against UVB radiation. Titanium dioxide protects against UVA 2 (315-340 nm) and UVB, but does not protect against UVA 1 as does zinc oxide.

What are the pros and cons of physical sunscreens?

Physical sunscreens work as soon as they are applied on the skin. They are unlikely to irritate the skin so they are good for sensitive skin types. They can also be good for rosacea skin types or patients with redness as they deflect heat from the skin. They are less likely to be pore-clogging so they are good for acne-prone skin.

They also last longer when in direct UV light, however, they can be rubbed off much more easily than chemical sunscreens especially if in contact with sweat or water. They can often leave white streaks or a white chalkiness on the skin so they are not ideal for under make-up and can be difficult to use for darker skin tones. They tend to be thicker requiring more effort to rub in.  They also tend to have a longer shelf life.

What is chemical or organic sunscreen?

Chemical sunscreens contain organic (carbon-based) compounds e.g. oxybenzone, octinoxate, octisalate and avobenzone. They create a chemical reaction and work by changing UV rays into heat and then release that heat from the skin. They consist of UVA and UVB blockers. Their structure allows for light to be absorbed.

What are the pros and cons of a chemical sunscreen?

They are usually thinner formulations which makes application easy, they do not cause much white streaking and spread easily. They are much more resistant to sweat or water compared to a physical sunscreen. They only start to be effective about 20 minutes after application to the skin and they require frequent reapplication as its protections get used up more quickly in direct sunlight. They are more likely to be irritating and the higher the SPF, the higher the risk of irritation. They can increase redness in rosacea-prone skin types and they can also clog pores causing an acne flare.

Physical vs chemical sunscreen, which is best for you?

The simple answer is… the one that feels the most comfortable on your skin. If you’re an oilier skin type you will want to choose one that is lightweight and not greasy. If you have sensitive skin that gets red easily you’ll want to find one that doesn’t irritate. If you have a darker skin tone you will want to choose one that doesn’t look chalky on the skin.

Both chemical and physical sunscreens do a great job of protecting your skin from the sun. The most important thing is to find a sunscreen that you like the look and feel of so that you are inclined to use it frequently and reapply regularly.

If you are concerned about the compatibility of your skin and a new sunscreen performing a simple patch test on your inner arm is a good idea, before using it all over your face.

For more advice, arrange a consultation with Dr Kara Heelan at either the Chelsea Outpatient Centre (020 3494 4024) or Sydney Street Outpatients & Diagnostic Centre (020 3733 9029).

photoprotection

Photoprotection – or the use of regular sunscreen – is encouraged by doctors and dermatologists because they are aware that our outdoor work and lifestyles mean that complete sun avoidance is not possible.

What is photoprotection?

  1. Why do we need photoprotection? Photoprotection is required to reduce ultraviolet (UV) radiation-induced skin damage, photo-ageing and skin cancers. Photoprotection includes sunscreens, clothing, hats and sunglasses.
  2. What is UV radiation? UV radiation affects the skin by causing ageing, sunburns, precancerous lesions, cancerous lesions and immunosuppression. There are 3 types of UVA radiation: UVC, UVB and UVA. UVA is associated with ageing and pigmentation, it produces free radical oxygen species, indirectly damaging DNA. UVB causes sunburn and DNA damage associated with non-melanoma skin cancers.
  3. What is SPF? SPF stands for sun protection factor and indicates the degree of sunburn protection given by sunscreens. It is a primary measure of UVB and to a lesser extent UVA. For a sun cream to be effective it needs to be applied liberally and 20 minutes before going outdoors.
  4. What type of sunscreen should I use? A broad-spectrum sunscreen, which involves UVA and UVB coverage, providing water resistance and a high sun-protection factor (SPF 30 or 50) should be used. Included in many sunscreens are antioxidants such as vitamin C, vitamin E and green tea polyphenols which can give additive protective effects. You may need to change the type of sunscreen you use according to what activity you are planning to do.
  5. How should I apply sunscreen? Apply 20 minutes before sun exposure. Reapply after 2 hours, after sweating or swimming. An adult requires 30 ml /body (2 tablespoons), with a teaspoon (5ml) used on the face, head and neck. For children the requirements vary according to size for example; 3 years: 10 ml (2 teaspoons), 7 years: 15 ml (3 teaspoons), 10 years: 20 ml (4teaspoons)
  6. Is it ok for babies to wear sunscreen? It is safe and recommended to use sunscreen in babies over 6 months. The best way to ensure babies and children are protected is to provide as much shade as possible, use protective clothing, hats and sunglasses. Physical sunscreens are less likely to irritate sensitive skin and eyes.

It is recommended that parents of babies under 6 months should consult a doctor before sunscreen use. This is due to the lack of development of metabolism and excretion of the chemically absorbed agents within sunscreen. If sunscreen is necessary, it should be limited and infrequently used on sun-exposed regions only.

For more advice on photoprotection, arrange a consultation with Dr Kara Heelan at either the Chelsea Outpatient Centre (020 3494 4024) or Sydney Street Outpatients & Diagnostic Centre (020 3733 9029).

dermatologist check-up

Patients are often shocked when they come for a dermatologist check-up and a full-skin examination is required. To help you make the most of your consultation, here are a few tips.

A full skin examination performed by a dermatologist is a great opportunity and should be availed of at your appointment.

What happens during a dermatologist check-up?

The exam itself is usually very brief, taking just a few minutes. It entails removing your clothing so that the dermatologist gets to visualise all of your skin. It is important that your whole skin is visualised so the patterns and types of mole you have are seen.

The more moles you have, the longer the exam will take. If unusual moles are noticed, you may be sent to the photographer for close up images to be taken of specific ones, so that these can be monitored over time. Sometimes your dermatologist may suggest taking a biopsy from your skin.

A biopsy means taking a sample of a small piece of skin that can be examined under the microscope. This is performed under local anaesthetic.

Remove nail polish from fingers and toes before examinations and be prepared to take off make-up if necessary – so bring some supplies in case you need to reapply. Don’t wear fake tan as this will make the examination more difficult and not as accurate.

A dermatologist check-up with Dr Kara Heelan will take place at either the Chelsea Outpatient Centre (020 3494 4024) or Sydney Street Outpatients & Diagnostic Centre (020 3733 9029).

skin examination tips

You should examine your own skin regularly approximately once a month, but often people aren’t sure what they are supposed to be checking for or how best to examine their skin. Here are some skin examination tips to follow:

Skin examination tips:

  • Remember to check your face, neck, ears, body, arms and legs front and back
  • Don’t forget your scalp, in between your toes and the bottoms of your feet
  • You can use a handheld mirror to look at your back or ask your partner to help
  • Things to be concerned about are new, changing lesions, very itchy or bleeding ones and any lesions or crusty sore ones that don’t heal up
  • Also seek medical advice if you find new lesions that change in colour, size, shape or thickness over a period of weeks to months
  • Remember, moles are not always brown-coloured, so look out for pink, red, blue-black or skin-coloured lumps and bumps also

Self-skin examinations are important for you to do at home at regular intervals. This increases your chances of noticing something unusual so that you can present to the doctor for investigation at the earliest stage possible. If you’ve noticed a skin change that is concerning, you can arrange a consultation with Dr Kara Heelan at either the Chelsea Outpatient Centre (020 3494 4024) or Sydney Street Outpatients & Diagnostic Centre (020 3733 9029).

gel manicure and skin cancer

This is a question I get asked a lot and what a wise question! For those of you who get fortnightly gel manicures, this is something to think about.

Traditionally, the lamps used during these manicures were ultraviolet lamps predominantly emitting UVA. Ultraviolet-A radiation is associated with a higher skin cancer risk. There have been cases reported of skin cancer developing after UV nail lamp exposure. A 2014 study in JAMA Dermatology found that the level of UVA associated with a fortnightly manicure is probably not high enough to increase the risk of skin cancer significantly.

Overall, the good news is that the majority of the bigger brands which are commercially available have now switched to LED-bulbs. LED stands for light-emitting diodes and they are safer than UVA. Unfortunately, LED lamps can still emit some ultraviolet radiation in the form of UVA.

Gel manicures and skin cancer: what to be aware of

So the science around the issue of gel manicures and skin cancer remains controversial and inconclusive but the American Association of Dermatology and the Skin Cancer Foundation have issued advice on this. They suggest that regardless of the type of lamp, before getting your nails done it is a good idea to protect your hands from UVA exposure by using a broad spectrum (UVA/UVB), high SPF sunscreen on your hands and or using a pair of fingerless gloves. There is also probably an unappreciated risk with the availability of at-home DIY gel manicure kits that come with their own lamps and the drying lamps used to speed up the drying of conventional air-drying polish.

So remember before your next manicure to help reduce your risk:

  • Check what type of lamp your salon is using
  • Put on sun cream
  • Invest in some fingerless gloves.
winter season skin protection tips

With winter sports enthusiasts about to take off down the slopes, here are some tips on how to keep safe in the winter sun! Higher altitudes and UV reflection by the snow can increase the risk of sun damage. The sun’s reflection off the snow is strong even on cloudy days. Ultraviolet radiation exposure increases with increasing altitude.

To protect your skin from the sharp cold, strong winds and winter sun here are some useful tips:

  • Look for a high factor (at least factor 30) sun cream which is broad spectrum.
  • Broad spectrum refers to the protection of the sun cream against both UVA and UVB radiation. UVA radiation causes skin ageing and UVB causes sunburn.
  • Apply 20-30 minutes before outdoors exposure and reapply after excessive sweating, exercise or every two hours.
  • Apply sunscreen to all exposed skin.
  • Remember these areas as they often forgotten… the lips, ears, around the eyes, the neck, the underside of chin, scalp and hands.
  • Always wear a lip balm with an SPF. There are several on the market with at least factor 30.
  • Bring along travel size or sample size sunscreens with you to reapply while sitting on the chairlift.
  • Remember there is no such thing as all day sun cream.
  • Wear protective hats and facemasks in addition to sun cream.
  • A teaspoon full of sunscreen is required to completely cover the whole face
  • The type of sun cream one uses (gel, spray, cream, mist) is not necessarily important, but finding one that you like using will make it more likely that you use it and reapply it often.
  • Sunglasses or goggles that have wraparound or large frames will protect your eyes, eyelids and the thin skin around your eyes.
  • Use a moisturizer during winter months. Winter conditions can be particularly harsh on the skin and even more so for people who suffer from eczema and dry skin conditions.
  • Remember to continue to protect your skin during your leisurely outdoors slope lunch break!

Enjoy the winter season!

A new vaccine has been developed that – when used in conjunction with existing therapies – has been found to not only successfully treat aggressive melanoma, but also can prevent its recurrence.

Researchers at the Scripps Research Institute in San Diego, California, worked with experts at other medical institutions to develop the vaccine that has proven 100% successful when tested in mice. They first screened around 100,000 compounds to look for one that could help them boost the effectiveness of a commonly-used cancer immunotherapy drug.

The co-lead of the study, Professor Dale Boger, commented: “Just as a vaccine can train the body to fight off external pathogens, this vaccine trains the immune system to go after the tumour. This co-therapy produced a complete response — a curative response — in the treatment of melanoma.”

Skin cancer study

Three groups were tested – the first were given the cancer vaccine and the second the vaccine plus a molecule called Diprovocim that boosts the immune response. The third group were given the cancer vaccine and a chemical known as alum which also activates the immune system but in a different way. All three groups were also given the anti-PD-L1 immunotherapy used in cancer treatment. The group that received the vaccine plus Diprovocim in addition to the anti-PD-L1 therapy had a 100% survival rate over 54 days.

The researchers established that Diprovocim boosts the immune response by ‘prompting’ the immune system to produce tumour-infiltrating leukocytes, a type of cell that attacks and kills cancer tumours.

Once an individual has been diagnosed and treated for skin cancer, their risk of developing skin cancer again increases greatly so what was also exciting was that the vaccine also protected the body from tumour recurrence.

So far results have only been demonstrated in mice with a genetically-engineered tumour so further testing is required into how this Diprovocium-boosted vaccine will work in humans and also how it might work in combination with other cancer therapies.

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