National Post (National Edition)
Remember: respect the sun
AS CASES OF MALIGNANT MELANOMA RISE, IT'S ALL THE MORE VITAL TO GET MOLES CHECKED
On a long weekend if the sun shines, people forget the SPF and head to the park. Off come the tops, shoulders are bared. By the end of the day, a large section of the population is pink and sore.
But even though we love bursts of sun after a long, cold winter, and exposure to sunlight is thought to increase the brain's release of the “feel-good” hormone serotonin — the sting of that sunburn could last in a way that is insidious and even deadly.
According to figures from top cancer hospital the Royal Marsden, rates of malignant melanoma are rising faster than any other common cancer, in fact. Around 15,400 people are diagnosed a year. Over the past decade, the number of people diagnosed has increased by 50 per cent, and experts think it's set to rise further. Children of the 1960s and '70s are especially at risk having not used sunscreen in their youth.
Melanoma is a serious form of skin cancer. While it is less common than basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), it's more dangerous because of its ability to spread to other organs more rapidly if not treated at an early stage. The most common sign is the appearance of a mole or a change in an existing one. Hence people — especially those over 50 — should check their moles regularly, and seek the advice of a GP or dermatologist if concerned.
“The highest risk factor for malignant melanoma is exposure to UV light,” says Dr. Haytham Al-Rawi, consultant dermatologist and dermatological surgeon at Spire Little Aston Hospital in Birmingham, U.K. “Melanoma is caused when the pigment-producing cells, or melanocytes, in our skin mutate and become cancerous over time.”
Julia Newton-Bishop, professor of dermatology at the University of Leeds, points out that it's the “intermittency” that's key: if you don't have much sun, then expose yourself suddenly, even for a short time, it can be dangerous. And a “burn” is not only a blister or peeling. “Going `pink,' which people think is normal at the start of the summer, is still a burn.”
Seventy-five per cent of people diagnosed with malignant melanoma have their cancers excised and are fine for the rest of their lives. But the other quarter are in danger of the cancer returning and spreading — which can be incredibly serious.
Sean Guinness, 60, is “all clear, at the moment, because that's all you can say” after a gruelling five-year battle with melanoma that spread to his digestive organs. Guinness travelled to sunny destinations with his parents as a child and often worked outdoors at summer events in the U.K.: in 1988, he spent a year volunteering on a kibbutz in Israel, working outside in the height of a summer where temperatures often reach 40 degrees Celsius. Guinness, who also smoked, never used sunscreen. “I found lotion sticky and uncomfortable. There was certainly no suggestion from anyone around me that I use it.”
Like many of his generation, Guinness, who has moderately fair skin, “loved having a golden tan, it was healthy and attractive.”
Then, in 2009, when he was 47, Guinness noticed a three-inch patch of blood on the front of his jeans: a mole on his calf had started to bleed. “I'd always had lots of moles, but had never taken particular notice of this one,” he says.
“The next day, I went to see a private dermatologist. She told me I had Grade One A skin cancer, and that I'd have to have the mole removed immediately. At the mention of the word `cancer,' I immediately felt deep, dark loneliness, felt `dirty' even.”
Guinness swiftly had two operations: the second “looked like a shark bite.” After surgery, the skin around the tumour was examined and shown to be clear — there was no need for chemotherapy or any followup treatment. “So I went away and forgot about it,” he says.
Then, at the end of 2017 — eight years after his operation — Guinness started to feel breathless. “I was a bit overweight, and thought it must be something to do with my heart,” he says. A GP performed a blood test, which showed Guinness was exceptionally low in hemoglobin, so he had some basic tests, which were inconclusive. On March 2, 2018 it was his wife's birthday. “I felt utterly awful, drained with no energy,” he says. “The next day, in the most excruciating abdominal pain, I saw a private colorectal consultant: I threw up on his shoes.”
Guinness was rushed to the hospital. When he woke up the next day — “dizzy on morphine, very upset” — he discovered he'd had a colostomy; his small intestine had burst, and a large section of it had been removed.
“They told me I had tumours in my small intestine, liver and gall bladder,” says Guinness. “After three weeks of incredible fear my surgeon told me he had very bad news. They'd deduced that these tumours were almost certainly linked to the melanoma on my leg and it was stage four metastatic cancer. I was told I had eight months to live.”
Melanoma is particularly serious because of the stealthy way it can spread around the body. “Biologically, the disease is not fully understood,” says Al-Rawi. “But the cells are more aggressive and have more potential to spread to the lymph nodes (known as metastasis).
Guinness was referred to oncologists who suggested a treatment which was at the time revolutionary: immunotherapy. “They told me that if I was able to complete the course of two years, it could buy me two years life expectancy after that: maybe more,” he says. “The problem, I discovered later, is that only 30 per cent of people can take immunotherapy. It has lots of side-effects, including heart, liver and kidney failure, and severe infections.”
Immunotherapy is different from chemotherapy in that the chemo poisons and kills the cancer cells (as well as healthy cells). Immunotherapy — which is usually given with a mixture of two drugs for melanoma — induces the patient's immune response to fight the cancer. But this immune response can also be dangerous.
After two years of gruelling therapy — including stomach ulcers, kidney problems, and a “very painful” colostomy reversal in November 2018 — Guinness got the “all clear” in May 2020. “I felt euphoric — all the clichés, that I'd just won the lottery, like my children had just been born,” he says.
He is now cancer free.