Why are so many deadly skin cancers caught late?
As hundreds of Britons die needlessly from melanomas every year . . .
JUST a few weeks before their marriage in July 1999, Terry and Joann Wheeldon each booked six sessions on a sunbed, ‘ to get a bit of colour for our wedding’. It was a decision that would have devastating consequences for the couple and their two daughters.
‘Terry never used sunbeds normally, or even went in the sun,’ recalls Joann.
He stopped after his fourth session when he noticed a red blister on his stomach. His GP said it was nothing to worry about, but in fact it was the first sign of a malignant melanoma — a deadly skin cancer that is easily cured if caught early.
Oblivious to this, the couple, from Prestwich, Manchester, got on with their lives and raising their daughters, Morgan and Demi. Terry worked as a forklift truck driver, while Joann, a school dinner lady, studied to become a teaching assistant.
But Terry’s blister never went away, and over the next five years it slowly turned into a small brown mole. He went back to the doctor on several occasions, but each time was told it was fine.
By June 2005, the mole — now larger, misshapen and darker in colour — had started to itch. Finally, Terry was referred to a dermatologist, who ordered a biopsy.
It was five months before the biopsy was carried out. Then came the shocking news that it was a malignant melanoma.
An operation to remove and test more tissue appeared to show that the melanoma had been caught in time.
But four years later, in April 2010, Terry spotted a pea-sized lump near the site of his original mole and a CT scan revealed seven small tumours in his lungs.
He had just 16 months left to live. During that time, he developed tumours in his neck, armpits and groin, and by June 2011 a scan found five in his brain.
Terry decided against having radiotherapy to prolong his life.
‘He went for quality of life,’ says Joann. ‘It was a really brave decision, and it was the right one. It was torture living with that time bomb, but he was so positive and determined not to let melanoma ruin the last months he had with his family.’
Terry set about putting together memory boxes for his daughters, then 15 and 16, and writing cards for their 18th and 21st birthdays.
Five months later, when the end came, it was quick. One morning he was struck by a severe headache. He fell into a coma and three days later, on November 17, 2011, 48-year- old Terry passed away peacefully, surrounded by loved ones.
That year, Terry was one of 1,167 men and 832 women who died from malignant melanoma. The cancer forms in the melanocytes, the cells that produce melanin, the pigment that colours skin.
The main risk factor is exposure to ultra-violet light, either from the sun or sunbeds, and people who are fair-skinned and have a lot of moles or freckles are in more danger.
AT FIRST, a melanoma is on the surface of the skin and can be easily cut out. But removal is the only cure — which is why early diagnosis is vital. Caught early enough, melanoma has one of the highest survival rates of all cancers.
If a melanoma grows deeper, the cancerous cells can reach the bloodstream and spread to organs such as the lymph glands, lungs and brain.
Once it has spread, melanoma does not respond well to chemotherapy. Some, like Terry, live with the disease for years. Others die frighteningly quickly.
Every year, hundreds of men and women are losing their lives needlessly to a disease that could have been beaten if treated early.
‘What is particularly depressing about melanoma is it’s all about early diagnosis,’ says Chris Bower, consultant dermatologist at the Royal Devon & Exeter Hospital.
‘Other cancers you might be able to cure with radiotherapy and chemotherapy; with melanoma you can’t,’ says Mr Bower.
So why isn’t more being done to detect melanoma sooner?
In fact, last summer, Public Health England ran a six-week pilot campaign in the South-West that caught many cases sufficiently early to save lives, Good Health has learned. The key message of the Be Clear On Cancer campaign was that ‘a change to a mole isn’t the only sign of skin cancer’, and anyone who spotted ‘any unusual or persistent changes’ to their skin was urged to visit their GP.
This is a broader message than Cancer Research UK’s awareness campaign, which has focused on the ‘ABCD’ message, drawing attention to moles that are becoming Asymmetrical, developing irregular Borders, having more than one shade or Colour, or a Diameter larger than 6mm.
The new message was welcomed by experts. ‘More than 50 per cent of melanomas actually arise from normal skin and not from a mole,’ says Stephen Kownacki, a GP and chair of the Primary Care Dermatology Society.
And the message got through. ‘We saw a definite increase in the number of referrals,’ says Mr Bower, whose dermatology department at the Royal Devon & Exeter Hospital was one of several centres in Somerset, Cornwall and Devon covered by the campaign.
During July, at the height of the campaign, the number of referrals to his department rose from the usual 600 to 1,000. Centres in Taunton, Torbay, Barnstaple, Truro and Plymouth also experienced a 40 to 45 per cent increase in urgent referrals from GPs.
Mr Bower said it was ‘reasonable’ to conclude that a national campaign would see a similar increase in referrals — and lives saved. Despite this, Public Health England told Good Health the pilot is still being evaluated. It has now delayed a decision on rolling out the campaign until after the election, in case any new government ‘has different priorities’.
But there is another factor that might prevent the life- saving campaign being rolled out nationally. The British Association of Dermatologists (BAD) says the profession is so woefully understaffed that dermatology centres would be overwhelmed.
‘We have a national workforce crisis,’ says David Eedy, president of the association and a consultant dermatologist at Craigavon Area Hospital in Northern Ireland.
It is estimated there are around 740 dermatology consultants n nationally, compared with t the 900 minimum recommended by the Royal College of Physicians.
It’s not that there aren’t sufficient medical graduates who want to go into dermatology — there are seven applicants fo for every trainee post. B But the number of training pl places for each speciality is fix fixed annually by Health Ed Education England and, says M Mr Eedy, dermatology is a ne neglected specialty, pushed as aside in favour of more politically sen sensitive issues, such as the need for more GPs.
A report last year by the Royal Co College of Physicians noted that ‘ de despite being a popular spe specialty, with high demand for tra training places’, only 55 per cent of advertised dermatology con consultant posts had been filled in 2 2013-14, ‘due to the shortage of t trainees’.
If the pilot were rolled out acro across the country, says Mr Eedy, ‘my reaction would have to be, well, we welcome anything that stops people being killed. But at the back of my mind I’d be thinking, please give me the workforce to do it because there aren’t enough of us.’
The extent of the staffing crisis was brought home to Dame Sally Davies, the Chief Medical Officer, when she ran a seminar for dermatologists in October 2013.
In a letter seen by Good Health, Dame Sally wrote to tell Ian Cumming, chief executive of Health Education England (HEE), that she was ‘horrified’ to discover ‘this is a profession in real crisis’.
EVEN the recommended number of 900 consultants, which if achieved would give a ratio of one consultant for every 62,500 people, was hopelessly inadequate.
‘If we really wanted to get this right,’ wrote Dame Sally, ‘ we would probably have 6,000 consultants’ — roughly equivalent to the ratio of dermatologists to patients in countries such as Italy, Germany, France and the U.S.
(France has one dermatologist for every 120,000 people: Britain has one for every 200,000, says the BAD.)
A spokesman for Health Education England said that last year it had commissioned 177 dermatology training places and would do so again next year. This would ‘continue the average 3.5 per cent growth per annum in the consultant workforce in line with the 28 per cent growth in the eight years to 2013’.
But the BAD dismissed this as ‘ weasel words’, and insisted Health Education England had ‘continually cut numbers’. Indeed, HEE’s own Workforce Plan shows it planned to actually recruit only 57 dermatologists in 2014/15.
There is no arguing with the way dermatology departments struggled to cope during last year’s Be Clear On Cancer campaign in the South-West. Good Health has learned that at the peak of the campaign several dermatology units were forced to close their doors to all but the most serious cases, turning away patients with other skin conditions.
Campaign or no campaign, Joann Wheeldon urges anyone with the slightest suspicion that something might be wrong to visit their GP without delay.
Since Terry’s death, she has worked as a counsellor, through her own website, Life After Melanoma, and with the charity Melanoma UK, and says she is constantly surprised by how little people understand about the danger of skin cancer.
‘Three years on, we still find it hard to go to Terry’s resting place knowing that if he had not used a sunbed, or if his mole had been removed at the beginning, he would still be here,’ she says.
‘It is devastating to know a mole killed my husband and robbed us of our dreams. I wouldn’t want anyone to go through what we have been through.’