Why it’s so crucial to respect the sun

As cases of malignant melanoma rise, it’s all the more vital that over-50s get their moles checked, says Miranda Levy

On a bank holiday Monday if the sun shines, mad dogs and Englishmen forget the factor 30 and head to the park. At least - given the unreliable British weather - that’s the plan. Off come the tops, shoulders are bared: we aren’t in Tenerife, so why should we bother with suncream? Yet, by the end of the day, a large section of the population has the British “tan”, pink and sore.

But even though we love our bursts of sun after a long, cold winter, and exposure to sunlight is thought to increase the brain’s release of the “feelgood” hormone serotonin – the sting of that evening 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 caught the package holiday era in their youth and not used suncream.

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. “Melanoma is caused when the pigment-producing cells, or melanocytes, in our skin mutate and become cancerous over time.”

One explanation for the rise in statistics, says Dr Al-rawi, is greater awareness: people see a doctor earlier than in the past. That’s the good news. But most of the increase is down to a rise in disease, due to holidays at home and abroad, and sun-bed use. Melanoma diagnoses are particularly high amongst the sun-worshippers of the 1970s and 80s, when to look “brown” was a sign of affluence and health. “To a certain extent, the problem has been ‘stored up’ from those days,” says Dr Al-rawi. “When people sat in the sun covered in olive oil, it was the worst thing they could do. My patients tell me: ‘I haven’t been in the sun for years,’ but they don’t realise the cumulative effect.”

In some ways, says Dr Al-rawi, we are “more guilty” at home. “Even on cloudy days, there is UV light,” he says. “Some of my friends were out on Easter weekend – those first warm few days of the year. Even though it was barely 20 degrees, they got burnt. We need to be more vigilant, even when playing golf, or gardening.”

Julia Newton-bishop, professor of dermatology at the University of Leeds, agrees. “Pale skinned people, whether they get burned in the garden at home or abroad, are most at risk,” she says. “And that includes many people in the UK.” (Australia, peopled by pale-skinned emigrants, has the highest melanoma rates in the world, despite the high profile Slip, Slap, Slop skin cancer campaigns of the 1980s.)

Newton-bishop 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 – as we Brits are wont to do – 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.” This is more dangerous than living in a hotter country, where you gain a gradual tan.

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 a management consultant from Harrogate, Yorkshire. He is currently “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 climes with his parents as a child and often worked outdoors at summer events in the UK: in 1988, he spent a year volunteering on a kibbutz in Israel, working outside in the height of a summer where temperatures often reaches 40 degrees centigrade. “I never used suncream,” says Guinness, who also smoked. “Being a guy, I didn’t like unguents. 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”. “But in that period, everyone was the same. My sisters threw themselves into the sun at any chance, covered in oil.”

Then, one day 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 follow-up treatment. “So I went away and forgot about it,” he says. “There was no discussion of staying out of the sun with my doctor, but I was less of a sun-seeker in my later adult life, anyway.”

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 haemoglobin, so he underwent some basic tests at a local hospital, 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 by ambulance. 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 gallbladder,” 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. My wife and I went into shock. We told my parents, and all burst into tears. We told our kids: more tears.”

Melanoma is particularly serious because of the stealthy way it can spread around the body. “Biologically, the disease is not fully understood,” says Dr Al-rawi. “But the cells are more aggressive and have more potential to spread to the lymph nodes (known as metastatis).

Guinness was referred to the Bexley

Wing at St James’s University Hospital in Leeds, where oncologists 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 sideeffects, 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 cliches, that I’d just won the lottery, like my children had just been born,” he says. His last cancer-free scan was a week ago. “I don’t look ahead too far, I’m here, I’m OK,” he says. “All I can do is live one day at a time. I might live til 75 and die of a heart attack. Or my cancer might come back at any moment. I’m in remission, but I will never be ‘cured’.”

He adds: “I was really unlucky that my cancer came back the way it did

– as well as incredibly lucky that immunotherapy has been so successful for me. But my story really is a cautionary tale – how men in their 20s, especially my generation – smoked, drank, sat outside and didn’t look after themselves. As parents, we take great care to school our children to eat right and exercise. In just the same way, we need to educate them about skin cancer. Even though we only see it in this country for two weeks a year – we need to respect the sun.”

‘I had tumours in my intestine, liver and gallbladder. I was given eight months to live’