Hello everyone,

Thanks very much to those of you who came along to our web chat with skin cancer nurse specialist Carol Goodman earlier this month.

For those of you who didn't make it, here is the transcript which includes some really helpful information about staying safe in the sun for those of you who don't have skin cancer - so don't think it's not relevant!

I hope you find it useful, and please enjoy the sun safely.

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Q:  Carol, have you found that skin cancers are more common or less common now that people are more aware of the risks and ways to help prevent skin cancers?
A: Skin cancers specifically Basal Cell Cancers (also known as BCC) are more common than ever. 75% of skin cancers are this type.

Q: Do you think it's mainly due to better rates of detection/awareness, or because people are taking more risks?
A: It is probably because we are much more aware, older people are showing the signs of years of not protecting their skin against the harmful suns rays because it was not an issue back 40 years or more. The damage starts in childhood. Also we have a tendency to strip off as soon as the sun appears!

Q: Are you pleased (like me) that under 18's won't be able to use sun beds anymore?
A: I am very pleased that the government is limiting the use in younger people; melanoma is very prevalent in those between the ages of 15-34.

Q: Do you know if there's any research that's shown that certain methods of persuasion work better than others - eg, advertising campaigns in other countries that have effectively helped reduce the amount of skin cancers?
A: Good advertising definitely works. There is a great way to show us what the sun is doing to our skin: a black light or UV lamp will show up the skin damage which is very good to scare you off. It shows people up to have terrible pigmented marks even when young. These marks then show up as you get older.

Q: Where can you find a black light or UV lamp to do this?
A: Dermatology clinics have the black light lamps and imaging systems that can do this.  

Q: I am pleased to hear of increased awareness and education for children and parents on the risks of sunburn and spotting skin cancer early, but there appear to be too many cases where doctors have missed early signs of skin cancer – is anything being done to address this?
A: It is often difficult to ascertain what lesions or changes are skin cancer and what is not. Early cancers like BCC (basal cell carcinoma) and SCC (squamous cell carcinoma) are often mistaken for solar lentigo, and psoriasis.

Q: But what about misdiagnosis of melanoma?
A: That is a difficult one. Moles can appear benign but are not.

Q: My hubby has CML (chronic myeloid leukemia) and I have also noticed a hard lump on his right shin and it’s getting bigger but he will not go to the doctor. He loves the sun and I have just got him to use sun screen
A: It’s good that your husband is protecting himself in the sun. The hard lump could be anything, I suggest you see the GP

Q: I think we need to educate all parents of the importance of frequently applying sun block to kids when they are outside, even when it is cloudy and a campaign aimed at kids so that it would be a normal part of their life.
A: Educating sun protection in children is vital and this is being addressed more and more in schools, as well as nursery and pre-nursery. Indeed making us all aware that even on a warm cloudy day you can burn. Applying lotions frequently especially if children are swimming is vital. There are also some new lotions (factor 50+) for children that are coloured pale green.  These show if you have missed a part of the skin when applying the lotion. Very helpful.

Q: Is there any advice you can give about differentiating between all the different sun creams out there? Does a cheap cream generally mean it's not as effective as a more expensive option, even if the SPF is high?
A: Cheap creams can be just as good as expensive ones. They are all tested in the same way and use the same rating systems.  The more expensive ones tend to be well known cosmetic brands. High sun protection factor (SPF 30 up to 50+) is good, or SPF15 used very freq. High UVB and UVA 5 star rated are the best. Always use up lotion within 2-3 years and try to get one that protects for both UVA and UVB rays.

Q: I’m worried about a mole but my GP says it’s fine, what should I do?
A: Ask your GP to refer you to a dermatology out patient clinic for absolute diagnosis or have it removed by them if need be. It is very difficult to decide if something is a cancer or not.  The National Institute for Health and Clinical Excellence (NICE) has produced guidelines for GP’s to help them with their assessments.

Q: I’ve finished chemo for lymphoma in December, I know my skin is still sensitive, is it best to avoid sun at all cost?
A: Cover up after chemotherapy if possible. Sit in the shade or stay out between 11-3pm. You can buy special UVA protection clothing, but normal close woven cotton is good too.

Q: Hi Carol - are there things people should ask their GP before letting them remove a lesion from the skin? Like should they have specific experience in doing this?
A: Some GP’s are trained to do this if they have a special interest in skin cancers. Ask if they have this specialty as an interest and have they trained to remove lesions.

Q: What about IPI any signs of it being used more here?
A: Ipilimumab (IPI) is a monoclonal antibody (MAB). It is being used in Professor Patel’s trial which finishes this July. Used for stage 3 but with very specific criteria.
 IPI for stage four is said to provide a few more months of quality of life. A trial comparing it with chemotherapy ended in 2008.

Q: My husband is stage 2c and is really well at the moment. We are obviously concerned (understatement!) given his 5 year survival stats. He had no SLNB (sentinel lymph node biopsy) and his last ct (Computerized Axial Tomography scan) was October. Anything we should or can be doing to improve his odds?
A: We would like to spend time talking with you about this so could you call our helpline 08088080000 and ask to speak to a nurse this may be helpful. We can talk to you in much more detail and specifically to help your husband than this short web chat will permit.

Q: This is probably a stupid Q, but is there any kind of injection or alternative method of protecting your skin from the sun other than either covering up, or slapping on sun cream at regular intervals?
A: I’m afraid not. The tried and tested ways are the most trustworthy. If an injection or tablet is ever produced it would have to be trialed thoroughly and to do that it would have to be randomized and controlled over many years. That would mean some of the participants would get a placebo. I am not sure how that would be ethically. If they expose themselves to the sun over many years and assume they are getting protection? I suspect that is not something that could be considered?!

Q: I thought it was worth asking anyway - you never know, the rate technology/medical science is progressing these days there might be something out there that's in development.    

Q: What do you think of the lack of scanning available to advance malignant melanoma patient Carol?
A: Like many types of cancer the need to diagnose really early is vital and is not readily available. It should be as it would save so many lives. Bowel is now checked earlier, if lung, skin especially melanoma, and cervical all were caught early - oh how good that would be!

Q: Another question on follow up appointments. As I understand anyone with malignant Melanoma gets 3 monthly follow ups for 5 years, but from what I have seen what happens in these follow ups appointments really varies across the country. Some get a full body check; others get a quick 5 mins in/out.
A: Yes it does vary from place to place. Most appointments should really involve a bodily check depending on the original cancer. Any signs of lymph nodes or other signs and symptoms.

Q: Would you recommend people had photographs taken of all their moles?
A: Yes photos are good to keep a record, as is examining moles regularly. You can always photograph your own if you are worried, not all trusts offer this but could always ask

Q: it's hard to tell if moles have changed I find? What should I look out for?
A: Yes indeed it is hard to tell – The method of ABCD should be used. See our website on melanoma for this. It stands for asymmetry, border, colour and diameter shows you what to look for

Q: I have felt that ct (Computerized Axial Tomography) scans with regularity would be more reassuring for myself and my husband.
A: Given his chances of being stage 4, the earlier this is detected, the better chance he has of receiving ipi (Ipilimumab) or plx (PLX4032 biological treatment) because conventional treatment has to fail first. You can find more information in this journal.

Q: If someone is diagnosed with melanoma from a biopsy, what sorts of things should they ask their specialist to help them understand the situation? What will happen next? More tests?
A: It depends on whether it is thin; under 1mm or over 1mm and what stage, if that or later.

Q: If it's over 1mm what should people ask about?
A: The stage and thickness of the tumour and the spread, has it ulcerated etc.

Q: What other reasons other than skin cancer can cause a change in moles - growth or other changes?
A: There are lots of conditions that can make moles look a little odd that may not be cancer. For example Seborrhoeic keratoses.

Q: Carol, do you think enough information is provided regarding lymphoedema after lymph node dissection?
A: I would say more than before but probably not enough. It is a shame because it is a big problem but often can be helped. It’s also common in other cancers breast especially, so clinics tend to be more geared for this.

Q: I would be very interested in more info on lymphoedema, as I have just had a block dissection and would like to avoid it if possible!
A: We have booklets available through our helpline or on our website. We can send the booklets out to you if you call the helpline. Booklets are also available on www.be.macmillan.org.uk. Here is a link too.

Q: Should everyone have a skin cancer specialist nurse?
A: It is helpful if you have access to a skin cancer nurse specialist/contact.

Q: Where can people get information and support when dealing with skin cancers and malignant melanoma? Who would you recommend?
A: I recommend the Macmillan information pages, or the support line for advice and support. The Online Community is also an excellent source of support. Other charities specifically for skin cancer include Skcin, The Melanoma Foundation at St. George's Hospital, and more generally, The British Skin Foundation.

Q: Where should I go with this my check isn’t until July and I don't see plastic surgeon until June?
A: You could go to GP or ask to see the specialist earlier.

Q: I have a specialist nurse but we keep missing each other I have e mailed her but not sure if she can reply to individual e mails?
A: She should be able to reply to individual emails. Maybe she is not getting these. Often they can go into her spam mail? Try to arrange an appointment first. Don’t be afraid to call her.

Q: My wound is right on my elbow every time I bend it, it puts pressure on it. Is there anything I can do?
A: That is difficult. Try to avoid bending it too much in the early stages to permit healing. After a 5-6 weeks gentle exercise and skin care could help.
Check with you GP or Nurse specialist
   
If any of you have any suggestions for future web chats, please email me.