Hot off the heels of Stress Awareness Month comes Sun Awareness Week (1st-7th May) and Mental Health Awareness Week in May.
Here in the UK, May tends to mark the start of the summer; or at least the sun will show its face and we all start leaving the house more, for longer. With the longer evenings and double bank holidays, we head to the parks, riversides and coasts for socialising and swimming after many months of dealing with the cold, rain and snow. The British Association of Dermatologists is launching a summer-long Sun Awareness campaign to re-emphasize the need for sun protection across the UK and inspire people to raise awareness themselves.
With that in mind, I’m going to talk about skin cancer. I perform at least 500 procedures per year related to it, so it’s something I’m very keen on sharing knowledge and raising awareness about.
Sun Exposure is the Main Cause of Skin Cancer
There is a lot of confusion and sometimes complacency about skin cancer, however, thankfully, this is gradually improving. My and my parent’s generation took little care of our skin, particularly with regard to sun exposure, which is the main cause of skin cancers.
It was common for sun exposure to be recommended as being ‘good for you’ and sunscreens were not in common use. I also treat a large (although decreasing) population of servicemen who were posted overseas - they were often ordered to go out in the midday sun to “get used to it” and now, they attend my practice regularly with multiple skin cancers.
First of all, sun exposure is the main risk factor for developing skin cancers. In particular, significant sunburn as a child has a strong correlation with developing skin cancer in later life, so the sooner we start looking after our skin, the better.
The standard advice is easy to find: use a high factor sunblock, limit overall sun exposure, avoid exposure during the hottest times of the day, and when possible, cover-up. It is advisable to avoid sunburn, however mild.
Everyone can get skin cancer. It is far more common in people with pale skin, but serious skin cancers like melanoma can develop in any skin type. Having a family history of skin cancers, particularly malignant melanoma, is another risk factor.
There are some special conditions that can predispose to developing skin cancers - anything that causes suppression of the immune system increases risk, and I frequently treat patients who are on long-term immunosuppressant medication e.g. for organ transplants.
It is important to recognise that we are continually exposed to the sun during daylight. I often speak to patients who are very surprised that they have developed a sun-related skin cancer as they "don't sit out in the sun". However, they often go on to describe long days working in the garden, playing golf or going fishing with little sun protection. Sun exposure doesn't just occur on a sunbed in southern Spain!
There are different types of skin cancer and although the term is very alarming, the most common type of skin cancer - Basal Cell Carcinoma is in reality fairly minor and although it is a type of cancer, it doesn’t spread around the body and therefore doesn’t have serious long-term implications. However, if left untreated for a long time, these lesions can be very destructive and require complex surgery to ensure their complete removal and provide a satisfactory, aesthetic outcome.
Treatment of Skin Cancer
Skin cancers and pre-cancerous lesions can be treated in a variety of ways and not all require surgery. Smaller, superficial skin cancers can often be treated with freezing (Cryotherapy) or topical creams such as Efudix (a chemotherapy drug in cream form) and Imiquimod (also known as Aldara) which is a drug that stimulates the immune system to kill cancer cells.
Surgery is usually required for larger or thicker skin cancers and skin cancers that have not responded to non-surgical treatments.
Surgery usually refers to cutting the lesion out and then reconstructing the resulting defect in some way. Some more minor procedures can also be effective, such as curettage and cautery, which involves scraping the lesion from the surface of the skin and cauterising the resulting wound - this is often useful for patients who are not fit enough for a more involved procedure.
As a Plastic Surgeon, the procedures I most commonly perform are more complex, where a skin cancer has to be removed and the resulting defect requires reconstruction - typically on the face or limbs.
Reconstruction can be with skin grafts or another technique called a local flap, which can give superior cosmetic results. I particularly specialise in local flap surgery for facial skin cancers as this facilitates the best oncologic treatment and final cosmetic result.
In addition to the top tips for reducing risk - high factor sunblock (that means 50!), cover up, avoid the hottest times of the day, limit overall sun exposure - it is important to take skin lesions seriously.
Monitor any moles you have for changes in size, shape, colour and of course any itching or bleeding. Early identification of skin cancers and pre-cancerous lesions increases the chances of complete cure dramatically.
Malignant melanoma when caught early, has a 99% 5 year survival rate, whereas with established melanoma that has spread elsewhere in the body this figure drops to around 30%.
And a note on Melanoma BRAF...
BRAF is a gene associated with cell growth and everyone has it. The normal, unmutated form is often referred to as ‘wild-type’. Mutations in this gene can be identified in some malignant melanomas (up to 50%) and are no doubt responsible for some of the characteristic features of cancer (e.g. uncontrolled growth).
These mutations occur spontaneously and may be related to damage from ultraviolet light (sun exposure). They are not inherited from parents or passed on to children.
The significance of BRAF is that we now have new treatments that target this genetic mutation. These new drugs have been a game-changer in the treatment of melanoma, even when it has spread to different parts of the body. All melanomas are tested for this mutation so that prompt treatment can be initiated if necessary.
But please don’t underestimate the great physical and mental health benefits of being outdoors (safely!). There are many great studies on the positive effects of being outside and being in the sun.
Mental Health Awareness Week
May also brings us Mental Health Awareness Week (15-21st May), and being a Consultant Plastic Surgeon, I take the mental health of my patients very seriously.
The positive impact of cosmetic procedures on mental health have been demonstrated in a number of studies. It is a complex area with many potentially confounding factors, however benefits have been found in a wide range of parameters such as anxiety, social phobia, depression, body dysmorphia, goal attainment, quality of life, life satisfaction, attractiveness, mental and physical health, wellbeing, self-efficacy and self-esteem.
This is not to suggest that cosmetic procedures should be used to treat these conditions however - it’s more complicated than that.
A key factor in the improvement in these conditions seems to be the patient’s expectations. Patients with very realistic expectations of what a treatment can and can’t deliver experience the best improvements in psychological symptoms, self-esteem etc
Having very high and unrealistic expectations of the outcome of a procedure often leads to disappointment and poor psychological outcomes. Equally, no procedure comes without risk and potential complications that can impact the final result.
Some procedures appear to have a stronger impact on psychological symptoms than others: Breast augmentation and breast reduction surgery are strongly associated with improvements in symptoms and emotional outcomes, whereas the impact of other types of surgery is more mixed.
The vast majority of my patients experience some form of improvement in confidence, self-esteem and body image. This is related to our approach at Profile Aesthetic. We give clear, honest advice on the pros and cons of the treatments and procedures we offer. We take time to get to know our patients and help to establish realistic expectations on the outcome of treatment.
At Profile Aesthetic we view the entire process as a journey and the journey starts with the basics. We help people to establish strong foundations in nutrition and skincare from the start. We also provide advice on physical activity and exercise, and importantly stopping smoking, as this has huge effects on general health and ageing.
We use a range of technologies including lasers and energy-based devices that are effective for those not ready or suitable for surgical procedures and as an adjunct to surgery, to enhance recovery and refine the overall result.
We know that improved physical health has an impact on mental health. Treatments such as Emsculpt NEO reduce excess fat and build muscle without surgery - this provides a huge opportunity for patients to kickstart their health and beauty regime with results that are visible, very quickly, with no downtime.
I have a number of patients who get stuck in a cycle of not exercising as they are self-conscious about their appearance - they then get more out-of-shape and the cycle of poor diet and lack of activity continues. Sometimes procedures such as laser-assisted liposuction provide an immediate improvement in physical shape that gives people the confidence to get back to a healthier lifestyle, with all the benefits that come with it.
If you have been impacted by anything mentioned in this article, please get in touch with myself or my team for more information or for a consultation.