Skin cancer exposed

It sounds like a breeze when you say it like that Slip, Slop, Slap!

In the sun we always say "Slip, Slop, Slap!" Slip, Slop, Slap!

Slip on a shirt, slop on sunscreen and slap on a hat Slip, Slop, Slap!

You can stop skin cancer. Say: "Slip, Slop, Slap!"

You couldn't go to Australia in the 1980s and not hear this jingle. Sung in the style of Rolf Harris by a cartoon seagull called Sid, it was devised to lodge in the brain like a novelty record.

I went to Australia as a gap-year traveller in 1987 and, along with everyone else, got nagged by Sid. He popped up on radio, television and billboards. Superficially, I got the message. I slipped, I slopped, I slapped - with fair skin I had no choice. But neither did I mean to stay alabaster white. My new Australian friends were sun-kissed and I longed for the sun to kiss me too. I was like a raw grey prawn just asking to be tossed on a barbecue.

Even in the 1980s, long before global warming entered the lexicon, it was well known there was a hole in the ozone layer over Australia and New Zealand. Certainly, the sun felt "burnier" there.

Yet with sunscreen and a stripe of fluorescent zinc on my nose, my skin seemed to adapt. My freckles began to join up; I bordered on beige. Occasionally I got burnt, which I took as a warning to use more cream. The prawn didn't sizzle, so long as it was marinated.

After six months nannying in Sydney, I backpacked up the coast to Queensland. There, it was said, one person in three had skin cancer.

In the veranda'd streets of every town, I saw Celtic-featured men in the old-school Aussie uniform of shorts and long white socks. Their arms and legs were covered with chalky white spots and splodgy brown moles.

I imagined these old chaps had been too macho or too uninformed - in the years before the government saw the need to raise awareness about skin cancer - to bother with suncream.

It didn't occur to me that their problem was also, potentially, mine - just as it is also, potentially, that of anyone who overdoes it on the beach this summer or already has a history of sunburn.

A few months ago a mole on my arm became slightly red and itchy. I went to the doctor, who thought it was benign, but said the only way to know for sure was to have it removed. I plumped, narrowly, for getting rid of it.

Ten days later he rang with the biopsy results. Some of the cells were abnormal.

"Do you mean it's skin cancer?" I asked, heart thumping.

"Yes. But it's usually fairly treatable."

He had already referred me to St Mary's, Paddington. Meanwhile, did I want the details? I scrabbled for a Post-It note.

"Superficial spreading melanoma, 1mm deep, Clark's level 4, mitotic index 4/10."

He rang off and the phone went again. It was the hospital, offering an appointment five days later.

Unsure how worried to be, I spent much of those five days on the internet. I tried to stick to responsible websites - Cancer Research UK, NHS Direct - but even they made alarming reading.

Somehow, despite "Slip, Slop, Slap!" and the mottled men of Queensland, I hadn't twigged that skin cancer is quite often fatal.

But here were the statistics -for Britain, a country where summer only ever comes in spurts.

There are at least 100,000 new cases of skin cancer a year. More than 90,000 are basal-cell or squamous-cell carcinoma and are rarely life-threatening.

Melanoma is a different story. Every year, 8,100 people are diagnosed with melanoma, and (a separate) 1,800 die of it. Incidence has trebled since 1975, and melanoma is now the second most common cancer in the 20-39 age group.

"You must be freaking out about this," said the consultant dermatologist at St Mary's. But the news wasn't catastrophic: my melanoma was "fairly thin", and 19 out of 20 people with similar cases were alive five years later.

Still, with red hair and blue eyes, I was at high risk. I should have a check-up every three months - sooner if I noticed a mole changing in size, shape, colour or texture.

Two weeks later, the rest of the tumour was removed. I asked the surgeon when the melanoma might have begun. "Probably in the first or second decade of your life," he said. But, I replied, I was always slathered in Uvistat as a child and didn't go abroad until I was nine, and anyway isn't the inside of the forearm an unlikely spot for sunburn?

"You probably got some sun there when you were young. Melanomas can take about 20 years to form." I did the maths: 2007 - 20 = 1987, my gap year. All those weeks spent on the Bounty-ad beaches of far north Queensland suddenly felt far from idyllic.

If I got my skin cancer in Australia, I got my awareness of it there, too. In 1998, I moved to Sydney and stayed for three years. Older, slightly wiser and much busier, I exposed myself less to the sun.

I went to the beach early in the morning for a walk or a swim, and only lay on it at weekends.

Sid the seagull had been succeeded by a public-health advertisement describing sunburn as a timebomb that could detonate into skin cancer. The television version showed a lithe brown torso being cut open and a globule of flesh being extracted with a pair of tongs. It was revolting, and clearly aimed at young people.

I had my moles checked. Australians go to the mole doctor as we go to the dentist.

Back in London, when I wanted a check-up a couple of years ago, I had to wait two months for an appointment. I then waited at the hospital for two hours, and was seen for little longer than two minutes by a dermatologist who glanced me over with her naked eye and told me I had nothing to worry about.

I should have gone to The Mole Clinic, which opened in London in 2003 and is expanding into 22 branches of Superdrug this summer. It was founded by Iain Mack, a lawyer from Glasgow who was alerted to a melanoma on his leg by a doctor he saw for food poisoning in Spain.

"I knew so little about melanoma I had to look up the word," he told me when I met him at The Mole Clinic.

"Then I did lots of research and found the death rate for those diagnosed with melanoma in the UK was one in four. The death rate in Australia was more like one in 10.

It's one thing being beaten at cricket, but this was awful." He went to Brisbane to find out why Australia had the edge.

"It's three things: awareness, resources and technology. Australians don't hesitate to get their moles checked.

GPs provide skin-cancer screening and they use digital dermoscopy, which captures a crystal-clear image of the mole, beneath its surface, at up to 50 x magnification. So they are seeing a huge amount of data that British doctors are not seeing."

This is the crux. Australia has by far the highest rate of melanoma in the world - 8,800 cases a year, among a population of just 20 million - but fewer than 1,000 deaths, about half the number in Britain. The Australians are detecting many more melanomas at a stage where lives can be saved.

"Melanoma is a unique cancer," Mack said. "It's largely preventable. If caught early, it is highly survivable. But if it isn't caught early, there is no known successful treatment.

Some melanomas develop over years, but others become invasive and spread to the major organs in months, even weeks."

Mack handed me on to Kate Sowerbutts, The Mole Clinic's senior nurse specialist. She examined my skin with a dermoscope.

Detailed images came up on the computer screen. A mole on the back of my knee that looked tonally uniform divided at 50 x magnification into three parts, brown, pink and white.

"A benign mole is like a bowl of rice - consistent all the way through," she explained. "A melanoma is a roast dinner."

She found another case of "meat and two veg", and recommended I have both moles removed.

Luminously pale, Sowerbutts has not sunbathed for five years.

"I feel like a milk bottle," she laughed, "but there is no such thing as a safe tan.

UVA causes ageing and skin cancer, UVB causes sunburn and skin cancer and even heavy cloud removes only 50 to 90 per cent of UV radiation.

" She wears sunblock from May to September. "Sunblock is SPF30 to SPF60, and broad-spectrum, meaning it protects against both UVA and UVB. But it's not a total block. In fact, we need to stay out of the sun or cover up well between 11am and 3pm, because that's when there's the most UV radiation."

UV radiation is most damaging in short, sharp shocks, so the worst thing we can do is "binge bake". Yet that is exactly what many of us do on holiday, hell-bent on acquiring a tan as if it were the ultimate souvenir.

"It's very intense and intermittent sun exposure that's most likely to cause melanoma," confirms Sara Hiom, deputy director of cancer information at Cancer Research UK.

"The more times you get sunburnt, the more at risk you become. We know a large proportion of people who get burnt do so abroad, when they're in stronger sun than they're used to.

It's easy to get caught out." It's also easier than ever to go on a sunny holiday.

It was only in 1998 that the British first took more holidays abroad than at home - 29 million of them. By 2005, the number of foreign holidays had ballooned to 44 million.

Just as mobile phones have led us to make phone calls we never used to make, so Ryanair and EasyJet have got us taking trips we never used to make.

"UNITED WE TAN," declaims the lastminute.com ad appearing on London buses. And thanks to climate change, it's getting hotter here. (April was the hottest in Britain for the 348 years since records began and then June was the wettest, while the eastern Mediterranean scorched under a merciless sun. July, however, is forecast to be warmer.)

All this means that Britons are exposed to more sun than before. And many of us are not designed for it: we simply don't have the melanin to cope with UV radiation.

Redheads and blonds with blue or green eyes are most at risk, but anyone, of any colour, can get melanoma. Bob Marley died of it.

In Britain, melanoma is increasing at a faster rate than any other cancer. Rates are set to triple by 2030 unless we change our behaviour in the sun (85 per cent of melanomas are caused by UV damage, the rest by genetic mutations).

Obviously it would be impractical to avoid the sun altogether, and nor should we because, in moderation, it does us good.

Sunshine lifts the spirits and stimulates the body to produce vitamin D - although, says Professor John Hawk, a dermatologist with the British Skin Foundation, "just a few minutes' exposure a day is enough. I do not recommend you go sunbathing to get vitamin D."

We have got to stop binge-baking, swear off sunbeds, which dispense 10-15 times as much UV radiation as the sun, and learn to love the shade.

Even those who haven't sunbathed for years should watch their skin for new or changing lesions - the damage can take decades to show up. There is such a shortage of dermatologists in the NHS that most hospitals cannot offer routine screening, so go to your GP or a private clinic.

Do not delay: if detected early, melanoma is highly survivable.

In Australia, melanoma rates are now declining, particularly among the 20-30 age group, the first generation to grow up with "Slip, Slop, Slap!" ringing in their ears.

In terms of awareness, Britain lags 20 years behind. Cancer Research UK's SunSmart campaign did not get going until 2003, and its message has yet to sink deep into the national psyche.

You have only to hang around the arrivals hall of any British airport to see the ignorance that persists among many holidaymakers. It's all over their faces - and their arms, legs, chests and backs.

"There's still the lure of the tan," says Hiom, identifying perhaps the biggest obstacle to preventing skin cancer. We have to stop thinking that a tan makes us look healthy and attractive, and start believing, as the flappers of the 1920s did, that keeping the skin tone we were born with is both natural and chic.

It's not an easy epiphany, but the converts number several role models. Nicole Kidman, Scarlett Johannson, Cate Blanchett, Damian Lewis, Lily Cole and Dita von Teese are all proof that pale can be interesting.

The impressively whey-faced Marcia Cross, who plays Bree in Desperate Housewives, is fronting America's skin-cancer awareness campaign.

For those who can't bear not to be bronzed, there is always the bottle. Fake tan is far safer than sunbeds, yet the Cancer Council Australia advises against it because it perpetuates the idea that a tan is desirable.

It used to annoy me when I came back from holiday and friends said, "You're not very brown, are you?" Now I've had skin cancer, I'll take it as a compliment.

source : www.telegraph.co.uk