Q:Yesterday I went to see my GP with a scarcely visible "rounding" of skin on my right cheek. To my dismay he made me sit down and felt my neck glands and said that though he wasn't sure, the most probable identification was a solar keratosis; that they took 10 to 15 years to develop into a scaly lump; but that we should review it in five years' time unless it itched, bled, went red, grew, etc., beforehand.
I understand that solar keratosis is a pre cancerous condition and I feel worried. Why doesn't he want to do something about it now, instead of waiting? Do you think I should insist on seeing a consultant at this early stage? I am a very fair skinned, freckly, moley person, the type most at risk from skin cancer. I garden with Body Shop SPF 20 on, sunglasses (surely these protect eyes and upper cheeks?) and a hat. What more can I do? D.S., Little Thurlow.....and also
Why do some women develop brown (melanin) skin patches, either as they get older or in sunny climates in the summer? T. D., Lincoln......
A:For the first letter writer, we spoke to Paul August, a dermatologist in Manchester recommended to us as someone who treats many skin problems conservatively.
In his view, your GP gave you good advice. Solar keratosis, which is a rough, warty patch caused by exposure to the sun, is usually quite a benign problem. For instance, for every 100 cases of solar keratosis, 50 per cent will get better in a few years, and 50 per cent will stay the same or get worse. Of those that get worse, 2 per cent will convert into squamous cell carcinoma, or cancer of the skin exposed to the sun. This kind of skin cancer appears as inflamed, hard lumps and can be surgically removed.
In other words, if you get lots of sun exposure, you're more likely to develop a skin cancer elsewhere than have your present patch turn into something to worry about. So although you have a very small chance of developing skin cancer from this patch, it's also prudent to heed your GP's second bit of advice to periodically check the patch and to immediately report any changes in it.
It sounds as though you are taking excellent precautions with your high sun protection factor sun lotion, the use of a hat and sunglasses. We would only add some caveats: in the last 10 years, cases of skin cancer have skyrocketed, and precautions that were adequate in the past may no longer apply. Even people who tan easily are being told to use sunscreens with a SPF of at least 8 and up to 15.
First, everyone should avoid the sun between 10 am and 2 pm when the rays are strongest. Second, select your sun preparation with caution. There are anti sunburn preparations, which keep out all but 5 per cent of the burning rays of the sun; sunscreen preparations which allow through some of the sun's tanning rays and about 15 per cent of the burning rays; and sun blocks, which form a physical block against all ultraviolet radiation. Fair haired easy burners shouldn't consider an SFP less than 10; older people one less than 15. Also, if you tend to swim a lot in summer, go for a sunscreen that is water resistant or waterproof. You also want a sunscreen that blocks not only UVA but also UVB rays.
Remember, too, that these lotions can affect your ability to sweat, so it's probably not a good idea to smother yourself with the stuff and then engage in hard physical activity on a hot day.
Finally, certain drugs can heighten your sensitivity to the sun's rays. Some of these include the oral anti diabetic drugs, thiazide diuretics, the Pill, tetracycline, griseofulvin, tar based drugs used for psoriasis, and even sunscreens containing amnobenzoic acid.
As for the second letter writer, those brown spots, often called liver spots, are the aging skin's response to ultraviolet rays, says Paul August; more of the brown skin pigment, melanin, migrates up to the skin's surface. They are an inevitable outcome of "photoaging" - too much exposure to the sun.
The best course is prevention and good practice in the sun. Once you've got them, however, you can try fading them with Retin A cream, the synthetic high dose variation of vitamin A, says Mr August, although you leave yourself open to the various side effects of Retin A, which include not only severe inflammation but also an enhancement of the cancer causing effects of ultraviolet light (for full details see WDDTY Vol 2 No 12). So you could end up trading off a few age spots for skin cancer or even birth defects in your offspring if you're about to or have become pregnant.
A less risky option are the fade out creams produced by chemists, most of which contain hydroquinone. They occasionally cause irritation or allergies, but the biggest problem with them, says Mr August, is that they often just don't work.