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 These images show keratoses on the scalp in a man who was exposed to excess sunshine whilst in the British Army. He also has an ulcerating squamous cell carcinoma on the ear.

 As British residents we are not accustomed to strong sunshine and we tend to get our sun exposure in short bursts e.g. on a summer holiday, or on a bank holiday weekend. Our climate does not provide regular exposure and therefore our skin does not develop much natural protection. All racial groups in Britain can suffer from sunburn but those with very fair skin, multiple frecides and moles, blue eyes and ginger or fair hair are most at risk.

 Sunscreens should be applied generously (and I stress generously); they should be applied at least 5 minutes before you go out into the sun; some sunscreens particularly the ones which are water-resistant should be applied at least 30 minutes before going out into the sun and you will need to follow the manufacturer's instructions carefully to achieve the best protection. Please remember that sunscreens are washed off the skin by any moisture including perspiration for example whilst playing tennis; under these circumstances you will need to reapply your protection frequently throughout the day - I would recommend applications about once every 2 hours.

The sun's intensity is greatest between the hours of 11 in the morning and 3 in the afternoon and this rule applies both at home and overseas. During these hours you are at greatly increased risk of suffering a severe sunburn which could ruin the rest of your holiday. You need to limit your exposure during these hours for at least the first few days of the holiday. My rough and ready rule is that you should limit your bare skin exposure during these hours to 15 - 30 minutes maximum per day until you have achieved a reasonable tan after the first few days holiday.

During these first few days, more prolonged bare skin exposure must only occur during those hours of the morning before 11 a. m. and those hours of the afternoon later than 3 p.m., but even then you should wear a sun block.

During these danger hours it is not advisable to rely only upon sun creams which can rapidly rub or wash off; you should also wear some light clothing e.g. a baseball cap to protect the face, a T-shirt to protect the shoulders and Bermuda-style shorts to protect the thighs. Wearing a T-shirt whilst swimming or enjoying other water sports is essential especially for young children.

Certain areas of the body are especially prone to sunburn and deserve a special mention; these areas include bald heads, shoulders, thighs, the nose and forehead, the tops of your feet and bare breasts; in other words those areas pointing up towards the sky and those areas which are usually covered. For these areas I strongly recommend a sun block of factor 20 or higher during the first 7 days of sunshine exposure and apply it at least 3 times per day; more often if you get wet or sweaty. Even during the second week of sunshine exposure I would recommend a sun protection factor of at least 15 to these areas at all times.

Other areas of skin on the arms and body do not bum quite so easily but nevertheless need high-level protection for at least a week. To these areas I recommend the use of a protection factor of at least 10-15 for 7 days and at least factor 4 thereafter.

Sensible exposure will enable you to enjoy the sun without looking silly on the beach or during the evening. If you do burn red you should immediately go indoors until the sun goes down. You must keep warm and drink plenty of water. 1% hydrocortisone cream should be generously applied to all burnt sites twice per day for 2 days; you can buy 1% hydrocortisone at any dispensing pharmacy in the UK without a Doctor's prescription so take some if you go abroad. At all costs you must avoid further sun exposure whilst the skin remains red.

As dermatologists, we are very concerned about the sun causing skin cancer. Particularly disturbing (as highlighted earlier) is the fact that sunshine exposure in childhood may cause skin cancer in later life. The number of skin cancers we see is increasing every year and the main reason is people's increased exposure to sunshine. It is important that you know what skin cancer can look like so that you can arrange to see your doctor for a check- up if you are worried.

The most dangerous type of skin cancer is the type called malignant melanoma where a brown, black or purple growth appears on the skin. This can look like a mole or sometimes can arise from within a mole perhaps even a mole which has been on the skin for years. If you see a new mole on the skin or if you notice a change in an existing mole then you might have a problem. If in doubt, it is always best to get your skin checked by your doctor rather than ignore a pigmented skin lesion which might later turn out to be something serious. It is important for you to have an accurate idea of what your moles look like at all times so that you will rapidly be alerted to any changes in their appearance. It might even be helpful for you to take a photo of any troublesome moles.

When Should a Mole Be Checked?

The simple message is - if a mole is changing in any way at all it is better to have it checked over by your doctor than to ignore it. No age group is immune; one tragic fact about melanoma is that it commonly affects young people.

The second main type of skin cancer is not brown or black but usually appears as a red or skin-colored and sometimes scaly patch and which occurs on those areas of skin which regularly see a lot of sunshine all year round e.g. the face, the scalp and the backs of the hands or forearms. Typically this problem affects people aged 40 or over and especially those who have been exposed to more than the average amount of sunshine during their lives either as a consequence of their occupation or as a consequence of living overseas. This type of skin cancer is slowly growing and can take 2 years to appear but occasionally it is more rapid. Again, I would stress that it is better to see your doctor if there is any doubt about your skin than to ignore a change on your skin which could be important. It is always easier to deal with skin trouble whilst the problem is small than to allow it to get bigger.

The basic message is:

1. you know your own skin, so do whatever is necessary to make sure you do not burn red in the sun.

2. seek medical advice early rather than late if you have significant skin changes.

Basal Cell Carcinoma (Cancer)

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This condition also known as a "rodent ulcer" is the commonest skin cancer. The great majority of these lesions do not spread anywhere else and can be treated on the skin surface relatively easily. They are related to sunshine exposure and therefore typically occur on the face and other areas of the body exposed to sunshine. They usually progress and enlarge only very slowly. Treatment is by surgical removal if possible. Other types of treatment include freezing the skin or treating the skin with X-rays.

 Treatment / Top of Page

Squamous Cell Carcinoma (Cancer)

This is the second commonest form of skin cancer after basal cell carcinoma (cancer). These occur on sunshine exposed areas and are related to outdoor exposure. There is very little chance of this problem spreading to any internal area of the body but they do need specialist assessment and surgical removal. Unlike basal cell carcinomas which are often smooth and domed, squamous cell carcinomas are usually scaly and more irregular.

 This is pronounced - ak tin nik / keh rat toes sis. These are scaley patches of different sizes appearing on skin which has been exposed to excess sunshine. A number of them - if left untreated will progress into squamous cell carcinomas. Treatment is by cryotherapy or some kind of surgery.

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Photosensitivity (Irritation by Sunlight)

This refers to a situation where the sufferer is unduly sensitive to sunshine and can come out in either a red rash or even a severe eczema only at the sites of sunshine exposure. For example, where the skin is protected by layers of underwear, it is common for the underlying skin to be completely normal but exposed skin to be very severely infected. Various rare diseases can cause photosensitivity but the commonest cause is taking oral medication such as antibiotics or diuretics (water tablets). Occasionally, skin surface creams can also cause photosensitivity and some patients even suffer this reaction from sunscreens.

Naevus (Mole)

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This term refers to a blemish on the skin varying between pink and brown in color. Naevi or moles, usually appear between the ages of about four and thirty years. In other words, it is common for naevi to appear throughout early adult life. A very small number of naevi are actually present and visible at birth. These are called "congenital naevi". It was once believed that congenital naevi carried quite a high chance of skin cancer development later in life but we now believe that this chance is much less. The total number of naevi appearing on the skin can probably be minimized by avoiding sunshine exposure in childhood and young adult life.

 Naevi are incredibly common but melanoma is rather rare. Nevertheless, any changing naevus should be viewed with suspicion. However, the commonest cause for a naevus changing is inflammation as a result of either injury or infection. Skin surface antibiotic creams are therefore often very helpful for an inflamed mole but if the inflammation fails to settle within a few days then a medical opinion needs to be sought.

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Melanoma (Malignant Mole)

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Melanoma is the most serious form of skin cancer and can spread to affect other areas of the body if it is not treated early. Melanoma usually presents as a brown, purple or black, raised skin lump typically 1-2cm in size. Sometimes they can be pink with only a very small amount of pigment contained within them. Any changing skin blemish particularly if it is dark, should be viewed as a potential melanoma and should be assessed by a doctor.

Melanoma can appear as a darker extension or growth within an existing mole - but sometimes (see images above) it can appear as a pink or fleshy growth rather than a darker area. Note the second image above which has both a very dark component but also a more recent pink enlargement - the small mole in the very bottom right corner is benign. A rarer type of melanoma (called acral melanoma) is the type that affects the skin beneath the toe nail - this can sometimes be mistaken for fungal infection for months - the clue is pigment leaking onto the surrounding skin - look carefully at the image.

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Pyogenic Granuloma

This condition appears very rapidly and grows as a pink pea-shaped raised skin lump. Minor injury is possibly the cause of these and pregnancy can predispose as well. They tend to bleed easily because they are in fact packed with small blood vessels. They are not cancerous and simple surgical removal usually leads to complete disappearance very quickly.

Keratocanthoma

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 This is a skin growth which often grows quite quickly, for example over the period of 1-2 months. A typical lesion contains a central crater filled with hard packed dead skin surrounded by a more skin-coloured shoulder. The overall appearance looks rather like a volcano. These lesions are benign but do need surgical removal for testing under the microscope. Sometimes, if left alone, they fall away spontaneously to leave a scar - the one above fell off one day before scheduled surgery.

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