25 Aug

image“And so with the sunshine and the great bursts of leaves growing on the trees, just as things grow in fast movies, I had that familiar conviction that life was beginning over again with the summer.”
― F. Scott Fitzgerald, The Great Gatsby
After a glorious summer where motivation has increased, our Vitamin D has been topped up and we have managed to get out and go to places we haven’t been to in years, sadly, there are some ill effects of summer.
Besides the passing tummy bugs or heat exhaustion the one thing we must be vigilant about is our skin.
Melanoma is the 6th most common cancer overall in the UK (if non melanoma skin cancer is excluded). More women than men get melanoma.

Every month it is worth doing a self-examination of the skin especially if you are at greater risk such as:-

Moles – the more moles you have, the higher your
• Being very fair skinned – especially with fair or red
hair, or having lots of freckles (although people
with darker skins can still get melanoma)
• Sunburn – getting badly sunburned increases your
risk of melanoma, particularly in childhood
• Where you were born – fair skinned people born
in a hot country, such as Australia or Israel, have a
higher risk of melanoma throughout their life
• Sun exposure – on holiday, as well as sitting in the
sun or sunbathing at home
• Sunbeds – using sunbeds, particularly before the
age of 35.
• Sunscreen – using sunscreens may protect you, as
long as you don’t spend too long in the sun.
There are other less common risk factors such as Family History involving more than 2 close relatives – these other less common risk factors can be found on the website link later in this blog.

How to perform a self-examination of the skin

Firstly find a bright room and use a large mirror where appropriate.
Look at the whole body front and back
imageWhen you have isolated a skin lesion that looks different or you think has changed using the acronym ABCDE to confirm your suspicions.
A Asymmetry – the mole halves don’t match
B Borders – they are uneven
C Colour – this is not uniform
D Diameter – this is larger than 4mm
E Evolution – the mole grows and may become inflamed and itchy


Where to look

Bend the elbows and look at the forearms, underarms and the palms. Your palms, bottom of the feet nails and nail beds – these are places where it is more likely to acquire acral lentiginous melanoma (ALM) which is more common in women especially with dark skin.
Check the back of the legs and feet including in between the toes and the soles of the feet and toenails. New and unusual bands on the nails could be a sign of sign of cancer.
Examine the back of your neck and scalp with a hand mirror. Ideally, it is better if you can get a friend or partner to help by using a blow dryer as this will allow a closer loo
If you find a mole that fits the above criteria it is important you are seen by your GP.

If you are not sure it is worth taking a photograph of the mole alongside a ruler and storing it on your PC to observe changes when you repeat the photograph a month later.

NICE guidelines for urgent referral follow the 7 point scale

The NICE guidelines say that all GPs should use the 7 point scale for assessing changes in moles. The scale has 3 major features and 4 minor ones.

The major features are
*Change in size
*Change in colour, such as getting darker, becoming patchy or multi shaded
*Change in shape

The 4 minor features are
*7mm or more across in any direction
*Oozing or bleeding
*Change in sensation, such as itching or pain

The doctor counts 2 points for any of the major features. Any of the minor features scores 1 point. If your mole scores 3 points you need urgent referral to a specialist. But the guidelines say that if there are strong concerns about any one feature, urgent referral is also reasonable.
If you are not sure it is worth taking a photograph of the mole alongside a ruler and storing it on your PC to observe changes when you repeat the photograph a month later.

More information can be obtained from:-
UK website

If you have had a melanoma always be vigilant.

David’s story

I remember a patient many years ago called David
He never went to the doctor and made it his business to keep well away under all circumstances. I knew his wife well and she attended very regularly and in passing had often remarked about her husbands dislike of doctors. Infact, the only notes on his record were a record of his childhood immunisations.
One day, on a Friday evening she appeared very anxious and said her husband had taken to his bed upstairs, because if he even attempted to move he was very short of breath and he had refused to call a doctor. Understanding her predicament and always enjoying the challenge of sorting out a difficult patient I decided to visit him. When I entered the house climbed the stairs, there was David in bed, sitting up with at least 5 pillows and so breathless he was unable to voice his disapproval of my presence. When I examined him more closely he was extremely swollen with fluid to the level of his waist- totally waterlogged!
I gently suggested a hospital admission and needless to say he summoned up enough breath to refuse outright. In situations like this negotiations are on a par with making a peace treaty between warring countries. After a while we negotiated a plan helped with the knowledge that his first grandchild was due – he would take the medicines I prescribed and if they worked he would attend the surgery on Monday morning before the doors ‘opened’, I would take blood and he would go to the hospital for a chest X-ray. If he was no better he would have the option of deciding the next move. We shook hands on this and I arrived Monday morning wondering if he was alive or dead and whether he would appear. I was not long in the surgery when the bell went and in walked David with his wife and I have say hardly breathless and a look of submission on his face.
I had the X-ray form prepared and proceeded to take blood. As he rolled up his sleeve there before me on his forearm a classical, fulfilling all criteria malignant melanoma. I remained calm as one must with a patient like this as they are likely just to get up and leave precipitantly.
After his remark of “is that it,doctor?” I retorted with ,”not quite, you did say you would go and have a chest X-ray and perhaps Hammersmith would be a better hospital for you and by the way could you just pop in to this clinic whilst you are there!” I quickly scribbled a note for the Walk-in skin clinic hoping that I was right in thinking I had him in my hand and that he would arrive at the clinic and not have to wait.
Later that day his wife phoned to tell me that he had done everything I had suggested and he had been admitted but was wanting to take his own discharge. The hospital doctors had made the diagnosis of malignant melanoma with spread to the lungs and heart failure. He had refused all treatment except what I had prescribed.
He soon came home and was told he was terminal. I visited him and even after lengthy discussion he was adamant that he was not going to have any treatment for this cancer. The Macmillan nurse arrived and he dismissed them as he could manage his own death and he had a lot of things to sort out and he didn’t have enough time to talk to nurses and doctors. The first most important thing to do was to phone the council and have the large tree removed from the family grave as the grave would be needed very soon – he felt it was disgusting how graves were looked after.
This was done by the council in record time.

David never appeared at the surgery again, failed to attend hospital follow ups but continued to take the medicines I originally prescribed. I kept in touch when his wife attended and she collected his medication. I only ever saw him across the road when he was on his way to the graveyard with his trowel and bucket to carefully maintain the grave. He would always wave and shout over , “How are you, doctor?” to which I would reply,”Fine , how are you?” and he would retort,”Fine” and continue about his business. He not only enjoyed the birth of his grandson for 4 other grandchildren and lived for almost 5 years of a good quality life but finally quite suddenly he died to go to the grave he had so lovingly tended.

The point of this story is that for some reason this tumour can become inexplicably dormant but then recur at a later stage even years later.


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