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BAD reaction to BMJ report on privatisation of the NHS

A statement from Dr. David Eedy, President of the BAD, in regards to the research released by Professor Oliver in the British Medical Journal regarding NHS contracts and management salaries:: 

The news today that a third of NHS contracts in England have been awarded to private sector providers since the service was reorganised in 2013 is a fact that dermatologists and their patients are all too aware of. In fact, some estimates put the figure at 70 per cent of NHS contracts going to private providers in just the first year.

Dermatology is a prime example of how government meddling is decimating the NHS, despite the fact that each year, 54 per cent of the population is affected by skin disease, and 23 to 33 per cent of the population at any one time has a skin disease that would benefit from medical care. Skin cancer is by far our most common cancer. That means thousands of patients let down because of spurious health service reforms.

Dermatology has been seen as an easy service for hard-pressed commissioners to shift ‘into the community’ with private providers, due to the widely held but mistaken view that skin diseases are minor ailments and can be easily identified and treated locally, reducing the burden on hospitals. However, the drive to shift treatment into the community leads to decommissioning of Dermatology hospital services, and has not achieved its intended aim of improving patient care. It makes no sense economically either, as in the majority of cases the cost of care remains the same per head of patients as the hospital service. 

Another concern is the practice of ‘cherry-picking’ by private healthcare providers who are more likely to take on relatively easy, high volume, lucrative work in the interests of profit. The upshot of this is that the local NHS hospital department is left to pick up the more difficult and expensive work while saddled with increased financial pressures. 

There have been cases of independent providers tendering for dermatology services without even having dermatologists or other appropriately trained staff in post.

To maintain a high standard of healthcare for patients it is necessary to retain a large degree of public accountability, from the very beginning of the tendering process all the way through to the treatment of patients, and beyond. However, commercial confidentiality clauses, which do not apply to the public sector, can stifle transparency when private companies are involved in bidding to provide healthcare services. This makes it hard for external bodies to scrutinize whether the new service is compliant with national guidelines.

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Early detection messages failing to halt deaths from UK’s most common cancer

Two studies due to be presented at the World Congress on Cancers of the Skin in Edinburgh, Scotland, this week, show an increase in advanced-stage skin cancers, highlighting an urgent need to publicise self-check and early detection messages.

Skin cancer is the UK’s most common cancer. Melanoma is the most dangerous form of the disease, and is relatively unique in that it is a highly visible cancer, allowing people to monitor their skin for changes themselves. As with most cancers, early detection improves the chances of survival.Melanoma tumours grow in ‘thickness’ (depth of invasion into the skin) the longer they are left untreated. The ‘Breslow thickness’ of a melanoma lesion, measured in millimetres, is used to assess how advanced it is and has five stages, ranging from the cancer cells only being in the outermost  layer of the skin, to the tumour being more than 4mm thick.*

The first study looked at 1,769 melanoma patients seen at the St. John’s Institute of Dermatology at Guy’s and St. Thomas’ Hospitals in London between 1999 and 2012. They found that the incidence of melanoma increased by 76 per cent during the 13-year period. The Breslow thickness of the melanomas increased across all demographic groups, from a mean of 2.25mm to 2.43 mm. 

As the data for thin, early stage tumours was excluded from this study, the results suggest that the overall increase in melanomas being diagnosed is, at least in part, due to more advanced cancers which have a much poorer survival, rather than a surge of early-stage tumours in response to greater awareness of the disease. 

Study author Dr Wisam Alwan said: “Our data shows an increase in the number of cases of melanoma seen across all stages of disease, including more advanced tumours, with no improvement in survival seen during the study period. 

“The number of people dying from melanoma is increasing year on year and this emphasises the necessity of early detection of tumours, given the poor outcomes associated with advanced disease. Strategies that tackle both the prevention of the disease, and that encourage people to seek help earlier, are crucial.”

The second study, from Barts Health NHS Trust in London, reviewed 92 cases of melanoma seen in the region over one year. 16 per cent (15 cases) of ‘thick malignant melanoma’, in which the tumour was greater than 3.5mm and therefore more advanced and harder to treat, were identified. The mean Breslow thickness in this group was 6.4mm, the thickest of the five stages on the Breslow scale (more than 4mm).

Despite the tumour size, 40 per cent of these patients had noticed a changing lesion for at least four months before seeking advice. Interestingly, most (73%) were a type of melanoma called ‘nodular melanoma’ and the authors speculate that current early detection messaging, using the ABCD acronym** (which stands for Asymmetry, Border, Colour and Diameter – the key areas of change to look out for), may not be as applicable to this type of the disease as to other subtypes.

Dr Andrew Lock, one of the study’s authors, said: “It has been suggested that nodular melanomas behave biologically differently from other subtypes, and the ABCD criteria to aid diagnosis may indeed lead to late presentation. Perhaps the latter is applicable mainly to the superficial spreading subtype, which is the more common type of melanoma.

“Our study reinforces the observation that the incidence of thick melanomas is not decreasing. New strategies and education programmes are therefore required for the earlier detection of such tumours.”

Nina Goad of the British Association of Dermatologists said:  “The majority of public education campaigns around skin cancer have focussed on preventing the disease, by staying safe in the sun. What these studies show is that we now also need to target our efforts on early detection, by encouraging people to check their skin and report anything suspicious to their GP sooner rather than later.

“We’ve been doing this for some years with our Be Sun Aware Roadshow, where we take mole-checking to high profile venues, and we are now trying to target the people we know tend to present late with skin cancer, which tends to be older men.

“However, the studies raise an interesting point about the different melanoma subtypes. Nodular melanomas, which accounted for the majority of melanomas in the review by Barts Health NHS Trust, are less common than the ‘superficial spreading’ type of melanoma, to which the ABCD rules apply. Their rate of growth is usually faster and unfortunately they are also harder to diagnose clinically. They become life threatening quickly and can mimic other, less harmful skin cancers and benign skin lesions. This makes public messaging for these cancers tricky, and something we are going to need to think about if we want to reduce our melanoma mortality.”

-Ends-

Notes to editors:

*More information on melanoma staging and the Breslow thickness scale can be found at:http://www.bad.org.uk/library-media/documents/Melanoma%20-%20Diagnosis%20and%20Staging.pdf

** There are three types of skin cancer, and all look different. The following ABCD-Easy rules show you a few changes that might indicate a 'melanoma', which is the deadliest form of skin cancer.As skin cancers vary, you should tell your doctor about any changes to your skin, even if they are not similar to those mentioned here.Remember - if in doubt, check it out! If your GP is concerned about your skin, make sure you see a Consultant Dermatologist, the most expert person to diagnose a skin cancer. Your GP can refer you via the NHS.

Asymmetry - the two halves of the area may differ in shape
Border - the edges of the area may be irregular or blurred, and sometimes show notches
Colour - this may be uneven. Different shades of black, brown and pink may be seen
Diameter - most melanomas are at least 6mm in diameter. Report any change in size, shape or diameter to your doctor
Expert - if in doubt, check it out! If your GP is concerned about your skin, make sure you see a Consultant Dermatologist, the most expert person to diagnose a skin cancer. Your GP can refer you via the NHS

For more information please contact: Matt Gass, Communications Officer, on 020 7391 6084 or atmatthew.gass@bad.org.uk

If using this study, please ensure you mention that the study was released at the World Congress on Cancers of the Skin. 

The conference will be held in Edinburgh from September 3rd to 6th 2014, and is attended by approximately 1,000 UK and worldwide health professionals.

The World Congress on Cancers of the Skin 2014 was founded by The Skin Cancer Foundation, the international organization devoted solely to education, prevention, early detection, and prompt treatment of the world’s most common cancer. It is organised by the British Association of Dermatologists.

Study details:

042, Epidemiological trends in Malignant Melanoma in a large urban population in England from 1999-2012; Wisam Alwan1, Panos Karagiannis2, George Poulos2, Katie Lacy2

1University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, UK, 2St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK

Analysis of trends in stage, site, 5-year survival and mortality from malignant melanoma in a patient population referred to a tertiary referral centre based in a centralized urban location.

Retrospective study of 1769 cases (913 male, 856 female) referred to our unit from 1999-2012 through analysis of our local melanoma database, electronic patient records and case note review. Cases of cutaneous malignant melanoma of histopathological stage IB and above according to the American Joint Committee on Cancer (AJCC) criteria[1] were included, with a smaller local cohort of 235 patients for which all stages of melanoma were recorded.  Data on incidence, mortality, Breslow Thickness, body site and disease stage were analysed.

Mean age of diagnosis was 58 years for all patients during the study interval (mean age for males 60, females 56). Incidence of melanoma (Stage IB and above) increased 1.7-fold from 3.28 to 5.77 per 105 of the population from 1999 to 2012 in line with national trends.

Breslow Thickness increased over the study period for the entire database population from a mean of 2.25mm in 1999-2000 to 2.43 mm in 2011-2012.   The trunk was the commonest body site affected in males (36%) and lower limbs in females (36%).  No significant differences were observed in stage of disease at presentation for different body sites.

Mortality rate (melanoma-specific deaths) also increased, with a rate of 1.96 per 105 in 2011-2012, compared to 0.10 per 105 at the outset of the study, with men having the poorest outcomes (2.24 per 105 in contrast to 1.70 per 105for females).

5-year melanoma-specific survival figures were 96%, 85%, 78% and 32% for stage I-IV disease respectively; consistent with published data[1].

Malignant Melanoma continues to rise in incidence and is associated with significant mortality.  Primary prevention strategies to reduce disease incidence and delayed presentation are crucial.   The rising mortality rate highlights the necessity of early detection of tumours given the poor outcomes associated with advanced disease.   No improvement in survival was seen during our study however we hope that the new targeted and immunomodulatory therapies will result in improved future survival rates in our patient population.

 References

[1] Balch CM, Gershenwald JE, Soong SJ, et al.  Final version of 2009 AJCC melanoma staging and classification.  (J Clin Onc. 2009.20;27(36):6199-206)

 

043, Thick melanomas: A persistent problem; Andrew Lock, Nilukshi Wijesuriya, Rino Cerio

Barts Health NHS Trust, London, UK

Cutaneous melanoma remains on the increase in Europe, but recently has stabilised. Many recent studies have shown an increase in detection of melanomas <1mm probably due to earlier diagnosis. However, the incidence of thick malignant melanomas (TMM) seems to have remained at least constant (Tejera-Vaquerizo A, Mendiola-Fernández M, Fernández-Orland A, et al. Thick melanoma: the problem continues. J Eur Acad Dermatol Venereol 2008; 22:575-9; Murray CS, Stockton DL and Doherty VR. Thick melanoma: the challenge persists. Br J Dermatol 2005; 152:104-9).

Our skin cancer multidisciplinary team (SMDT) meeting serves a region with a population of approximately 1.7 million. We manage over 200 new cutaneous melanomas per year. We reviewed our primary cutaneous melanomas over a 12 month period, specifically those with a breslow thickness ≥ 3.5mm, aiming to identify important associations or demographic factors associated with TMM.

15 cases of TMM were identified. Of these, 9 were females and 6 males. 13 of the 15 (87%) were aged over 60 years and most patients were of white ethnicity. 11 of the 15 (73%) melanomas were of nodular subtype and breslow thickness ranged from 3.5mm to 15mm (mean 6.4mm). Of the cases, 7 were ulcerated (47%) with a mean dermal mitotic count of 9 per mm2 (range 1-27 per mm2). Pre-existing naevus was seen in none and lymphovascular spread was present in 2/15 (13%). Despite the size, 6/15 (40%) patients had noticed a changing lesion for at least 4 months before seeking advice. Most (67%) cases of TMM identified were in caucasian patients ≥ 60, and were of nodular subtype. Body site was variable and included most sites, including the ankle.

It may be that nodular melanomas behave biologically differently from other subtypes, and the ABCD criteria to aid diagnosis may indeed lead to late presentation. Perhaps the latter is applicable mainly to the superficial spreading subtype.

Our study reinforces the observation that the incidence of TMM is not decreasing. In this group sex difference was minimal. The reason for our findings remains unclear and is multifactorial. However, new strategies and education programmes are, therefore, required for the earlier detection of such tumours to reduce its incidence in these patients.

 

About the BAD

 

The British Association of Dermatologists (BAD) is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. The BAD provides free patient information on skin diseases and runs a number of high profile campaigns, including Sun Awareness, which runs from May to September annually and includes national Sun Awareness Week in May. Website: www.bad.org.uk/sunawareness

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Moles on the skin increase skin cancer risk

Having moles on your skin can quadruple your risk of developing the deadliest type of skin cancer, according to a study due to be presented at the World Congress on Cancers of the Skin in Edinburgh, Scotland, today.

‘Melanocytic naevi’ are more commonly known as ‘moles’. The word ‘melanocytic’ means that they are made up of the cells, melanocytes, which produce the dark pigment, melanin, that gives the skin its colour. Melanocytes clustered together form naevi. In other words, moles are generally harmless groups of melanocytes. However, the deadliest type of skin cancer, called melanoma, is linked to moles, and approximately half of melanomas develop in pre-existing moles.

This study, from the University of Oxford, UK, and Epworth Hospital in Melbourne, Australia, sought to establish the level of subsequent melanoma risk in people with a hospital record of moles. The researchers compared the medical records of two groups of people – 271,656 for whom moles had been recorded during a hospital visit for any condition, and 10,130,417 people who did not have moles recorded.  Anyone who had been diagnosed with melanoma, either previously or at the time the moles were recorded, was excluded from the study.

Comparison of the two cohorts revealed that over all, the group with moles were approximately 4.6 times more likely to develop melanoma than the group with no recorded moles. Significant risk increases were present when moles and subsequent melanoma occurred at the same site on the body, as well as when they occurred at different sites. For example, moles on the trunk were associated with an increased risk of both melanoma on the trunk and melanoma elsewhere. However the increase was greater when the mole was at the same site as the melanoma – people with moles on their trunk were nine times more likely to develop melanoma on the trunk, and 5.6 times more likely to develop melanoma elsewhere on the body. 

Study author Dr Eugene Ong, of the Nuffield Department of Population Health, University of Oxford,   said: “Our results show that patients with a hospital diagnosis of melanocytic naevi, or moles, have a high risk of developing melanoma both around the site of the mole and elsewhere on the body. These people might, therefore, benefit from increased surveillance.

“Unfortunately we were unable to distinguish between different types of moles or to ascertain the number of moles in each patient.  Our patients were in hospital or in day-case care when their moles were recorded, and so the patients in our cohort are likely to have presented with unusual appearances in the moles, in order for them to have warranted recording.  A mole or moles were the principal reason for hospital contact for 91 per cent of patients in that cohort. So while this study does not suggest that everyone with a single mole is far more likely to develop melanoma, it does illustrate the link between moles and skin cancer. This is why it is vital people check their moles regularly and report any changes to their doctor.”

Nina Goad of the British Association of Dermatologists said:  “When melanoma develops in a pre-existing mole, there is usually an area of colour change, and it is the distinction in colour from the remainder of the mole that is a clue that it might be harmful. Or the mole might be changing in another way, such as growing. If a mole changes in size, shape or colour, or a new mole develops in an adult, then it is best to see your GP.”

Melanoma is the least common but most serious type of skin cancer. In the UK, 6,853 new cases were diagnosed in women and 6,495 in men in 2012. Over the last 30 years, incidence rates of melanoma in Britain have increased more rapidly than any of the top ten cancers in both men and women, and there is no sign of plateauing. Prevalence in men increased around five-fold while in women, rates more than tripled between 1980 and 2009.*

-Ends-

Notes to editors:

More information on melanoma and skin cancers can be found at http://www.bad.org.uk/for-the-public/skin-cancer

*British Association of Dermatologists, Cancer Research UK, Doctors.net.uk: Skin cancer Recognition Toolkit.

For more information please contact: Matt Gass, Communications Officer, on 020 7391 6084 or at matthew.gass@bad.org.uk

If using this study, please ensure you mention that the study was released at the World Congress on Cancers of the Skin. 

The conference will be held in Edinburgh from September 3rd to 6th 2014, and is attended by approximately 1,000 UK and worldwide health professionals.

The World Congress on Cancers of the Skin 2014 was founded by The Skin Cancer Foundation, the international organization devoted solely to education, prevention, early detection, and prompt treatment of the world’s most common cancer. It is organised by the British Association of Dermatologists.

 

 

Study details:

Risk of subsequent malignant melanoma in patients with melanocytic naevus in England: a national record-linkage study; Eugene Ong1, Raph Goldacre1, Rodney Sinclair2, Michael Goldacre1

1Nuffield Department of Population Health, University of Oxford, Oxford, UK, 2Epworth Hospital, Department of Dermatology, Melbourne, Australia

High numbers of melanocytic naevi (MN) or dysplastic (atypical) MN have consistently been shown to be important and strong risk factors for the development of melanoma. We aimed to further characterize the risk of melanoma in those with a melanocytic naevus, using linked hospital and mortality records covering the whole population of England from 1999 to 2011. We constructed two cohorts: one that comprised people with a hospital or day-case record of MN (271,656 people) and a control cohort comprising people without (10,130,417 people).  Anyone with a melanoma on the same record as MN, or one prior to it, was not admitted to either cohort.  We "followed up" these two cohorts to determine observed and expected numbers of people in each cohort diagnosed with subsequent melanoma and calculated rate ratios (RR), based on person-years at risk, standardized by age, sex, year of first admission, Region, and quintile of socio-economic deprivation score. We excluded people diagnosed with melanoma within 1 year of cohort entry to reduce any biasing effects of misdiagnosis. Comparing the MN cohort relative to the non-MN cohort, the overall RR was 4.68 (95% CI 4.39-4.98).  RRs were significantly high across all age groups (<25 year olds RR 3.79 (2.82-5.03); 25-59 year olds RR 5.02 (4.62-5.45); 60+ year olds RR 4.68 (4.19-5.21)). Significantly increased RRs were found for both males (RR 5.92, 5.36-6.53) and females (RR 4.13, 3.81-4.48). We found RRs to be increased across all anatomical sites.  Significant increases were present when MN and subsequent melanoma occurred at the same site as well as when they occurred at different sites.  RRs were consistently higher when considering same-site associations.  For example, MN on the trunk was associated with an increased risk of both melanoma on the trunk (RR 8.99, 95% CI 7.69-10.46) and melanoma elsewhere (RR 5.66, 4.97-6.42). We were unable to distinguish between different types of MN or to ascertain the number of MN in each patient.  Our patients were in hospital or in day-case care when MN was recorded, and so the patients in our cohort are likely to have presented with atypical MN appearances.  MN was the "principal" reason for hospital contact for 91% of patients in the MN cohort.  Our results show that patients with a hospital diagnosis of MN have a high risk of developing melanoma both around the MN site and elsewhere in the body, and might, therefore, benefit from increased surveillance.

About the BAD

 

The British Association of Dermatologists (BAD) is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. The BAD provides free patient information on skin diseases and runs a number of high profile campaigns, including Sun Awareness, which runs from May to September annually and includes national Sun Awareness Week in May. Website: www.bad.org.uk/sunawareness

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One in ten doctors admit to using sunbeds

A recent study, presented by researchers at the World Congress of Cancers of the Skin in Scotland, has shown that many British doctors take part in activities that put them at an increased risk of developing skin cancer.

The researchers, from Sandwell and West Midlands Hospitals NHS Trust, Birmingham and North Cumbria University Hospitals NHS Trust, Carlisle, advocate that sun safety advice be made more widely available to medical professionals.

The study showed that a third of doctors demonstrated sun-seeking behaviours, such as sunbathing and tanning. 10 per cent of respondents admitted to using sunbeds, despite the fact that the link between skin cancer and sunbeds has been well documented. In 2009 the International Agency for Research on Cancer (IARC), part of the World Health Organisation, classified sunbeds as a Group 1 carcinogen (carcinogenic to humans), the same classification as given to tobacco.

The study reflected similar trends that previous research1 has revealed amongst the general public, in that female doctors reported more frequent sun-protective behaviours compared to their male colleagues. Despite their caution though, women were more likely to have more than one incidence of sunburn a year than men.

The study revealed that only one in three doctors has performed self examination of their skin in the last 12 months, despite recommendations from the British Association of Dermatologists (BAD) to check skin monthly. Interestingly, a similar survey conducted by the BAD in 2013 showed that ordinary members of the public check their skin more frequently, with 43 per cent of the general public compared with 65 per cent of doctors responding that they have not examined their skin for signs for skin cancer.

Dr Jingyuan Xu, one of the researchers from Sandwell and West Midlands Hospitals NHS Trust, said: “The attitudes and behaviours of doctors don’t just impact on their own wellbeing, but can have an influence on how these messages are relayed to patients and the wider public. It’s very important that people are aware that ultraviolet radiation from the sun increases the risk of skin cancer, and that they understand the benefits of enjoying the sun safely.

“It is worrying that a large number of doctors are not looking after their skin in the sun, and only a third of them are checking their skin for cancer. This is a fairly simple thing to do and can make all the difference when it comes to catching potential skin cancers early.”

Matthew Gass of the British Association of Dermatologists said: “Most people enjoy spending time in the sun to one degree or another. However, it’s important to enjoy the sun responsibly, taking necessary precautions and avoiding getting sunburnt.

“It’s disappointing that some doctors are not following the advice that they should be passing on to others. Particularly worrying is the fact that 10 per cent of those questioned admitted to using sunbeds. We would hope by now that most doctors would recognise that if you are looking to get a tan, it’s much safer to get it from a bottle.

“It would be very interesting to see further studies in this area, with a larger sample size.”

Skin cancer is the most common form of cancer in the UK. Melanoma is the most deadly form of skin cancer, with 13,348 people in the UK being diagnosed in 2011 and 2,209 deaths in the same year.

The study invited doctors from a range of specialities and training grades to answer an anonymous questionnaire, which resulted in 163 responses.

1 Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr, accessed on 24 January 2014

-Ends-

Notes to editors:

For more information please contact: Matt Gass, Communications Officer, on 020 7391 6084 or at matthew.gass@bad.org.uk

If using this study, please ensure you mention that the study was released at the World Congress on Cancers of the Skin. 

The conference will be held in Edinburgh from September 3rd to 6th 2014, and is attended by approximately 1,000 UK and worldwide health professionals.

The World Congress on Cancers of the Skin 2014 was founded by The Skin Cancer Foundation, the international organization devoted solely to education, prevention, early detection, and prompt treatment of the world’s most common cancer. It is organised by the British Association of Dermatologists.

 

Study details:

Evaluation of sun exposure behaviour and use of sun protection among medical professionals.

Jingyuan Xu1, Kim Varma2

1Sandwell and West Midlands Hospitals NHS Trust, Birmingham, UK, 2North Cumbria University Hospitals NHS Trust, Carlisle, UK

Excess exposure to ultraviolet radiation has been identified as the most important modifiable risk factor for skin cancer. Physicians' individual attitudes and behaviour will not only impact personal wellbeing but also influence promotion of sun protection to others.

The study aims to look at the behaviours concerning sun exposure and its prevention among doctors across various specialties in the United Kingdom. No previous studies have been identified in the literature regarding the sun exposure behaviours among secondary care medical professionals.

Doctors were invited to participate in an anonymous questionnaire, which was available both in written and online format. 163 medical professionals completed the questionnaire. A third of doctors demonstrated sun-seeking behaviours and over 10% of medical professionals use tanning beds. Incidences of sunburn (more than 1 episode per year) was rated the highest amongst women, but interestingly female doctors also reported more frequent sun-protective behaviours compared to their male colleagues. More than 65% of medical professionals have never performed skin self-examination or had their skin examined by another healthcare professional.

Our findings illustrate that doctors engage in multiple skin cancer risk behaviours. A comprehensive approach to change behaviour requires exploration of attitudes and sun education should be highlighted among medical professionals and promoted within healthcare system.

About the BAD

 

The British Association of Dermatologists (BAD) is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. The BAD provides free patient information on skin diseases and runs a number of high profile campaigns, including Sun Awareness, which runs from May to September annually and includes national Sun Awareness Week in May. Website: www.bad.org.uk/sunawareness

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Skin cancer hospital admissions soar by 41% in just five years

Embargo to: 00.01hrs on 02.09.2014

The number of hospital admissions for skin cancer treatment in England has increased by 41 per cent in the space of just five years, according to a study being presented this week at the World Congress on Cancers of the Skin in Edinburgh, Scotland (September 3rd to 6th).

According to the study conducted by researchers at Public Health England, figures rose significantly from 87,685 admissions in English hospitals in 2007 to 123,808 in 2011. This study does not include treatment in outpatients units or by GPs.

Skin cancers are the most common form of cancer in England, with numbers of skin cancers equal to all other types of cancers combined. Whilst skin cancers can be serious, they are also largely preventable as excess sun exposure is a major avoidable cause. In spite of this, this study has revealed a 30 per cent increase in admissions for melanoma treatment, the most serious type of skin cancer, in English hospitals over the five-year period, in an addition to a 43 per cent increase in non-melanoma skin cancer admissions.

The surge in incidence rates has resulted in an annual spend of over £95 million on inpatient skin cancer care, with the most common procedure for both melanoma and non-melanoma skin cancers being surgical excision.

Johnathon Major of the British Association of Dermatologists commented: “As holidays to sunny locations become cheaper and tanned skin remains a desirable fashion statement, we have seen an inevitable increase in skin cancer incidence rates and the associated health and financial burden they place on the nation. Skin cancers are largely preventable and more must be done to communicate to the public the serious risks associated with unmediated sun exposure if we are to see a decline in these figures.”

Julia Verne, Director of the South West Knowledge and Intelligence Team, Public Health England added: “The number of procedures required to meet the demands are increasing at a significant rate. Surgery was required for 78 per cent of non-melanoma skin cancers and 71.5 per cent of melanomas. Over 16,000 skin grafts and flaps were required for the treatment of skin cancer in 2011 and the majority are on the head and neck.

Ends-

Notes to editors:

For more information please contact: Matt Gass, Communications Officer, on 020 7391 6084 or at matthew.gass@bad.org.uk

If using this study, please ensure you mention that the study was released at the World Congress on Cancers of the Skin.  

The conference will be held in Edinburgh from September 3rd to 6th 2014, and is attended by approximately 1,000 UK and worldwide health professionals.

The World Congress on Cancers of the Skin 2014 was founded by The Skin Cancer Foundation, the international organization devoted solely to education, prevention, early detection, and prompt treatment of the world’s most common cancer. It is organised by the British Association of Dermatologists.

 

Study details:
Skin cancer care in England; V.Poirier, T.Jones, A.Ives, J. Newton-Bishop and J.Verne
Background:
Skin cancers – Non Melanoma Skin Cancer (NMSC) and Malignant Melanoma (MM) are the most common cancers in England. The treatment and consequent cost related to NMSC is often considered insignificant compared to MM. We considered the trends in numbers of day case and inpatient treatments for skin cancer during a five year period in England, including procedures used, specialties involved and costs.
Method:
Details of admissions between 2007 and 2011 for a diagnosis of skin cancer (ICD 10 code C43 or C44) were extracted from the inpatient hospital episode statistics (HES). We identified the procedures used and the specialties involved. Healthcare Resources Group (HRG) codes were used to estimate the costs involved. NMSC admissions were matched to the National Cancer Data Repository to determine their morphology: Squamous Cell Carcinoma (SCC) or Basal Cell Carcinoma (BCC).
Results:
There has been a significant increase in hospital admissions between 2007 and 2011 for NMSC (76,528 vs. 109,333) and MM (11,157 vs. 14,475).The main procedures recorded in 2011 were surgical excisions both for NMSC (78%) and MM (71.5%). Moh’s surgery was mainly undertaken for BCC. Over 16,000 flaps and grafts were undertaken for NMSC in 2011 compared to 1,766 for MM. There was some use of amputation for MM and SCC. Most day cases were managed by Dermatologists and Plastic Surgeons and the latter represented the main specialty involved with inpatient care. Dermatologists’ involvement with day cases increased between 2007 and 2011 (3.9% for NMSC and 5.3% for MM) but decreased for Plastic Surgeons (-3.3% and -5.9%). The overall cost of inpatient treatment in England in 2011, based on our data, was £81,114,834 for NMSC and £14,355,797 for MM.

About the BAD

 

The British Association of Dermatologists (BAD) is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. The BAD provides free patient information on skin diseases and runs a number of high profile campaigns, including Sun Awareness, which runs from May to September annually and includes national Sun Awareness Week in May. Website: www.bad.org.uk/sunawareness

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Incidence of skin cancer on the rise in Scotland once more
CORRECTION: It has come to our attention that the study outlined in the press release below, contained inaccurate data when originally released on August 28th. The amended version is below. 
 

 

Despite a recent decline in Scotland of skin cancer, the UK’s most common cancer is once more on the rise, according to a study being presented at the World Congress of Cancers of the Skin this week in Edinburgh (September 3rd-6th).

The researchers, from the Alan Lyell Centre for Dermatology in Glasgow, analysed data on skin cancer incidence and survival from the Information Services Division (ISD) Scotland. The data showed that the incidence of melanoma and non-melanoma skin cancer has increased 273 per cent (two and half fold) since 1990.

Between 2009 and 2010 there was a one per cent fall in the incidence rate for skin cancer, however this subsequently increased in 2011 above the previous highest recording.

There are three main types of skin cancer. Melanoma is the least common but most deadly form. Squamous cell carcinoma is the second most common type, and together with basal cell carcinoma – the most common but least dangerous form – is known as non-melanoma skin cancer. Of the three skin cancer types, the following increases were noted between 1990 and 2011:

·         Basal cell carcinoma rose from 2910 cases across all age groups in 1990, to 7553 cases in 2011, equal to a rise in incidence of 160%.

·         Squamous cell carcinoma rose from 892 cases in 1990, to 2982 cases in 2011, equating to rise in incidence of 234%.  

·         Cutaneous melanoma increased from 495 cases in 1990 to 1202 cases in 2011, a rise of 143%.

The researchers were also able to report some positive trends, with survival rates soaring over the last 30 years, probably due to better public health messaging on the importance of early detection of skin cancer. Survival at five years after diagnosis between 1983 and 1987 was 64 per cent for men and 81.9 per cent for women. This had increased to 85.4 per cent and 91.7 per cent for males and females respectively for the period 2003 to 2007.

Dr Gregory Parkins, one of the authors of the study, said: ““There are several factors which are likely to be contributing to this increase in skin cancer in Scotland, including more affordable holidays to sunny destinations, sunbed usage, and an aging population.

“It will come as no surprise to the people of Scotland that a large proportion of us have pale skin, which makes the risk of developing skin cancer higher. This means that education around skin cancer and sun protection is hugely important.

Matthew Gass of the British Association of Dermatologists said: “The incidence of melanoma and non-melanoma skin cancer continues to rise at a worrying rate, and although the rise in incidence has been met by an improvement in survival rates, the ultimate goal is to prevent skin cancers occurring in the first place. There is still a long way to go in terms of education around sun awareness and skin cancer. We hope that people recognise that prevention is far better than a cure.”

-Ends-

Notes to editors:

For more information please contact: Matt Gass, Communications Officer, on 020 7391 6084 or at matthew.gass@bad.org.uk

If using this study, please ensure you mention that the study was released at the World Congress on Cancers of the Skin. 

The conference will be held in Edinburgh from September 3rd to 6th 2014, and is attended by approximately 1,000 UK and worldwide health professionals.

The World Congress on Cancers of the Skin 2014 was founded by The Skin Cancer Foundation, the international organization devoted solely to education, prevention, early detection, and prompt treatment of the world’s most common cancer. It is organised by the British Association of Dermatologists.

Study details:

Incidence of Skin cancer within the Scottish Population, Gregory Parkins, Allan Matthews, Grant Wylie; Alan Lyell Centre for Dermatology, Glasgow, UK

Skin type, ultra violet radiation and genetics all play a role in the development of melanoma and non-melanoma skin cancers. With a large number of the population in Scotland having Fitzpatricks type I &II skin, the risk of developing skin cancer is higher. Our aim was to assess the general trends in skin cancer incidence within Scotland. We sourced data on melanoma and non-melanoma skin cancers from the Information Services Division (ISD) Scotland which had figures for skin cancer incidence and survival. We specifically looked at trends in the incidence of melanoma, basal cell carcinoma and squamous cell carcinoma. The incidence of melanoma and non-melanoma skin cancer has increased. The number of cases of basal cell carcinoma rose from 2910 cases across all age groups in 1990, to 7553 cases in 2011, equal to a rise in incidence of 160%. A similar picture was seen with squamous cell carcinoma with 892 cases in 1990, rising to 2982 cases in 2011, equating to rise in incidence of 234%. The number of cases of cutaneous melanoma increased from 495 cases in 1990 to 1202 cases in 2011, a rise of 143%. It was noted between 2009 and 2010 the rates of melanoma and non-melanoma skin cancer fell by 1%, but subsequently increased in 2011 to above the previous highest recording. The relative survival at five years after diagnosis between 1983 and 1987 was 64% and 81.9% for males and females respectively. This had increased to 85.4% and 91.7% for males and females respectively for the period 2003-2007. Incidence of melanoma and non-melanoma skin cancer has risen exponentially. Increasing age and exposure to UV radiation through holidays abroad and sun beds play a role in the trends seen. The levelling off incidence in recent years may reflect a plateau in skin cancer rates. It is encouraging however, that the rise in incidence has been met with improvement in survival from melanoma, especially amongst males who have shown an absolute increase in survival of 21% over 20 years. Given the management of melanoma has not really changed in this time, the improved survival may be a result of public health messages specifically on sun protection and the importance of early detection of skin cancer.

Reference: ISD Information Services Division, NHS National Services Scotland, Cancer Statistics, Skin Cancer.

About the BAD

The British Association of Dermatologists (BAD) is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. The BAD provides free patient information on skin diseases and runs a number of high profile campaigns, including Sun Awareness, which runs from May to September annually and includes national Sun Awareness Week in May. Website: www.bad.org.uk/sunawareness

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Risk of common skin cancer increased by as much as 90 per cent, study finds

 

Research being presented this week at the World Congress on Cancers of the Skin in Edinburgh, Scotland, shows that sunbeds significantly increase the risk of a potentially serious skin cancer that is twice as common as melanoma.

Warnings about sunbeds often focus on melanoma, the least common type of skin cancer, which is linked to sunburn. Some sunbed operators therefore claim that as long as skin does not burn, there is no cancer risk.

However this latest warning, from researchers at University of Dundee in Scotland and Leiden University Medical Centre in the Netherlands, relates to squamous cell carcinoma (SCC), the second most common type of skin cancer. SCC is caused by longer-term, cumulative exposure to UV, such as through repeated tanning, rather than isolated incidents of burning. SCC accounts for about 20 per cent of all skin cancers, while melanoma accounts for just one per cent.

In January 2013, the same researchers from Dundee published a study which measured ultraviolet (UV) radiation levels emitted by 402 sunbeds across England*. This showed that nine out of ten sunbeds emitted UV levels that exceed European safety limits.

In this latest study, the team used these data on the UV intensity levels, factored in the average length of sunbed sessions, and the number of sessions each year, as well as a person’s cumulative UV exposure from the sun, and then applied an equation that links UV exposure and SCC incidence, to predict risk to people who use sunbeds.

The researchers found that by 55 years of age, people who used a sunbed were 90 per cent (1.9-fold) more likely to develop SCC than those who did not. Sunbed use was defined as having a 12 minute session about every eight days (or a six minute session every four days), over a 15 year period from age 20 to 35 years, using a sunbed with a median UV dose**. For high dose sunbeds the risk is increased by 180 per cent. Even the sunbeds giving the lowest UV dose found in the 2013 study were linked to a 40 per cent increased risk of developing SCC.  

This is the first study to estimate the risk of SCC according to the type of sunbed (high, medium and low output), session time, and number of sessions per year, and consider those in relation to day-to-day exposure and holiday exposure.

Professor Harry Moseley of the University of Dundee, one of the study’s authors said: “There is considerable variation in the output of artificial tanning units which people should be aware of. The results of our study indicate that the additional UV dose from sunbed use compared to normal day-to-day sun exposure potentially adds a significantly increased risk for development of SCC.”

Nina Goad of the British Association of Dermatologists said: “While other types of skin cancer, such as melanoma, are linked to sunburn, SCC is caused by more chronic, long-term, cumulative sun exposure. One defence of the sunbed industry is that sunbeds do not increase your risk of skin cancer if you do not burn, however this study weakens this argument. It is something that people should be warned about, so they are fully informed of the risks when making choices about sunbed use.”

There are two main types of skin cancer: melanoma and non-melanoma skin cancer. SCC is a non-melanoma skin cancer, and the second most common type of skin cancer in the UK. While it results in fewer deaths than melanoma (approximately 500 SCC deaths per year in the UK compared to 2,200 deaths from melanoma), it has metastatic potential (it can spread to other parts of the body) and can have a significant impact on the patient, including extensive scarring following surgical removal.

The most common cause is too much exposure to ultraviolet (UV) light from the sun or from sunbeds. This causes certain cells (keratinocytes) in the outer layer of the skin (the epidermis) to grow out of control into a tumour. SCC can be cured if detected early, however if an SCC is left untreated for too long it may spread to other parts of the body, which can prove fatal. About 23,600 new cases of SCC are diagnosed in the UK each year. However, as not all cases are registered, the actual figure is believed to be far higher.

-Ends-

Notes to editors:

*http://www.bad.org.uk/media/news?SiteSectionId=154&page=3&from=01/01/2013%2000:00:00&to=01/01/2014%2000:00:00&range=2013   

** A Standard Erythemal Dose (SED) is a standard measure of UV dose. The median total sunbed irradiance was calculated to be 0.54 Wm-2 which is equivalent to 3.9 SED for a 12 minute sunbed session. High dose is defined as 302 SED and low dose as 82 SED.

For more information please contact: Matt Gass, Communications Officer, on 020 7391 6084 or atmatthew.gass@bad.org.uk

If using this study, please ensure you mention that the study was released at the World Congress on Cancers of the Skin. 

The conference will be held in Edinburgh from September 3rd to 6th 2014, and is attended by approximately 1,000 UK and worldwide health professionals.

The World Congress on Cancers of the Skin 2014 was founded by The Skin Cancer Foundation, the international organization devoted solely to education, prevention, early detection, and prompt treatment of the world’s most common cancer. It is organised by the British Association of Dermatologists.

Study details:

156, Predicted increased risk of squamous cell carcinoma induction associated with sunbed use, Patrick Tierney1, Sally Ibbotson1, Frank de Gruijl2, Harry Moseley11Photobiology Unit, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK, 2Dept. of Dermatology, Leiden University Medical Center, Leiden, The Netherlands

Solar Ultraviolet (UV) radiation is acknowledged as the principle cause of skin cancer. Furthermore, sunbeds have been classified as carcinogenic by International Agency for Research on Cancer.  Therefore an increased risk of developing non-melanoma skin cancer (NMSC) is expected when one is exposed to both sources of UV radiation. The additional risk factor was determined from a squamous cell carcinoma (SCC) tumour induction model based on albino mice1. The risk model for SCC induction was adapted to include the use of sunbedsalong with lifetime cumulative dose from day-to-day and holiday exposure.  The latter two were established as the “baseline” exposure. Age and environmental UVR exposure are the two most important factors in determining the relative risk. Application of meta-analysis with biological amplification factor 2.3 and age dependent factor 3.8 from epidemiological studies is used to estimate risk of SCC associated with the extra dose accumulated with sunbeds. The relative risk was defined as the risk of SCC induction from (sunbed + baseline) / baseline. We additionally investigated the various body-sites, from those normally exposed such as face and arms to more usually unexposed sites. With these scenarios the relative risk of SCC induction from median sunbed exposure output in addition to median baseline sun exposure level was 1.9 at age 55 years. This is the first time that a risk model for skin carcinomas has been developed that includes real sunbed exposure data. It shows that the additional risk associated with sunbed use may be significant, particularly when high output, fast tan sunbeds are used.

1De Gruijl FR, Van der Leun JC. Development of skin tumors in hairless mice after discontinuation of ultraviolet irradiation. Cancer Research 1991; 51: 979-84.
Tierney P, Ferguson J, Ibbotson S et al. Nine out of 10 sunbeds in England emit ultraviolet radiation levels that exceed current safety limits. British Journal of Dermatology 2013; 168: 602-8.

 

About the BAD

 

The British Association of Dermatologists (BAD) is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. The BAD provides free patient information on skin diseases and runs a number of high profile campaigns, including Sun Awareness, which runs from May to September annually and includes national Sun Awareness Week in May. Website: www.bad.org.uk/sunawareness

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Older men at higher risk of skin cancer: sun safety campaigns too youth-focused

A study being presented next week at the World Congress on Cancers of the Skin in Edinburgh Scotland (September 3rd to 6th), reveals melanoma skin cancer rates in England to be rising faster in older men than any other demographic, suggesting that awareness campaigns might be too youth-focussed.

Conducted by analysts at Public Health England (PHE), the research discovered that the incidence rate of melanoma, the most serious form of skin cancer, is rapidly increasing in the older population, in particular amongst men, raising concerns that current sun safety campaigns are not reaching these groups.

The most common type of melanoma – called superficial spreading melanoma – increased by 12 per cent per year over a 21-year period (1990 to 2010) for men aged 60 and over, surpassing the incidence rates for older women (nine per cent) and younger men (eight per cent). The increase in thicker (more advanced) tumours in older men is also increasing at a greater rate than in other demographics – a 12 per cent increase per year compared to just six per cent in younger men -  suggesting that older men may be seeking medical advice later.

Melanoma is more common on the back in men and it is difficult for patients to spot early changes in a lesion on the back. Furthermore, in older people it is common to develop a variety of harmless lesions on the skin, such as warts. Differentiating melanomas from these is difficult. These two observations may contribute to older men presenting with thicker tumours.

The increase in melanoma incidence rate for older men varied by body site, with the fastest rise on the trunk and upper limbs (both around nine per cent per year), whilst for other demographic groups there was no such variation.

PHE’s findings are mirrored by an earlier study into skin cancer incidence rates in the Scottish population*, which showed rates of melanoma trebling in males between 1979 and 2003 (with 206 cases between 1979 and 1983, and 2073 from 1999 to 2003) and the greatest increases being seen in those aged 60 and over.

Julia Verne, Director of the South West Knowledge and Intelligence Team, Public Health England commented: “Studies into the causes of melanoma have emphasised the importance of excessive UV exposure and especially burning through recreational activities and holidays. The findings of this study highlight the need for education campaigns to target the entire spectrum of people across all demographics about the dangers of sunburn and sunbathing.”

Johnathon Major of the British Association of Dermatologists added: “Older men have continuously proved a problematic group for us to target with skin cancer advice and studies such as these underline the requirement to reach them. We are constantly developing our communication initiatives to tender to wider audiences and target groups such as these who have been demonstrated to be in particular need.With health messaging, there can be an over-reliance on newer technologies such as social media, but these don’t always reach the groups most in need. 

“For this reason we now operate two major sun awareness campaigns each year - Sun Awareness Week and the Be Sun Aware Roadshow, both of which are aimed at all age groups. We try to visit a range of outdoors events, from sporting events to gardening shows, to capture people whose recreational activities mean they spend time in the sun, perhaps unprotected.

“There are two issues at play here – skin cancer rates are rising faster in this group, so we conclude that protecting the skin from sun damage is important for adult men as well as others, and second, there is concern that older men also seem to be presenting later. This shows we need to address both our prevention messages, and our early detection messages, at older people as a matter of priority. ”

-ENDS-

For more information please contact: Matt Gass, Communications Officer, on 020 7391 6084 or at matthew.gass@bad.org.uk


If using this study, please ensure you mention that the study was released at the World Congress on Cancers of the Skin.


The conference will be held in Edinburgh from September 3rd to 6th 2014, and is attended by approximately 1,000 UK and worldwide health professionals.


The World Congress on Cancers of the Skin 2014 was founded by The Skin Cancer Foundation, the international organization devoted solely to education, prevention, early detection, and prompt treatment of the world’s most common cancer. It is organised by the British Association of Dermatologists.

Study details:


Cutaneous melanoma in older persons, V.Poirier, T.Jones, A.Ives, J. Newton-Bishop and J.Verne
Background


Previous reports from the UK highlighted a higher incidence of melanoma in women. However, we recently reported a considerable and remarkable change in melanoma incidence with the most rapid increase occurring in older people and especially men. We consider here whether this reflects an emerging pattern indicative of a proportion of tumours with a different aetiological route to melanoma.
Methodology


We examined melanoma (ICD-10 C43) incidence trends (1990-2010) in England using the National Cancer Data Repository. Three cohorts were compared: Males 60+ years (older men), females 60+ years (older women) and males under 60 years (younger men); broken down by the following variables: anatomical site, socio-economic deprivation, tumour morphology, Breslow thickness and previous occurrence of skin cancer.


Directly standardised incidence rates were calculated and Poisson regression was used to model the changes in these rates over time.


Results
Between 1990 and 2010 the melanoma incidence rate for older men varied by anatomical site (p<0.01), with the fastest rise on the trunk and upper limbs. There was no significant variation for older women (p=0.07) or younger men (p=0.89).


Melanoma incidence rates have increased irrespective of deprivation status but rates in the least deprived population increased faster for older men than younger men (7.1% vs. 3.9%; p=0.03).
The incidence rate for superficial spreading melanoma in older men increased faster (12.4%) than older women (8.9%) and younger men (7.9%), although not significantly (p>0.05).


For older men, melanoma incidence rates increased faster for thicker tumours (>4 mm; 11.5%) compared to older women (9.4%) and younger men (6.3%).


Older men had a higher proportion of previous squamous cell carcinomas than older women or younger men (p<0.01), and this proportion increased significantly faster for older men than younger men (p=0.046).


Conclusions
Epidemiological studies have consistently reported evidence that recreational sun exposure rather than chronic sun exposure is associated with melanoma risk. The new data presented here suggest that health promotion campaigns should address the risks associated with recreational sun exposure at all ages, on all body sites including the head and neck, and deliver early detection campaigns to older individuals and especially men.


*Second study: Melanoma incidence and mortality in Scotland 1979-2003, MacKie, R M1; Bray, C; Vestey, J; Doherty, V; Evans, A; Thomson, D; Nicolson, M. Department of Public Health and Health Policy, University of Glasgow, Glasgow G12 8RZ, UK. R.M.Mackie@clinmed.gla.ac.uk. British journal of cancer 96.11 (Jun 4, 2007): 1772-7.
 

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Dermal piercings: Dermatologists raise concerns over unregulated high street surgery

Dermatologists are warning the public about a type of piercing called a dermal anchor, at a presentation given at the British Association of Dermatologists Annual Meeting in Glasgow this week.

Dermal anchors consist of two main components, usually made out of titanium or stainless steel: a flat plate called the ‘anchor’, which sits beneath the skin, and a changeable piece of jewellery that sits on the surface. They are connected by a ‘post’, which is fixed to the plate and protrudes through the skin for attachment of jewellery. These devices are designed to allow greater scope for body decoration, as they enable decoration in areas of the body where traditional piercings wouldn’t be possible, and to have more permanence, as they require professional assistance to remove.

But doctors are raising concerns about how these anchors are inserted into the skin, the safe removal of the anchors, and potential complications. They warn that the procedures involved with inserting and removing these devices are not straightforward, and in the event of something going wrong the NHS is saddled with the burden.

Insertion requires the use of either a scalpel, dermal (skin) punch, or in the case of smaller incisions, a piercing needle. The anchor must be placed deep enough to minimise the risk of the piercing moving, known as migration, but not so deep that the skin begins to grow over the piercing, known as embedding.

 Because local anaesthetic injections can only be administered by those with a medical qualification, those undergoing the procedure have to do without, which has the potential to be very painful. Even once successfully administered, complications can occur. One example raised by the dermatologists is a 29 year old woman referred to a dermatology clinic in Glasgow for repeated inflammation and pain in her hand, caused by a dermal anchor inserted nine months before.

How these devices are removed is less clear, particularly as piercers are not recommended to attempt this procedure themselves. In the above case, it was surgically removed by medical professionals, and it soon became clear that it was embedded into the dermis (the lower layer of skin).

Dr Greg Parkins, one of the doctors issuing the warning, said: “If the popularity of this permanent body art continues to increase then so too will the number of patients seeking removal. This has potential health economic consequences, especially if patients are relying on removal of these implants on the NHS.

“It’s important that the public, medical professionals and those carrying out these piercings are aware of the dangers and difficulties associated with dermal anchors. Although local councils regulate businesses that insert dermal anchors through licencing, there is less clarity when it comes to guidance on how these devices should be removed, and by whom.

“The practice of clinical surgery without medical qualifications is a criminal offence in the UK. With dermal anchors the distinction between piercing and surgery is becoming less clear and I feel there are legitimate concerns over adequate training, hygiene and disease transmission.”

Matthew Gass of the British Association of Dermatologists said: “Dermatologists are not trying to dictate what people should and should not do with their bodies. However, it is important that they understand the long-term consequences of these piercings and the associated risks.”

Other observed complications have included infection, patients requiring Magnetic Resonance Imaging (MRI – a medical imaging technique used to internally examine the body), and pregnant women who have developed acute rejection of abdominal piercings.

-Ends-

For more information please contact: Matt Gass, Communications Officer, on 020 7391 6084 or atmatthew.gass@bad.org.uk

Study details: 'Dermal piercings: unregulated high street surgery?'

G. Parkins and M. Porter

 

Alan Lyle Centre for Dermatology, Glasgow, U.K.

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Doctors raise safety fears over new on-call plans
 

Trainee dermatologists are warning that any plans to make them work on-call in general medicine will put patient safety at risk, with 82 per cent strongly opposed to such reforms, according to a survey released this week at the British Association of Dermatologists’ Annual Conference in Glasgow.

Specialists in general internal medicine (GIM) care for a wide variety of patients who may be suffering from any number of common disorders, may have multiple conditions or complex needs or may represent a diagnostic conundrum. These doctors have a continuing responsibility for hospital inpatients who are not being cared for in the acute medical unit.

The NHS is faced with a range of problems, including the rising tide of acute admissions, patients with increasingly complex illnesses and a medical workforce crisis. The Future Hospital Commission was established by the Royal College of Physicians to find solutions to the current challenges. In September 2013, the Commission recommended training in general internal medicine to be mandatory for all doctors training in medical specialties.

Now a survey of trainee dermatologists across the UK, conducted by doctors at Norfolk and Norwich University Hospital,reveals that 82 per cent are strongly opposed to the inclusion of general medical on-call for dermatology trainees, and 80 per cent strongly disagree that participation in a general medical on-call rota would be beneficial for the development of dermatology-specific skills. Patient safety was a frequently raised concern. Particular worries included performing unsupervised procedures that are not regularly done by dermatology trainees, including placing central lines, inserting chest drains and temporary cardiac pacing.

Dr Nick Levell, one of the study’s authors, said: “The results of this survey indicate that the majority of dermatology

trainees are opposed to the inclusion of general medical on-call. The General Medical Council states that doctors must put patients’ safety first and make sure that the care they provide is safe and effective. Patient safety must be taken into account when considering the inclusion of general medical on-call for dermatology trainees.”

Professor Chris Bunker, President of the British Association of Dermatologists: “This study highlights a major flaw in the agenda to make participation in general medicine mandatory for those training in all medical specialties. The trainees who would be tasked with the work have stated that they do not feel it is safe for them to do so. We recognise the crisis facing hospital services generally. However a viable solution should not be one that undermines the work of individual departments. Also, it is imperative that training the right number of specialists with the right skills in the right place is a protected priority, and that the effectiveness of this training is not diluted to fight fires in other areas of hospital services.

“In many specialties like ours, trainees provide a large part of the service. Forcing dermatology and other specialty trainees to fill the gaps in general medicine denies specialist patients the care they require. Furthermore, these trainees may not have maintained the required level of skills to serve the needs of general medical patients. This practice is not just harmful to specialty training and patient care in dermatology, but it’s also likely to have minimal impact on the crisis in the acute setting.”

The Future Hospital Commission report (Future Hospital: Caring for medical patients) was released on Thursday September 12th, 2013. The full report can be viewed here: http://www.rcplondon.ac.uk/projects/future-hospital-commission

 

-Ends-

For more information please contact:  Nina Goad, Head of Communications, 0207 391 6094 or mobile 07825567717 during conference week, or email: nina@bad.org.uk, Website: www.bad.org.uk

Study details: Exhibition poster P24; Dermatology trainee doctor survey: acute general medical on call could endanger patients; R. Coelho and N. Levell; Norfolk and Norwich University Hospital, Norwich, U.K.

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EU fail to ban controversial preservative, as new research shows it is still causing acute contact allergy reactions

A preservative causing an epidemic of skin allergy is to remain in a range of cosmetic products, despite a widespread call for it to be banned, it has emerged today.

According to a decision made by the EU Commission, Methylisothiazolinone (MI) will be removed from products left on the skin, except for those used on the hair and scalp. However it will not be banned from products that are rinsed off the skin, and nor will its permitted concentration in these products be reduced.

It has been a year since dermatologists first warned the public about a contact allergy epidemic in the UK, largely stemming from the use of MI as a chemical preservative in cosmetic products. In addition to this latest EU ruling, new research is being presented from tomorrow at the British Association of Dermatologists’ Annual Meeting in Glasgow tomorrow, warning about the use of the chemical in other products, such as paints and detergents, as well as in the workplace, as the epidemic shows no sign of abating.

This decision not to ban the chemical outright in cosmetic products will further inflame the problem.

MI is widely used, either on its own or in combination with methylchloroisothiazolinone (MCI), as a preservative in personal care products such as moist tissue wipes, cleansers, shower gels, deodorants and shaving foam. However, it can also be found in everyday professional and household products such as detergents, paints and glues.

Since last July, when the British Association of Dermatologists first raised the issue, several new studies have been conducted.   At the time, a team at the Leeds Centre for Dermatology showed a sharp rise (up to 6.2 per cent sensitivity) in contact allergy to MCI/MI and MI over the previous three years. This, combined with other studies released by the British Association of Dermatologists, prompted a public outcry about the continued use of the chemical.

In December 2013, in response to pressure from dermatologists, Cosmetics Europe, the European cosmetics trade association, recommended to all its members that MI should be immediately removed from all leave-on skin products and personal care products, including cosmetic wet wipes, without waiting for action from regulators.

In practice, however, many leading household name cosmetic products containing MI have remained on the shelves during the last six months and are now likely to do so for the foreseeable future. MI continues to feature in a wide range of household and industrial products, often without sufficient labelling.

Prior to 2005, MI had to be mixed with MCI and was generally found in concentrations of around four parts per million (ppm) in personal care products. However, from 2005 MI was permitted for use on its own in far higher concentrations - up to 100 ppm – which is a 25-fold increase on the previous levels of the preservative and widely thought to be responsible for the disease increase.

The Scientific Committee on Consumer Safety of the European Union recommends limiting the concentrations of MI in rinse-off products, such as shower gels, to 15 parts per million (ppm). This has not been upheld in the decision by EU Commission’s decision.

 

MI Research presented at the BAD Annual Conference, 30th June to the 3rd July 2014

MI in paint causing acute facial dermatitis and difficulty breathing:

Dermatologists from University Hospital Lewisham and St John’s Institute of Dermatology have identified MI in paint as a serious potential public health concern. Exposure to paints with MI can trigger reactions in those already sensitised to the allergen, as well as causing those with no history of allergy to MI to be reactive.

To illustrate the problem, the researchers used the case of a 52-year-old woman who presented with severe facial eczema and difficulty breathing, caused when she repainted her living room. She had no past medical history of asthma or other respiratory conditions. The symptoms started with an itchy rash over the cheeks, which progressed to involve the entire face, eyelids, upper chest and dominant hand.

After initial treatment, the patient then suffered a further flare-up of her symptoms when she tried to continue painting her living room, not knowing this was the trigger for her reaction, and her breathing difficulties became so serious that she required emergency treatment. The use of MI in the paint was eventually identified as the cause of the reaction; however, the patient had to avoid her living room for the next two months.

Dermatologist Dr Wisam Alwan, one of the authors of the study, said: “Lack of necessary regulation regarding the use of MI in paint means there is no current maximum permitted concentration and no requirement to label MI as an ingredient.

 

“As with its use in cosmetics, urgent action is required to assess and manage the risk of including MI in paints and other non-cosmetic products. At the very least, MI should immediately be classified as an allergen with the potential to cause serious harm to human health and it needs to be regulated. It also needs to be identified in all product labelling. Given the serious reactions seen with MI exposure from paints, its use should be restricted and alternative, safer preservatives should be considered.”

 

MI an occupational health hazard:

Scientists from the Leeds Centre for Dermatology and the Faculty of Medical and Human Sciences at the University of Manchester are presenting research identifying MI and MCI as an occupational health risk. This research is backed-up by a case presented by dermatologists from The Royal United Hospital, Bath, of two workers from the same furniture factory who presented with allergic contact dermatitis (eczema) caused by MI in glue.

In the Leeds study, an analysis of the data from 1996 to 2012 regarding occupational skin disease caused by MCI and MI, across a range of professions, showed a 4.1% annual increase in the number of cases. This included a 3.8% increase in workers exposed to personal care products, with the greatest increases in healthcare workers (8.1%) and beauty workers (6.6%). There was also a 6.3% increase among manufacturing workers.

In the second study, two men, working at the same furniture factory under identical conditions, both suffered for almost two years from severe allergic contact dermatitis due to MI in the glue they used to assemble the furniture.

Dr Rachel Urwin, of the Leeds Centre for Dermatology and one of the authors of the first study, said: “This research shows that a review of regulations in an industrial setting is needed. There is currently little guidance and an improvement in labelling would allow workers to protect themselves against contact allergy from MI.”

Dr Deirdre Buckley, Consultant Dermatologist at The Royal United Hospital, Bath, said: “These cases add to the evidence that MI can be a significant occupational allergen, and suggest that limitation of the exposure concentration in industrial products may be advisable. It is reasonable for workers to expect to work in conditions which are not detrimental to their health.”

 

Speaking of the latest EU ruling, Dr David Orton of the British Association of Dermatologists said: “I am extremely disappointed at this decision and remain concerned for all UK consumers, both adults and children. The ban on the use of MI in leave on cosmetics was requested over a year ago and even industry's own representative body, Cosmetics Europe, suggested this six months ago. Yet these products remain on the shelves even today. There is no argument that these sorts of products sensitise people, so every day more people will be sensitised and have the capacity to react to MI. Dermatologists unequivocally know such sensitised people will react to MI at concentrations of only 50 parts per million (ppm) so it is not joined-up thinking to continue to allow rinse-off products to be sold at concentrations of 100 ppm. It allows continued severe allergic reactions to highstreet cosmetics to occur.

The data supplied by the cosmetics industry lobby to the European Parliament is a predictive tool which is not uniformly accepted  and it is being used in a retrospective fashion. UK and European citizens continue to be industry's guinea pigs. I urge them to put the health of their consumers first.”

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The conference will be held at SECC in Glasgow from July 1st to 3rd 2014, and is attended by approximately 1,300 UK and worldwide dermatologists and dermatology nurses.

 

For more information please contact: Matt Gass, Communications Officer, on 020 7391 6084 or atmatthew.gass@bad.org.uk

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“Thou art a boil, a plague sore, an embossed carbuncle” – is Shakespeare’s enduring popularity to blame for continuing stigmatization of skin disease?

There is no doubt that people suffering from skin diseases and conditions that cause visible difference still face, and fear, stigmatization, which can lead to social anxiety and depression.  Research, due to be presented at the British Association of Dermatologist’s Annual Meeting this week, looked at whether this stigma is a hangover from Elizabethan England, preserved by the enduring popularity of Shakespeare.

Researchers from Nottingham, Leicester and Derby, analysed Shakespeare’s language and found that it reflected the Elizabethan obsession with perfect, unmarked, pale skin. They speculate that the playwright’s status as the most well-known English language writer of all time, may be helping to fuel ongoing stigma around skin disease. Many of his most memorable insults are derived from skin imperfections:

“Thou art a boil, a plague sore, an embossed carbuncle” (King Lear).

“Thou art a perpetual triumph, an everlasting bonfire night. Thou has saved me a thousand marks in links and torches” (Henry IV part 1).

“A pox upon him” (All’s Well That Ends Well)

“I scorn you, scurvy companion” (Henry IV part 2).

Dr Catriona Wootton, Dermatologist at Queen’s Medical Centre in Nottingham and one of the study’s authors, said: “Rat-infested and with open sewers, overcrowding and sexual promiscuity, Elizabethan London was a melting pot for diseases such as plague, syphilis and smallpox. Many of the diseases of the time involved lesions or sores on the skin, so skin imperfections were seen as a warning sign for contagious disease.  This was not limited to signs of infection, but to any blemishes or moles, which were considered ugly and signs of witchcraft or devilry. Shakespeare uses these negative undertones to his advantage, employing physical idiosyncrasies in his characters to signify foibles in their behaviour.”

Shakespeare was not at the root of this stigmatisation, and indeed in Hamlet, he highlights the innocence of affected individuals: “that for some vicious mole of nature in them, as in their birth – wherein they are not guilty, since nature cannot choose his origin – their virtues else, be they as pure as grace, as infinite as man may undergo, shall in general censure take corruption from that particular fault”.  However, many far less tolerant examplesabound and it is argued that his success has led to the perpetuation of this stereotype.

Nina Goad of the British Association of Dermatologists said:

“It is interesting to note that much of the Elizabethan stigma over disfiguring skin disease still persists today.  Over the last few decades dermatologists have tried to address the effect this can have on patients.  However, even now, many examples exist in films and literature where visible disfigurements are used to represent villainy or malice. This is particularly concerning when such films are aimed at children, who learn that beautiful, flawless people are kind and trustworthy, and scarred or blemished people are to be feared. Nobody is suggesting that we edit Shakespeare but maybe we should ensure that new films and books don’t reinforce this stereotype. Many skin patients require psychological support to deal with the visual aspect of their disease. Whilst this support remains patchy, the British Association of Dermatologists is working on a Department of Health funded project to provide online support, which is a good first step.”

-Ends-

For more information please contact:  Nina Goad, Head of Communications, 0207 391 6094 or mobile 07825567717 during conference week, or email: nina@bad.org.uk, Website: www.bad.org.uk

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Doctors advised to be on the look-out for leprosy

Doctors attending a leading medical conference this week are being informed that leprosy, commonly thought by the public to have been eradicated in the UK, is still present and may be masquerading as other more common skin diseases.

A team of dermatologists from Cardiff in Wales are issuing their advice to 1,300 doctors at the British Association of Dermatologists’ Annual Conference in Glasgow, after seeing two leprosy cases in their clinics that had originally been misdiagnosed as more common skin complaints.

Both cases, diagnosed at the University Hospital of Wales, were in men who had moved to the UK from Asia within the last few years. The first, aged 25, had been experiencing changes to his skin’s colour and sensation on the left side of his face for six months, and lightening of the skin on his right shoulder for a year. The symptoms on his face had been previously misdiagnosed as a skin infection called erysipelas, while the skin lightening was treated as a rash called pityriasis versicolor. The second man, aged 35, had scattered patches of skin lightening over his body, raised red areas called plaques on his forehead, and circular lesions on his legs. These lesions brought about changes in his skin’s sensation. He was initially diagnosed with a type of eczema called discoid eczema. Both men were subsequently diagnosed by dermatologists as having leprosy and referred to infectious disease specialists for appropriate treatment.

Also known as Hansen’s Disease, leprosy is a chronic infection caused by bacteria called Mycobacterium leprae and Mycobacterium lepromatosis. It is unusual in that symptoms can occur several years after initial infection, sometimes even decades later. It causes lesions on the skin and diminished or loss of sensation in the affected areas, which can eventually cause further complications. Leprosy is not highly contagious and it is not fully known how it is passed from person to person but it is thought to be via droplets from the nose and mouth. The spread of leprosy is caused by close and frequent contact between a person who is genetically susceptible to develop the disease, and an untreated contagious patient.

It is a relatively rare disease with approximately 232,000 cases reported annually worldwide, the majority of which occur in south-east Asia. 129 cases were reported in England and Wales between 2001 and 2010.

Dr Ausama Atwan, one of the reporting clinicians in Cardiff, said: “Our aim is not to alarm people unduly as leprosy is still uncommon in the UK, but it is certainly something that doctors should be mindful of if they encounter patients, especially those originally from endemic countries, with persistent or unexplained lesions, changes to skin pigmentation and sensation. Leprosy may masquerade as various other skin disorders, given its range of symptoms. Due to its rarity in Europe, it may easily be misdiagnosed and consequently pose future health risks for patients if missed. A detailed medical history, including factors like travel to areas where the disease is more common, and examination of the skin and peripheral nerves, together with a high degree of suspicion in individuals at risk, are crucial towards diagnosis and the eventual treatment of leprosy. The potential prolonged incubation period must also be borne in mind.”

Nina Goad of the British Association of Dermatologists said: “When people hear the term leprosy, they generally think of leper colonies and references to the disease in the Bible or films like Monty Python’s Life of Brian. They are probably not aware that it can still occur here in the UK. Diagnosis in western populations such as the UK is often delayed because doctors are unaware of the disease’s presence in their country, or of its symptoms. Dermatology is hugely underrepresented in GP training to start with, so rare diseases like leprosy are seldom taught. However, early diagnosis and treatment are crucial in limiting the nerve damage that causes the numbness that can in turn lead to loss of limbs or digits.”

The first known written mention of leprosy is dated 600 BC. Throughout history, leprosy patients have often been ostracized by their communities and families. This has led to the disease’s name commonly being used to represent social stigma and ostracization. Leper colonies were set up throughout the middle ages to quarantine patients, the vast majority of which have since closed.

In June this year, researchers in the US announced that they are developing a vaccine against the disease that is due to be trialled next year.

 

-ENDS-

 

For more information please contact:  Nina Goad, Head of Communications, 0207 391 6094 or mobile 07825567717 during conference week, or email: nina@bad.org.uk, Website: www.bad.org.uk

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Sunbeds still a burning issue. New regulations recommended by Parliamentary skin group

The British Association of Dermatologists welcomes the publication, today, of the All Party Parliamentary Group on Skin’s (APPGS) recommendations regarding sunbed regulation in England.

The British Association of Dermatologists worked closely with the APPGS to gather evidence and to consult with a range of stakeholders leading to an oral evidence session in the Houses of Parliament in January this year.

Professor Harry Moseley, spokesperson for the British Association of Dermatologists says:

“The evidence shows that despite the promising step forward made by the passing of the Sunbed (Regulation) Act 2010, many providers of sunbed facilities are failing to ensure that they reach basic standards. This proposed regulation would close loopholes, such as under-18s using unmanned tanning facilities, and see stricter enforcement for businesses that continue to irresponsibly use appliances that fail to meet standards, often producing radiant dose levels well over acceptable levels. Proportionate and sensible regulation of sunbeds is important to mitigate that risk and stem the rising tide of cases of skin cancer.

“Skin cancer cases in the UK are rising at an alarming rate and there is little doubt that sunbeds increase the risk of skin cancer in fair skinned populations.” 

Skin cancer rates in the UK are high compared with other cancers. There are around 100,000 cases of non-melanoma skin cancer alone each year and the actual figure may in fact be higher due to under-reporting. For melanoma, the most deadly form of skin cancer, there are just under 13,000 cases a year and about 2,700 deaths.

The link between skin cancer and sunbeds has been well documented and in 2009 the International Agency for Research on Cancer (IARC), part of the World Health Organisation, classified sunbeds as a Group 1 carcinogen (carcinogenic to humans), the same classification as given to tobacco.

The 2010 Sunbed (Regulations) Act was the first step in restricting sunbeds and regulations have been enacted in Wales, Scotland and Northern Ireland. Since the introduction of the regulations and the ban on use by under-18s, the number of young people using sunbeds has diminished. However in a report commissioned by CRUK, Public Health England found that of those under-18s still using sunbeds over half had been burnt, including all those who reported frequently using coin-operated/token operated salons, and over half had never been asked to show ID as proof of age. 

The recommendations from the APPGS ask for further action and better enforcement of existing regulations, particularly in England:

A Ban on Unstaffed Tanning Facilities
A ban on unstaffed tanning facilities (which already exists under the regulations enacted in Scotland, Wales and Northern Ireland) is considered vital as a way of ensuring that under-18s don’t access sunbeds and that other safety measures are adhered to. Currently regulations in England do not provide for such a ban and the BAD would strongly endorse the recommendation that the Department of Health urgently look into introducing this measure in England.

Appropriate Screening of all Customers’ Skin Types
If staff are not trained to recognise skin types or advise customers on how, for example, very fair, sensitive skin or the presence of an existing skin condition, might disqualify them from using a sunbed, the potential for harm is serious.

The APPGS recommends that the English sunbed regulations be extended to include the requirement that salon staff are fully trained in the different skin types and their associated risk levels when exposed to UV light, and thought should be given to a system of certification to ensure compliance.

Compliance Testing for radiant exposure (dose) and irradiance limits
British and European Standards, agreed in all EU countries, limit the strength (irradiance) of the UV emission. Equipment that emits high levels of UV radiation has the potential to cause increased harm in a short time period. The APPGS recommends that the English sunbed regulations be extended to include compliance testing for radiant exposure (dose) and irradiance limits. It is proposed by the APPGS that the Department of Health undertake a study into the appropriate method of measuring total dosage and irradiance. The agreed method of measurement should then be incorporated into the current list of investigative duties outlined in the 2010 Sunbed (Regulation) Act. In the meantime, however, it is important that operators stay within the currently prescribed limits.

Provision of balanced health information
In Scotland, Wales and Northern Ireland, sunbed regulations already contain provisions for this and might be used as precedents in English regulations. The detail of the content of such health information would be for the Department of Health to decide. 

Provision of safety goggles
The 2010 Sunbed (Regulation) Act already contains provision for protective eyewear to be mandatory but the recommendations of the APPGS (and Public Health England) also urge the Government to consider the challenge of verification with the possibility of mandating the type of eyewear to be used – i.e. those verified by a marking scheme.

Licensing
Liverpool City Council raised a concern, shared by many, as to how possible it was to enforce existing regulations without a registry or licensing system. A 2009 survey of Local Authorities suggested that the majority would welcome the introduction of mandatory licensing of sunbed outlets. This could be made possible if the Local Government Association’s plans for a new system of local authority licensing are implemented (as set out in their report “Open for Business: rewiring licensing”). 

These recommendations represent a golden opportunity for the UK government to mitigate the unnecessary skin cancer risk from sunbeds through improving regulation, enforcement of regulation and provision of mandatory health information to users.

-Ends-

Contact:

Deborah Mason 020 7391 6355
Matt Gass 020 7391 6084
Email: comms@bad.org.uk

The British Association of Dermatologists (BAD) is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease.
British Association of Dermatologists, Willan House, 4 Fitzroy Square, London W1T 5HQ
www.bad.org.uk
@healthskin4all
 

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Cancer Research UK, the British Association of Dermatologists and Doctors.net.uk team up to help GPs tackle rising rates of skin cancer

Cancer Research UK, the British Association of Dermatologists (BAD) and Doctors.net.uk have teamed up to launch an updated online toolkit to help all GPs diagnose the UK’s most common cancer.

Launched today (May 9) in conjunction with BAD’s ‘Sun Awareness Week’, the skin cancer toolkit provides a range of images from real-life, in-clinic cases, to illustrate which lesions require urgent referral, routine referral or are benign.

Investment in the digital toolkit comes as Cancer Research UK announces that rates of people diagnosed with malignant melanoma, the most serious form of skin cancer, are now five times higher than 40 years ago.* 

The updated toolkit supports GPs in assessing atypical/borderline lesions in a variety of ways, including an image library, a forum that enables them to discuss lesions and share their experience, and clinical cases studies.

GPs will be able to access this important tool on their mobile devices ensuring that it is always accessible. GPs will also be able to record their learning in an online appraisal folder.

The first digital toolkit developed by Cancer Research UK and BAD was launched on Doctors.net.uk in 2012, and helped GPs identify ‘red flag’ cancer symptoms. An in depth analysis of the programme in 2013 showed that its users had significantly increased their confidence in referring skin lesions. The toolkit was used by over 10,000 GPs and was highly commended in the PM Society Digital Awards 2013.

Nina Goad, of the British Association of Dermatologists, said: ‘Skin cancer is the UK’s most common type of cancer – in fact it is more common than all other cancers combined. One of the problems is that GPs receive very limited training in dermatology – as little as a week – and are then expected to be able to recognise cancerous lesions from a whole host of other issues, and to know which to refer urgently.

‘Not only is this a problem for the GPs, but it can also delay the patient accessing a Consultant Dermatologist. This toolkit, available across a range of media platforms, is a simple visual guide, highlighting the differences between the many different types of skin cancer and non-cancerous lesions. We hope it will be bookmarked and used regularly by doctors as it is a very valuable tool.’

Liz Bates, Primary Care Engagement Lead for Cancer Research UK, said: ‘GPs are expected to constantly maintain and improve their knowledge, but with increasing demands on their time, we know that GPs are struggling to find time to study. We are committed to providing educational content that is easy to access and targets real problems that GPs face in day-to-day practice. We believe that digital innovations are key to providing the vital information that GPs need at their fingertips.’

Dr James Quekett, a practising GP and director of Educational Services, Doctors.net.uk, commented: ‘This much-needed resource provides an excellent, structured, problem-based approach to the diagnosis of malignancy. What is particularly valuable is that it has the input of specialists but it is presented in a format that is useful for the problems GPs encounter in primary care. It moves away from a teaching model into a collaborative learning approach which is much more effective.’


* http://www.cancerresearchuk.org/about-us/cancer-news/press-release/skin-cancer-rates-five-times-higher-than-in-70s

NOTES TO EDITORS:
For media information:
Andrew Baud, Catherine McNulty or Lydia Hayward
T: +44 (0) 20 3397 3383
M: +44 (0) 7775 715775
E: m3@teamtala.com

Bristol-Myers Squibb has provided funding to support the development of this toolkit. Bristol-Myers Squibb has had no editorial control over its content. The original toolkit, launched in 2012, was funded by the Department of Health’s Third Sector Investment Programme.

Doctors.net.uk
Doctors.net.uk is the largest and most active network of doctors in the UK. Doctors.net.uk has a membership of more than 205,000 doctors. It supports them in making the best decisions for their patients, with services including forums for discussion, extensive online education resources and a range of editorial content, such as conference highlights. Doctors.net.uk also offers a range of market-leading services that deliver measurable impact and outcomes to pharma and other healthcare companies. These include targeted display advertising (CPM and CPC), email marketing, e-newsletters, promotional campaigns, educational programmes and recruitment services.


About The British Association of Dermatologists:
The British Association of Dermatologists (BAD) is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. The BAD provides free patient information on skin diseases and runs a number of high profile campaigns, including Sun Awareness, which runs from May to September annually and includes national Sun Awareness Week in May. Website: www.bad.org.uk Email: comms@bad.org.uk

About Cancer Research UK
• Cancer Research UK is the world’s leading cancer charity dedicated to saving lives through research
• The charity’s pioneering work into the prevention, diagnosis and treatment of cancer has helped save millions of lives.
• Cancer Research UK receives no government funding for its life-saving research. Every step it makes towards beating cancer relies on every pound donated.
• Cancer Research UK has been at the heart of the progress that has already seen survival rates in the UK double in the last forty years.
• Cancer Research UK supports research into all aspects of cancer through the work of over 4,000 scientists, doctors and nurses.
• Together with its partners and supporters, Cancer Research UK's vision is to bring forward the day when all cancers are cured.

For further information about Cancer Research UK's work or to find out how to support the charity, please call 0300 123 1022 or visit www.cancerresearchuk.org. Follow us on Twitter and Facebook

About skin cancer:
There are two main types of skin cancer: non-melanoma, the most common, and melanoma, which is less common but more dangerous. The toolkit features images and information on these and also pre-cancerous lesions and a range of others.

Skin cancer is the most common type of cancer in the UK, with more than 100,000 new cases diagnosed every year. However, a recent study estimates that rates of the most common type of skin cancer, basal cell carcinoma (BCC), are now twice as high as government statistics suggest and that there are now around 200,000 cases of BCC each year, meaning it has risen 80 per cent over the past decade.
 

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Olympic heroes don the Lifeguard shorts for Sun Awareness Week 2014

Olympic heroes and British icons Louis Smith and Greg Rutherford will swap their Team GB kit for the red shorts of the Lifeguard and step onto the beach to guard the nation’s skin in the name of Sun Awareness Week 2014.

Louis and Greg will be appearing as Sun Awareness Week’s ‘Save Our Skin’ lifeguards at a pop-up beach at Bluewater shopping centre on May 10th, where visitors will be able to pose for photos with the stars against a blue sky and white sand background, and receive their own postcards as a memento to share with friends and family.

Run by the British Association of Dermatologists, and sponsored this year by Laboratoires Bioderma, one of the leading French dermo-cosmetic brands, Sun Awareness Week has become a staple in the nation’s summer calendar, bringing invaluable sun safety messaging to the British public.

Rates of malignant melanoma, the most deadly form of skin cancer, have soared in recent years, with 13,000 new cases emerging annually and 2,000 deaths from the disease in Britain each year. More affordable holidays and an ever increasing fashion for tanned skin have been major contributors to a general lack of consideration for the dangers posed by the sun. Skin cancers are now the UK’s most common type of cancer and the need to arm the public with the means to protect themselves from the sun has never been more vital.

Johnathon Major of the British Association of Dermatologists commented: “We so rarely see the sun in Britain it is little wonder that when people have the chance they make the most of it. However, this means that when the sun’s out we tend to overdo it and many people view getting sunburnt as just a step on the way to getting a tan. We’re not calling for people to never leave their homes again during the hours of daylight, we’re merely asking people to enjoy the sun sensibly and take the necessary precautions, especially to avoid sunburn.”

Mathilde Castang of Laboratoires Bioderma said: “As a dermo-cosmetic laboratory we are highly committed to sun protection and consumer education through our PHOTODERM range and our numerous partnerships with photobiology researchers around the world. Sun Awareness Week is a very important cause and we are very proud to sponsor it as part of our commitment.”

Louis Smith said: “As an athlete I understand the importance of keeping yourself healthy, this means more than just diet and exercise. Working with the British Association of Dermatologists and Bioderma on Sun Awareness Week has been an eye-opener. The effect skin cancer is having on people’s lives is huge. I'm really happy to be able to help in delivering lifesaving messages.”
Greg Rutherford commented: “Having seen the stats, skin cancer rates in the UK are a massive concern, made even worse by the fact that they’re growing. Being a fair-skinned sportsperson who spends a considerable amount of time outside, I know the importance of sun protection. Contributing to Sun Awareness Week, and the work the British Association of Dermatologists and Bioderma are doing to fight skin cancer, has been a great way of promoting healthy living and providing people with the knowledge to protect themselves.”

There are two main types of skin cancer: non-melanoma, the most common, and melanoma, which is less common but more dangerous.

Skin cancer is the most common type of cancer in the UK, with more than 100,000 new cases diagnosed every year. However, a recent study estimates that rates of the most common type of skin cancer, basal cell carcinoma (BCC), are now twice as high as Government statistics suggest and that there are now around 200,000 cases of BCC each year, meaning it has risen 80 per cent over the past decade.

The primary way to protect yourself is to wear protective clothing and seek shade during the hottest hours of the day, 11:00-15:00. The frequent application of a sunscreen with an SPF no lower than 30 to guard against UVB, and with high UVA protection also, is another vital part of sun protection.


-Ends-
Contact:
British Association of Dermatologists Press Office: Johnathon Major or Matthew Gass on 020 7391 6096 / 020 7931 6084 or email comms@bad.org.uk
Notes to editors:
1. Members of the media are welcome to attend the event

2. Exclusive quotes relating to the campaign only may be available by prior arrangement with the press office.

3. Sun Awareness Week takes place from the 5th to 12th May. It is owned by and trademarked to the British Association of Dermatologists, and is supported this year by Bioderma.

4. The official hashtag is #SunAwarenessWeek


The British Association of Dermatologists (BAD) is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. The BAD provides free patient information on skin diseases and runs a number of high profile campaigns, including Sun Awareness, which runs from May to September annually and includes national Sun Awareness Week in May. Website: www.bad.org.uk/sunawareness

About Bioderma:

Prescribed by physicians and recommended by pharmacists, Bioderma has a unique approach of dermocosmetics skincare: biology at the service of dermatology. Bioderma believes that temporary relief alone is insufficient in treating most skin problems. Consequently, it offers a holistic, corrective solution for each skin type. Through enabling skin to achieve a sustainable recovery of its original wellbeing, Bioderma allows it to restore its natural balance. All the products are performance driven, high tolerance dermo-cosmetics.

For further press information or to set up interviews with the Bioderma key spokespeople, please contact: Wizard Publicity on 0207 725 9290 or email: wizards@wizardpublicity.com

Bluewater shopping centre can be found a short journey away from Greenhithe Station in Kent. Please note – the Olympians will be on-site from 11am to 6pm with a scheduled break. Public photo opportunities are on a first-come, first-served basis.
 

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Green tea and pomegranate aid in preventing skin damage

Green tea and pomegranate may help to protect against skin damage, according to a new study* which is to be released at the British Society for Investigative Dermatology’s Annual Meeting in Newcastle this week.

Environmental factors, such as excessive sun exposure and subsequent UV radiation, can lead to significant increases in the level of oxidative stress in the body. Oxidative stress occurs when molecules known as ‘reactive oxygen species’ are created in the body and damage the structure of the surrounding cells. This process can cause damage to the DNA of cells known as skin fibroblasts, found in the second layer of skin where these cells maintain and repair the skin in case of injury. This damage prevents the skin fibroblasts from protecting the skin and can result in serious skin damage, which is a major contributor to skin ageing and skin cancer.

Polyphenols, a class of organic chemical compounds naturally found in food sources such as green tea and pomegranates, are known to break down reactive oxygen species, rendering them harmless, and can therefore decrease the overall levels of oxidative stress in the body. This study demonstrated that pomegranate significantly reduces the damage inflicted by reactive oxygen species on DNA in skin fibroblasts by 47%, proving almost as efficient as the 56% reduction provided by MitoQ, an artificially engineered antioxidant used to prevent oxidative damage to cells and reduce the risk of a variety of diseases – including cancer and Parkinson’s disease.

Dr Christine Bösch from the University of Leeds, Lecturer in Nutrition, says: “Mitochondrial DNA is a form of DNA which is central to healthy cell operations and is found throughout the body, including skin fibroblasts. Mitochondrial DNA is particularly susceptible to oxidative damage, partially due to its less effective repair mechanisms as regular DNA, said damage can be a contributing factor in the development of serious diseases such as skin cancer. The effects of pomegranate on oxidative damage in mitochondrial DNA have been an intriguing revelation which may lead to further discoveries of effective, natural antioxidants.” 

Prof Mark Birch-Machin, the senior co-author from Newcastle University, Dermatological Sciences says; “For almost 20 years, my group at Newcastle University has been at the forefront of pioneering mitochondrial DNA as a highly sensitive biomarker of sun-induced damage in skin which can lead to ageing and skin cancer”. He goes on to say that: “This work also represents a unique collaboration with the other senior co-author, Dr Georg Lietz, a senior lecturer in Nutrition at Newcastle University and co-director with myself of a University spin out company called PB Bioscience Ltd”.

Johnathon Major, of the British Association of Dermatologists commented: “Skin cancer is the most common cancer in the UK, causing an average of seven deaths a day. Such research is vital in revealing resources to use in a multi-pronged approach in prevention of the disease. However, these additional resources should not replace the essential practices of sun protection, such as using a sunscreen with at least SPF 30, wearing protective clothing and seeking shade.”

The study was conducted by researchers at the University of Leeds and Newcastle University. 


-Ends-

Notes
1. If using this study, please ensure you mention that the study was released at British Society of Investigative Dermatology Annual Meeting. The meeting is being held in Newcastle, April 7th to 9th 2014. 

“Effects of polyphenols on mitochondrial DNA damage in skin fibroblasts.”; C. Bosch, G. Lietz and M. Birch
Machin. 1University of Leeds, Leeds, U.K. and 2Newcastle University, Newcastle upon Tyne, U.K.

2. The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.bad.org.uk .

3. Skin cancer: More than 100,000 new cases of skin cancer are diagnosed annually in the UK, and while the disease can also occur on parts of the body not exposed to sunlight, extensive sun exposure is thought to be responsible for the vast majority of cases. In more than four out of five cases skin cancer is a preventable disease.

Every day 35 people in Britain are diagnosed with the disease, two of which being young people aged between 15 and 34. Whilst organisations such as ours are leading the fight in prevention and treatment, skin cancer is still proving to be fatal; seven people in the UK die every day from the disease.

UV irradiation in the form of UVA is associated with skin ageing. UVA affects the elastin in the skin and leads to wrinkles and sun-induced skin ageing (for example coarse wrinkles, leathery skin and brown pigmentation), as well as skin cancer. UVA can penetrate window glass and penetrates the skin more deeply than UVB. UVA protection in a sunscreen will help defend the skin against photo ageing and potentially skin cancer. UVB is the form of UV irradiation most responsible for sunburn and has strong links to malignant melanoma and basal cell carcinoma risk (types of skin cancer).
 

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Men most in danger from the sun

A new study featuring in the British Journal of Dermatology (BJD), published by the British Association of Dermatologists, has revealed that men are more likely to ignore sun safety advice and not engage in sun protection behaviours, despite being more at risk of skin cancer than women*. With skin cancer being the UK’s, and many other western populations’, most common cancer (recent high profile cases including Hugh Jackman, Ewan McGregor and Vinnie Jones) it has never been more imperative to pay attention to the dangers of UV radiation.

 

The study (Factors associated with sun protection compliance**)uncovered that those who were the least likely to heed warnings over sun radiation were males aged below 20 and over 64. The same demographic demonstrated the least knowledge about sun protection methods and the risks involved with sun exposure.

 

Women aged 20 to 64 were the most likely to understand the harmful potential of UVA and UVB rays emitted from the sun and were more likely to actively take protective action, with using sunscreens with a high SPF, and wearing protective clothing and a hat being deemed as the most effective measures. Understandably, people who were more aware of the dangers of sun exposure were the most likely to utilise protection methods. However, the same individuals were revealed to spend more time in the sun, suggesting that those who are more likely to take care in the sun wrongly believe that doing so permits them to spend extended periods sunbathing without risking damage to their skin.

 

Johnathon Major, of the British Association of Dermatologists stated: “Affordable holidays and the fashion for tanned skin have led to high levels of sun exposure for many Brits. The dangers posed by UV radiation are real; this study has demonstrated the need for greater education on sun related risks and how to protect yourself. Sun Awareness Week and the Be Sun Aware Roadshow are two of the initiatives the BAD undertake to educate and protect the public. For us to turn the tide on skin cancer the wider public needs to acknowledge that the issue is serious and take the preventive measures available to all of us.”

 

Contact:

 

John Major on 020 7391 6096 or Matt Gass on 020 7391 6084

Or email john.major@bad.org.ukor matthew.gass@bad.org.uk

 

Notes

*Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence

and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France:

International Agency for Research on Cancer; 2013. Available from:

http://globocan.iarc.fr, accessed on 24 January 2014

 

**U. Sattler; S. Thellier; V. Sibaud; C. Taieb; S. Mery; C. Paul; N. Meyer. BRITISH JOURNAL OF DERMATOLOGY.BJD-2013-1778.R1. Factors associated with sun protection compliance: results from a nationwide cross-sectional evaluation of 2215 patients from a dermatological consultation. 2014. 

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Alcohol consumption raises skin cancer risk

Regular alcohol drinking could increase your risk of developing melanoma, the most dangerous form of skin cancer, by up to 55 per cent, according to research published in the British Journal of Dermatology today.


The study was in the form of a meta-analysis, a type of research that combines the results from previous investigations taking due account of the strength of evidence in each study. In this case the results were drawn from 16 studies, for a combined total of 6,251 cases of melanoma.


The study focused on the effect of what the researchers classify as moderate to heavy drinking (more than one drink, or 12.5g of ethanol a day), and found that this increases melanoma risk by 20 per cent. There has been very little research into the effect of heavy drinking (more than 50g of ethanol a day) in this area, however it was noted that risk increased proportionately with alcohol intake, allowing the researchers to estimate an increased risk of 55 per cent for heavy drinkers.


It has been previously reported that alcohol drinking increases the severity of sunburn , which is one of the major risk factors for melanoma, however, this study, by researchers from Italy, Sweden, USA, Iran and France, has made the link between alcohol consumption and skin cancer.


Behavioural factors are an obvious cause of increased risk of sunburn – alcohol can impair our judgement and lead us to spend longer in the sun or forego sun protection. However, this study explores the biological changes caused by alcohol, and how these may also increase our cancer risk.


Exactly how alcohol consumption increases your chances of developing melanoma is not fully established, but the researches explain that ethanol is converted to a chemical compound called acetaldehyde soon after it is ingested. It is thought that acetaldehyde may act as a ‘photosensitizer’ (making skin more sensitive to light), which in turn generates molecules called ‘reactive oxygen species’ that damage cells (known as ‘oxidative stress’) in a way that can cause skin cancers.


Dr Eva Negri, one of the authors of the study, said: “We know that in the presence of UV radiation, drinking alcohol can alter the body’s immunocompetence, the ability to produce a normal immune response. This can lead to far greater cellular damage and subsequently cause skin cancers to form. This study aimed to quantify the extent to which the melanoma risk is increased with alcohol intake, and we hope that armed with this knowledge people can better protect themselves in the sun.”


The authors do, however, add a note of caution to interpreting the results, as it is not possible to quantify the impact of UV in isolation on each individual and retrospectively adjust the results accordingly if this wasn’t factored into the original study.
Professor Chris Bunker, President of the British Association of Dermatologists said: “Skin cancer is the most common type of cancer in the UK and melanoma is its deadliest form, any research into this area is very welcome. Brits haven’t always been known for their moderation when it comes to either alcohol or the sun, but this research is important as it provides people with further information to make informed choices about their health.


“We would always urge people to be careful in the sun and try to enjoy it responsibly. It is not uncommon to have a few drinks whilst on holiday or at a barbeque, we would just encourage people to be careful and make sure they are protecting their skin, this research provides an extra incentive to do so. Many of us have seen holiday makers who have been caught unawares the day before, fuzzy-headed and lobster red – an unwelcome combination.”


Alcohol consumption is one of the most important, and potentially avoidable, risk factors for cancer. About 3.6% of all cancers (5.2% in men, 1.7% in women) are attributable to alcohol drinking worldwide.


Facts about melanoma:
• Skin cancer is the UK’s most common cancer, and melanoma is its deadliest form
• There are approximately 13,000 new cases of melanoma per year in the UK (2010)
• Melanoma is the 5th most common cancer in the UK (2010)
• Melanoma is most common in the South East of England and Scotland
• Incidence of melanoma increases with age, however skin cancers are becoming increasingly common in young people
• Incidence rates in general have been increasing in the UK, partly due to changing habits in the sun, and an increase in foreign travel with the availability of budget flights to sunny destinations


Notes to editors:
If using this study, please ensure you mention that the study was published in the British Journal of Dermatology.
For more information please contact: Matt Gass, Communications Officer, Phone: 0207 391 6084, or Nina Goad, Head of Communications, 0207 391 6094, Email: comms@bad.org.uk, Website: www.bad.org.uk.


Study details: "Alcohol drinking and cutaneous melanoma risk – A systematic review and dose-risk meta-analysis”
M. Rota1,2, E. Pasquali3, R. Bellocco3,4, V. Bagnardi3,5, L. Scotti3, F. Islami6,7, E. Negri2, P. Boffetta6,8, C. Pelucchi2, G. Corrao3, C. La Vecchia2,9
1 Department of Health Sciences, Centre of Biostatistics for Clinical Epidemiology, University of Milan-Bicocca, Monza, Italy. 2 Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. 3 Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy. 4 Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden. 5 Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy. 6 The Tisch Cancer Institute and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, USA. 7 Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Science, Theran, Iran. 8 International Prevention Research Institute, Lyon, France. 9 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. 

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