ALWAYS COVER up, apply factor 15-plus suncreen and never allow yourself to burn. These are the rules of sun protection according to Cancer Research UK’s SunSmart campaign, which aims to reduce the 69,000 new cases of skin cancer diagnosed each year. In most cases, says the charity, sun damage is to blame for all forms of the disease. But a leading American dermatologist who has published 625 research papers on aspects of skin care is now questioning whether the link between sun exposure and melanoma, the most serious form of skin cancer, exists.
Professor Bernard Ackerman, the director of the Ackerman Academy of Dermatopathology in New York and this year’s single recipient of the prestigious Master Award for outstanding contributions the profession presented by the American Academy of Dermatology, says that there are so many misconceptions about the risks of skin cancer that the entire “field is just replete with nonsense”.
He claims, for instance, that there is no scientific confirmation that blistering sunburn in early life sets the stage for melanoma and that no evidence exists to support the fact that sunscreens offer protection against the disease. He points to a report in the journal Archives of Dermatology which supports this view. Moreover, says Ackerman, the common wisdom that the “more intense a person’s sun exposure, the greater their risk of melanoma” remains unsupported, with epidemiological data on the subject proving “imprecise and inaccurate”.
They are views that concern many British experts. A statement by the British Skin Foundation, the charity administered by the British Association of Dermatologists, describes Ackerman’s comments as provocative. It says that the “relationship between melanoma and the sun is complex” but that “it is hasty to suggest there is nothing to link the two”. Dr Rino Cerio, a consultant dermatologist and reader in dermatopathology at St Bartholomew’s and Royal London Hospitals, describes Ackerman as “a giant in the field and probably the best-known living skin pathologist” but adds that “he’s not being very responsible about this when you consider the deaths we are seeing from all types of skin cancer”.
Since the early 1980s the incidence of skin cancer in the UK has doubled to make it the most common cancer among 15 to 39-year-olds. More than nine out of ten cases are non-melanoma skin cancers which are easier to treat than malignant melanoma. Many forms of the disease are potentially fatal if left untreated and skin cancer now kills more than 2,000 people a year. While Professor Ackerman concedes that avoiding sunlight may help to prevent premature ageing and non-melanoma conditions such as squamous cell carcinoma, he insists that it has not been shown to protect against melanoma.
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“It is important not to confuse the association between sun damage and particular types of cancer,” Cerio says. “What Ackerman is saying is that we don’t yet have enough evidence for a link with melanoma. But in fact we do have proof from studies here and in Australia which definitely show that children exposed to the sun are at greater risk of all forms of skin cancer.”
Ackerman argues that anyone who believes sunburn causes melanoma must first explain why black and Asian people get the condition almost exclusively on skin not exposed to sunlight, such as soles of the feet and palms of the hand. Even on white skins, he says, the most common sites for the disease (legs in women, trunk in men) are on body parts that are considerably less exposed to the sun than others, suggesting that factors apart from sunlight might be to blame.
While there is no confirmed genetic link with skin cancer, Cerio says that there are definitely some families that are more vulnerable than others to damaging ultraviolet rays. “There is no disputing the evidence that the number of deaths is higher in people with fairer skin and freckles,” he says. “But they aren’t the only ones at risk.” As for whether or not sunscreens are worth the money, Cerio says that in studies some people have been shown to become complacent about sunbathing when they use them.
“Basically, they slap on some suncream and think it gives them carte blanche to stay out for longer and tan, which has an effect when it comes to analysing whether or not they work,” he says. “We do need sunshine for the production of vitamin D and for endorphins which make us feel good. But the message is to protect against it because there is no such thing as a safe tan.”
Ackerman remains to be convinced. “If the evidence were compelling I’d be the first to capitulate,” he says, adding that on a recent holiday to Israel he wore no hat, no sunscreen and returned with a deep, golden tan.
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www.cancerresearchuk.org/sunsmart
www.britishskin-foundation.org.uk