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Beware of the sun!


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Sun awareness and sun protection measures should not be confined to the
beauty counter but be an essential part of every pharmacist’s professional activity as part of their role in providing disease prevention advice and product guidance  
Christine Clark PhD FRPharmS FCPP(Hon)
Editor, HPE
The recent death of distinguished sports commentator, Richie Benaud, from secondary melanoma serves to remind us that skin cancer, especially melanoma, is not a trivial illness. In the UK, diagnoses of malignant melanoma continue to rise. In 2011, 13,348 people were diagnosed with malignant melanoma and in 2012 there were just over 2000 deaths from the disease. In Europe, it is estimated that more than 100,000 new cases of malignant melanoma were diagnosed in 2012.
However, survival from malignant melanoma can be good, depending on the stage at which it is diagnosed. Overall, nine out of ten people diagnosed with malignant melanoma survive for at least ten years. New treatments are making in-roads into the management of secondary (metastatic) melanoma but, as with so many things, prevention is better than cure. In practice, this means minimising the risk of developing malignant melanoma and seeking prompt treatment of suspected disease.
Malignant melanoma is not the only skin cancer that gives cause for concern. Squamous cell carcinomas (SCCs) can also be invasive and the great majority of these arise from actinic keratoses (AKs). These are small, discoloured, roughened lesions that occur as a result of exposure to ultra-violet light. The majority are harmless but it is estimated that up to 10% of AKs will transform into SCCs each year. There is no way of predicting which AKs will transform into SCCs but it is more likely to occur in people who are immunosuppressed. Transplant patients, who are routinely immunosuppressed, are 250-times more likely to develop an AK than immunocompetent individuals, and 100-times more likely to develop a SCC. This means that transplant patients need education about the risks, serious photoprotection of exposed skin with high-factor sunscreens and regular monitoring of their skin for suspicious lesions.
There are approximately ten-times as many diagnoses of basal cell carcinoma.
It is generally regarded as being less serious because although it can be locally invasive, it does not metastasise.
Last, but not least, emerging evidence shows that some drugs known to be photosensitisers – notably thiazides and some antimicrobial agents – could increase the risk of developing non-melanoma skin cancer.
What does this all mean for pharmacy? There are a few things we need to remember: tanning, burning and DNA damage are all part of the same process. The trigger for melanogenesis – of which the end result is tanning – is DNA damage. UVB burns and causes direct damage to DNA; UVA penetrates deeper into the skin and causes free radical formation which, in turn, damages DNA and collagen. As we say, “B for burning and A for ageing”. Recent evidence also shows that infra-red A radiation also causes skin ageing. For this reason, in the near future, cosmetic products are likely to contain infra-red protection agents as well as UV protection. Most importantly, advising people about appropriate UV protection measures is not a trivial activity limited to the beauty counter. It should be seen as an activity that adds value to the overall medicines management process. It goes hand-in-hand with the provision of information about dispensed medicines and advice on adherence.

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