Take a look — Could it be skin cancer?

Irish people are often at a higher risk of skin cancer, so it’s important to know how to spot a melanoma and distinguish it from a normal freckle or mole

Every year, 1,200 people in Ireland are diagnosed with melanoma. Picture: iStock 

While the country basks in glorious summer weather and the seaside calls, spare a thought for your skin — your body’s largest organ. Sunburn is one of the leading causes of skin cancer.

Every year, 1,200 people in Ireland are diagnosed with melanoma, a type of skin cancer that often occurs in young and middle-aged adults.

Melanoma rates in Ireland have surged over the last three decades, with the number of new cases each year increasing by 81% between 1994 and the early 2020s. Rates are predicted to double again by 2050.

This alarming rise has left dermatologists searching for answers. Studies have shown that the native Irish population has the most lightly pigmented skin in the world, meaning that they lack melanin, a natural pigment which serves as the skin’s biological shield against damaging ultraviolet radiation from the sun.

Generated by specialised skin cells called melanocytes, melanin is capable of absorbing and redistributing UV rays, preventing the kind of DNA damage that can lead to skin cancer. But without sufficient quantities of melanin, sun-loving Irish people often unknowingly place themselves at a heightened risk.

“Having severe sunburn where you develop blisters, even in childhood, almost doubles your risk of getting melanoma later on,” says Prof Anne Marie Tobin, consultant dermatologist at Tallaght Hospital, Dublin, who sits on the board of the Irish Skin Foundation.

Prof Anne Marie Tobin: ‘Early detection is key. Cure rates depend on whether the cancer has spread.’ 

Research has also suggested that use of indoor sunbeds in Ireland, which use concentrated, high-intensity UV rays to quickly tan the skin, could also be contributing to melanoma risk. As a result, a new alliance of doctors and cancer patients, known as the Coalition Against Sunbeds are calling for the Government to ban them, citing findings which show that people who begin using indoor sunbeds before the age of 35 have a 75% increased risk of melanoma.

Around 270 people in Ireland die every year from a form of skin cancer, but while melanoma is becoming more common, five-year survival rates have improved to 92%. Tobin says that melanoma can be highly curable, particularly if caught early, as the tumours can be completely removed through surgery.

“Early detection is key,” she says. “The cure rates depend on whether the cancer has already spread to your lymph nodes, or beyond to involve other organs.”

The question is, how to spot a melanoma and, most importantly, distinguish it from an ordinary freckle or mole.

1. Superficial spreading malignant melanoma

Tobin says there are several forms of melanoma, and the most common form dermatologists encounter in Ireland is superficial spreading malignant melanoma, which accounts for approximately 70% of all cases.

These melanomas tend to appear as a new mole, but Tobin says that there are some instances where it can be an existing mole which gets bigger or darker.

To spot one of these melanomas, she recommends following the so-called ABCDE guidelines, which advise people to seek medical advice if they notice a mole that appears asymmetric, has irregularly bordered edges, shows colour variation, is larger than 6mm in diameter, or is evolving (changing over time).

“If there’s more than two colours in it, and if it’s growing, then it’s worth getting it checked,” she says.

2. Nodular melanomas

Nodular melanomas are less common, making up 10-15% of all cases. But despite their low prevalence, they are known as the most aggressive form of melanoma, growing faster than other subtypes and presenting as a thick, firm, raised bump.

Nodular melanomas are typically most frequently diagnosed in the over 50s.

“They’re usually on the face and neck, and black and discoloured, like a black bump on the skin,” says Tobin.

3. Acral melanoma

One of the rarer forms of melanoma, acral melanomas represent just 1-3% of all cases in Ireland, and tend to be more common in people of darker skin tones, such as those of Asian, African, and Hispanic descent.

These melanomas can appear as unevenly pigmented, changing brown or black spots on the palms or soles of the feet, or as dark streaks under fingernails and toenails, which are often mistaken for a bruise.

4. Lentigo maligna melanoma

Another form of melanoma, which primarily affects older individuals, aged between 65 and 80, lentigo maligna melanomas comprise somewhere between 4% and 15% of melanoma cases. They arise out of patches of sun damage, often on the face or neck, and typically appear as flat, dark brown or black, like a dark freckle or sun spot.

Known for their slow growth, lentigo maligna melanomas are less aggressive than other forms and can take many years to invade the deeper skin layers.

5. Ocular melanoma

Developing in the pigment-producing cells of the eye, ocular melanomas can appear as a growing dark spot on the iris, sometimes mistaken for floaters.

Like acral melanoma, these melanomas are extremely rare, accounting for around 3-5% of cases. But they are still the primary form of cancer in the eye in adults. Warning signs can include blurred, distorted vision or the appearance of flashing lights in your field of vision.

Non-melanoma skin cancers

Of course, not all skin cancers are melanomas. According to the Irish Cancer Society, forms of non-melanoma skin cancer — which develop in either flat, scaly cells called squamous cells or rounder cells called basal cells — are the most common of all cancers in Ireland, contributing to around 10,000 cases per year.

Many appear as either non-healing scabs or pinkish growths. They get less attention because, unlike melanoma, they are not as serious and are relatively easily treatable with surgery or even cryotherapy — freezing the affected area so that the scab or growth falls off.

“The biggest difference to melanoma is that they don’t tend to spread to distant tissues and distant organs,” says Adil Daud, director of melanoma clinical research at the UCSF Helen Diller Family Comprehensive Cancer Centre in San Francisco. “They are much more common and the majority of people will have them at some point in their life, especially outdoorsy people. They should definitely be removed but they’re much less of a threat to your life.”

Survival rates

When it comes to melanoma, Tobin is keen to highlight that while survival rates in Ireland are improving for women, the outlook isn’t as good for men. Research carried out by the National Cancer Registry Ireland has highlighted that men are 1.6 times more likely to die from melanoma than women.

“One of the reasons for that is that women tend to get the melanomas on their legs, whereas in men, they tend to appear on their backs, which is a relatively hard site to see,” Tobin says. “So they’re often presenting with the disease at a later stage.”

She advises men in particular to ask a partner to check their back, especially if they have a history of sun exposure.

Improved treatments and outcomes

For those who are diagnosed late, when melanoma has already spread to other parts of the body, the prognosis has still improved over the last 15 years, due to the arrival of a range of targeted therapies which can halt the progression of the cancer.

In particular, people whose cancer carries a mutation in the BRAF gene can benefit from either BRAF inhibitor tablets, which target the faulty gene to stop the cancer from growing, or MEK inhibitors, which block specific enzymes involved in tumour growth.

In addition, some of the most dramatic improvements in survival rates for late-stage melanoma are due to immunotherapies such as anti-PD-1 drugs and CTLA-4 inhibitors, which help activate the immune system’s white blood cells and encourage them to seek out and fight the cancer.

Tobin is also optimistic about a range of new clinical trials taking place in Ireland, which are investigating using immunotherapy at a slightly earlier stage.

“The big area of interest now is neoadjuvant therapy,” she says. “What that means is if someone is diagnosed with a melanoma, they are treated with immunotherapy before their surgery to try and shrink the cancer. We don’t know the results yet, but it certainly seems to be capable of shrinking the tumours.”

How to reduce your risk

Best of all is prevention. Tobin says that people tend to associate melanoma risk with hotter temperatures, but in fact, Irish people are vulnerable to incurring skin cell damage from the sun’s UV rays between early April and the end of September, particularly in the middle of the day and early afternoon.

As a result, she advises everyone, especially those of a fair-skinned complexion or people with a family history of melanoma, to follow the Irish Skin Foundation’s SunSmart advice.

“April to September is the period where there’s sufficient UV radiation to cause [damaging] changes in your melanocytes,” says Tobin. “So it’s about the need to protect your skin during those months, through slapping on the sun block, with factor 30 at least on your face, sunglasses, and staying out of the sun during the really hot parts of the day.”

• Anyone concerned about their skin and whether they have melanoma can receive free, specialist guidance via the Irish Skin Foundation’s Ask-A-Nurse helpline