Preventing melanoma

If you have had an early melanoma removed in the past, you are at higher than average risk of getting another one. So you need to be extra careful in the sun.

Sunburn can double your risk of skin cancer. Basically, you should keep out of the sun when it is at its most intense. You should never use a sunbed. Remember to

• Spend time in the shade between 11am and 3pm
• Make sure you never burn
• Aim to cover up with T shirt, hat, and sunglasses
• Remember to take extra care with children
• Then use factor 15 sunscreen (sun cream) or higher

People most at risk are those with fair skins, lots of moles or freckles, or a family history of skin cancer. The Cancer Research UK  SunSmart pages have lots of information about protecting you and your children from the sun in the UK and abroad.

The sun is at its strongest in the middle of the day, between 11am and 3pm. During this time, stay in the shade when you can. If there's no shade, the best way to protect your skin is with clothing. At least wear a T shirt, hat and sunglasses. Remember that the sun will reflect from the surface of water. So if you are in or near water, you are much more likely to burn. You should cover up or use sun cream that is at least factor 15 and preferably water resistant.

The amount of protection you get from your clothes varies depending on the type of material. The closer the weave of the fabric, the more likely it is to keep the sun off. Thin, loose weave fabrics such as cheesecloth give very little protection. Close weave cotton (T shirt material) gives quite good protection.

In the UK, manufacturers of clothing (particularly children's clothing) are beginning to put sun protection factor labels in their clothes. The higher the number, the more protection the clothing gives. Wet fabric can stretch and lose some of its ability to protect from the sun. Sunsuits are now available to give children and adults greater protection on the beach.

Wear a hat with a brim to protect both your face and the back of your neck. Babies and children should always wear brimmed hats in the sun. Baseball caps may look smart, but they leave the back of the neck and ears completely exposed. The foreign legion type of hat is much better as it has a cloth flap that covers the back of the neck. These are now widely available for babies and young children.

Don't forget to protect your eyes. Wear good quality, wrap around sunglasses. Wrap arounds stop the sun from getting in at the sides. Buy these for children too – toy sunglasses can do more harm than good. When choosing sunglasses, look out for

• The CE mark and British Standard mark (BS EN 1836: 1997)
• A UV 400 label
• A label saying that the glasses give 100% UV protection

Whether to use suncream or sunblock is a subject of a lot of discussion. Some doctors and researchers think that sun creams could be harmful because they encourage people to stay out in the sunshine for longer. Unless the creams and lotions are used properly they may not give you enough protection to reduce the risk of melanoma. The only way to be absolutely sure of reducing melanoma risk is to avoid over exposing your skin to the sun. If you must get a tan, do it gradually so that you minimise the damage to your skin.

Having said all that, using a sun cream is better than getting burnt so here is what we know about them.

The level of protection a sunscreen gives you against the sun matters more than its price. This is the sun protection factor or SPF. The SPF tells you the amount of protection the sunscreen gives against UVB radiation. We recommend at least factor 15.

Choose a sunscreen that says it is broad spectrum. This means it protects against both UVA and UVB radiation from the sun. In the UK we measure UVA protection with the star system. So you will see UVA protection on your sun cream measured between 0 to 5 stars. But, this is only a rough guide because the number of stars depends on how much UVB protection the sunscreen offers. For example, an SPF 25 with 3 stars may screen out more UVA overall than an SPF 10 with 4 stars.

Don't assume that because you have put on sunscreen, you can stay out in the sun without burning. Keep an eye on your skin (and your children's skin) at all times. Children have thinner, more delicate skins than adults and are at higher risk of burning. It is best to use waterproof sunscreen because it is less likely to be sweated or washed off.

Do check the use by date. Most sunscreens will last about 12 to 18 months after opening  ̶̶  so it is fine to use last year's, but not a bottle from 5 years ago.

You should put your sunscreen on before you go in the sun. Then put on another layer to make sure you haven't missed any bits. Put it on before anything else so it is next to your skin. If needed you should apply moisturiser, insect repellant or make up afterwards. This is particularly important if you are using an organic (chemical) sunscreen. Most sunscreens now include a moisturiser and some also include an insect repellant.

It is crucial that you apply sunscreens generously and regularly. Sunscreens do rub off. Even if they say they are waterproof, they may come off when you are swimming. In order to get the best protection, you must re apply them often – at least every two hours. And you need to use more if it is washed, rubbed or sweated off.

Sunscreens only work if you use enough. Nearly everyone puts them on much too thinly. Thinly applied sunscreens don't give as much protection as it says on the bottle. You should be able to see it and spread it very easily. If it all disappears as soon as you start rubbing it on, you haven't used enough. About a golf ball sized dollop should do for small children.

If your whole family only uses one bottle throughout a 2 week holiday, you definitely aren't putting it on thickly enough. It can be expensive, but it is worth it as protection against skin cancer.

Usually, the higher the SPF, the more the product costs. We recommend using at least factor 15.

There are no laws to make manufacturers test sun creams. But there are laws about what they can say about them. If they say a sun cream has a particular SPF, it must have been tested, because the manufacturer has to be able to produce the evidence supporting its claim. If a company were to claim that their product had been tested when it hadn’t, they would be breaking the law. There is more information about the law on testing sun creams in our section of skin cancer questions and answers.

Vitamin D is essential for healthy bones. Low levels of vitamin D for long periods of time can lead to rickets in young people (which makes the bones bend), and osteoporosis if you are older (which causes bone thinning and increases the risk of fractures). Some studies say that if you are low in vitamin D, you have a higher risk of getting bowel cancer.

You can get vitamin D from sunlight and from your diet. It is added to some margarines and breakfast cereals, and can be found in fatty fish like salmon or sardines. Sunlight stimulates your skin to make vitamin D.

In the UK, the winter sun is not strong enough to get your skin to produce much vitamin D. So by early spring, a lot of otherwise healthy people have low levels of vitamin D. The situation is worse the further north you live. So it is important to try to keep vitamin D levels within the normal range. We can try to do this by eating fatty fish, and possibly taking a supplement like cod liver oil during the winter. Cod liver oil is rich in vitamins A and D.

Some people worry that they may not get enough vitamin D if they don't sunbathe. It is important not to let your skin get burned in the sun, but it should be possible to make enough vitamin D by regularly going outside for a few minutes in the middle of the day without sunscreen. The amount of sunlight you need to get enough vitamin D will always be less than the amount that makes your skin tan or burn. There is information about this on our page about vitamin D, sunlight and cancer. Some people are more at risk of low vitamin D levels, including those with darker skins and older people. If you are worried that you may be lacking vitamin D, talk to your GP.

Babies and young children have thinner, more delicate skin than adults. Because of this, their risk of getting sunburnt is much higher. The information above about covering up gives you the main tips on how to protect babies and children in the sun. But there are other things to think about.

The links below take you to information on the SunSmart pages about protecting children. If you want to come back to this page you will need to click on your back button.

Schools can help to protect children by

• Developing their own school sun protection policy
• Including sun protection into the school curriculum
• Making sure they provide enough shade in the school grounds

Children are often too busy running around to worry about looking after their skin. But as a parent you can make a real difference to the damage your children receive early in life. You can

• Find out why it is important for parents to protect their children's skin
• Read tips about how you can keep children safe from the sun

It is important that you make a habit of regularly checking your own skin. If you find any changes or abnormal areas on the skin that don’t go away after 4 to 6 weeks, or existing ones that are getting bigger, you should get your GP to look at them. This is especially important if you are at a high risk of getting melanoma or have had treatment for a previous melanoma. Look at the pages about symptoms and risk factors in this section and make sure you know if you are at risk and what to look out for. There are also pictures of abnormal moles.

If your GP is worried that you may have a melanoma, they will refer you to a skin specialist. Depending on local NHS services, they may refer you to a rapid access suspected skin cancer clinic. The National Institute for Health and Clinical excellence (NICE) has written guidelines for GPs so they know when to refer someone with skin changes to a specialist. You can read about these guidelines for seeing a specialist on the page called should I see a melanoma specialist.

There are private, walk in, skin clinics in the UK. But before you pay for this type of service, do make sure you know exactly what method of screening they use and whether it is reliable. Check if the people carrying out the screening are medically qualified because often they are not. If you want a skin change checked, it is best to see your GP.