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April 8, 2011 / molehunter

young woman ‘who hated the sun’ dies of melanoma

My Google alert on melanoma throws up many sad stories about people who have suffered from melanoma. One such story is covered in the Daily Mail. See here http://www.dailymail.co.uk/health/article-1373583/Student-hated-sun-dies-skin-cancer-aged-just-21.html

For those outside the UK, the Daily Mail is a right-leaning tabloid daily paper which has more stories on health, fashion , shopping, travel and personal finance than news. The story of Cerys Harding, who died of melanoma aged 21, is very sad and has been widely told. All 3 of the patients in my clinic that I mentioned the story to this week had heard of it. The message they took was (A) ‘how sad’, and, (B) ‘she never sunbathed’. The implication of the latter point being that perhaps sunlight doesn’t cause skin cancer after all.

I’m not going to emote unduly about someone I never knew, that would be bogus, although I am sorry about the death of any young person. Lots of emotive posts have been made on the Mail blog, as you can see. Fair enough, but many posts also contain nonsensical assertions about the role of vitamin D, ‘sunlight is good for you’, ‘we need more research’ to find the REAL cause of melanoma, ’cause, like it can’t be sun damage since Cerys ‘never sunbathed’. This is an example of poor logic being driven by emotion.

I am not questioning her poor bereaved mother’s account any more than I would apportion blame if the deceased HAD been a regular sunbather. What I do challenge is the acceptance at face value that (A) Cerys Harding had in fact literally NEVER sunbathed, and (B) that assuming this were so, that it in any way disproved the assertion that MOST skin cancers are caused by radiation damage from the sun. In other words, the evidence that she had not had any significant sun exposure is limited to her mother’s recall, but in any event we still have bags of evidence that excessive sun exposure is the primary cause of skin cancer. The fact that some people who are not heavy drinkers get liver cirrhosis does not alter the fact that most people who get cirrhosis get it due to heavy drinking.

The objective reality is that melanoma deaths are rising (see the graph I have posted) and there is a strong statistical association with ultraviolet light damage, as well as a perfectly sound biological mechanism (photons smashing DNA causing loss of control of mitotsis). Nonsense is still nonsense even if spoken kindly about the death of a pretty young girl. Where is Richard Dawkins, the self proclaimed apostle of public understanding of science, when there is an opportunity for him to say something useful? If he can spare a few minutes away from his anti-religious crusade, perhaps he could try to explain the evidential difference between five decades of accumulated epidemiological data and one uncheckable anecdote.

I wish people wouldn’t suggest that deodorants and cosmetics, even sun protection creams, are the real cause of skin cancer and that there is a conspiracy to frame sunlight as the culprit so that more sun cream can be sold. The price of free speech is indeed eternal b*******.

It is worth reading the comments of the ‘sunbathing prevents other cancers and does not cause melanoma’ brigade as a sobering reminder that sun avoidance advice WILL NOT WORK. People enjoy the pleasant feeling that sunbathing gives them, and they will do it. If they need a justification, they will pluck one from the air. I saw 2 young men stripped to the waist in the street yesterday as I drove from the hospital clinic to the community clinic to do an operating list, and this morning I saw a red haired woman wearing a low cut dress and sunburned upper chest. Its the first week of April, the sun is shining and people are out there soaking it up. The vitamin D story and the way it has been handled has undone lots of good work, because people WANT to believe that sunbathing is good for them.

That is why I put my hope for reducing melanoma deaths in early diagnosis rather than primary prevention. Even if you can’t persuade someone to avoid at-risk behaviour, you might be able to persuade them that getting a funny mole checked is in their interest, and you might be able to train health care workers to be better at picking up early melanomas. Education aimed at preventing the melanoma by sun avoidance in the first place is humane and rational, and of course we should do it-especially for mothiers with light skinned children-but interventions based on persuading people to stop doing things they enjoy are of limited effect. Hasn’t worked very well for sexually transmited infections, has it? People will  do what makes them feel good today rather than deny themselves to  avoid a possible future risk. The way the vitamin D story has been spun and anecdotes about people who ‘never sunbathed’ but still got melanomas are just what the committed sunbathers and tanners want to hear.

I am, and will remain, very sorry about the death of anyone from melanoma, which is why I started this blog and launched a new course to teach better diagnosis. But I wish that ignorant people with stronmg opinions based on theior feelings would wise up or shut up rather than shooting their mouth off.

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2 Comments

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  1. Nigel Kinbrum / Feb 8 2013 3:34 pm

    Would you like to comment on this lecture by dermatologist Richard Weller? He makes the point that deaths from heart disease are 100 times higher than deaths from skin cancer.

    • molehunter / Aug 19 2014 10:38 am

      That is of course true. Which is why so many resources are quite rightly directed at heart disease. I’m not anti heart disease work, just in favour of skin cancer work. Kind regards.

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