Skin cancer is the most common form of cancer in the UK and rates continue to rise, with around 16,700 new melanoma skin cancer cases and more than 210,000 new non-melanoma skin cancer cases every year according to Cancer Research UK.
Since the early 1990s, melanoma and non-melanoma skin cancer incidence rates in the UK have more than doubled. Melanoma is the deadliest skin cancer, causing more than six deaths every day. Melanoma is disproportionately high in young adults and is one of the biggest killing cancers in 15 to 34-year-olds.
Despite these worrying statistics, up to 90% of skin cancer cases in the UK are preventable. We know that children who suffer from frequent or severe sunburn are at much greater risk of developing skin cancer as adults.
Under the statutory RSHE curriculum, pupils must be taught by the end of primary school “about safe and unsafe exposure to the sun, and how to reduce the risk of sun damage, including skin cancer” (DfE, 2019).
This article outlines the different types of skin cancer and strategies for skin cancer prevention. It will also discuss free support available from Skcin, a charity dedicated to promoting the importance of sun safety and the early detection of skin cancer. In particular, Skcin’s Sun Safe Schools programme can support primary schools to fulfil the statutory requirement to educate pupils about sun safety.
Types of skin cancer
Skin cancer can be broadly classified into two main types: non-melanoma and melanoma.
Melanoma is significantly less common, but it can quickly spread to other parts of the body and is the deadliest form of skin cancer. There are more than 2,300 melanoma skin cancer deaths in the UK every year, and mortality rates have more than doubled since the early 1970s.
Meanwhile, the two most common types of non-melanoma skin cancer are:
- Basal cell carcinoma: The most common type of skin cancer. It usually affects sun-exposed areas (head, face, neck and ears, etc). It is slow-growing and rarely spreads to other parts of the body, but if left untreated it can enlarge and damage nearby tissues and organs.
- Squamous cell carcinoma: The second most common type of skin cancer in Caucasians and the most common type in black people. It also usually affects sun-exposed areas of the body. It tends to grow faster and is more likely to spread to other parts of the body, although this is still rare.
Risk factors for skin cancer
The most common risk factor for both melanoma and non-melanoma skin cancer is exposure to ultraviolet (UV) radiation. This can be from both sun exposure and sunbed use.
According to Cancer Research UK, UV radiation causes 86% of melanoma skin cancer cases and 50 to 90% of non-melanoma skin cancer cases in fair-skinned people.
Too much ultraviolet radiation damages the DNA in our skin cells causing them to mutate and build up over time to cause skin cancer. Importantly, sunburn is a sign of skin damage and getting sunburn just once every two years can triple your risk of melanoma skin cancer compared to those who have never been burnt.
Sun exposure during childhood is most damaging and people who had frequent or severe sunburn during childhood are most at risk of developing skin cancer as adults.
People most at risk of sun damage are those with fair skin and blonde or red hair. Skin cancer is less common in individuals with darker skin because the pigment in their skin provides more protection against UV radiation. However, they are still at risk and individuals with darker skin are more likely to die from skin cancer due to delayed diagnosis.
Other factors that increase the risk of skin cancer include a family history of skin cancer and suppression of the immune system due to certain medications or medical conditions such as organ transplants and HIV.
Strategies for prevention
The good news is that most skin cancers are preventable through avoidance of excessive UV radiation exposure. The NHS advises that we should take extra care to protect babies and children because their skin is much more sensitive than adult skin.
Skcin, a charity dedicated to preventing skin cancer, offers its useful five “S” mnemonic:
SLIP on clothing
- Clothing is one of the most effective barriers between our skin and the sun and should always be considered the first line of defence against UV radiation,
- Clothing should always cover shoulders, but ideally as much skin as possible.
SLOP on sunscreen
- Always use sun protection factor (SPF) 30 or above.
- Make sure the sunscreen carries a UVA symbol with a four or five-star rating and check the expiry date.
- Apply a generous amount, evenly to exposed skin 20 minutes before going outdoors.
- Reapply at least every two hours, and more often if perspiring and immediately after swimming.
SLAP on a sun hat
- Always wear a wide-brimmed hat to protect the scalp and provide shade to the face, neck, ears, cheeks and eyes.
SLIDE on sunglasses
- Our eyes are up to 10 times more sensitive to UV damage than our skin.
- Wear quality sunglasses rated CE UV400+ or EPF (Eye Protection Factor) nine or 10.
SHADE from the sun
- Seek shade wherever possible, particularly during peak UV hours (11am to 3pm).
- Keep toddlers in the shade as much as possible and keep babies in the shade at all times.
The UV index
The steps above should be followed when the UV Index reaches three or above. The UV Index is an international standard measurement of the strength of sunburn-producing UV radiation at a particular place and time. The higher the number, the stronger the UV radiation and the less time it takes for damage to occur.
Checking the UV Index on a daily basis is important in helping teachers and children understand and be prepared for the level of protection required. The daily UV forecast can be accessed on Skcin’s Sun Safe Schools website or by installing the Skcin app. The app (see further information) provides users with the current and daily peak UV Index and alerts to let users know when the UV Index reaches three and when it reaches its daily peak.
How can Skcin help schools?
Skcin (the Karen Clifford Skin Cancer Charity) is a specialist skin cancer awareness charity dedicated to the prevention and early detection of skin cancer through educational intervention. It was set up by the family of Karen Clifford, who passed away from melanoma skin cancer in 2005.
Skcin has introduced several national educational initiatives and campaigns and its app also offers education and self-management tools.
Skcin developed the Sun Safe Schools accreditation programme in 2013. The programme offers free resources to primary schools to assist them in their duty of care to safeguard children against UV radiation and prevent skin cancer through education. Free resources include:
- An online sun protection policy creator, ensuring that schools have considered each important aspect of sun protection, communication, and implementation.
- Personalised letters and awareness resources for parents to enable schools to communicate effectively and gain the required support.
- A whole-school assembly plan with script and song.
- Books and animated story, wall display templates and competitions.
- Workbooks, curriculum-linked lesson plans and fun and engaging activities for all ages and abilities from reception to year 6.
Schools can, if they wish, take part in a four-step accreditation process to gain certification testifying to their work protecting children, educating about sun safety, and working with families.
The Sun Safe Schools programme is recognised by NICE (the National Institute for Health and Care Excellence) and, alongside its sister programme Sun Safe Nurseries, there are currently more than 6,000 primary and pre-schools enrolled.
Dr Hannah Wainman is a dermatologist at Gloucestershire Royal Hospital, dermatology lead and champion for inclusion of skin of colour for the University of Bristol and an ambassador for Skcin.
Dr Eliza Hutchison is a junior doctor at Weston General Hospital and an ambassador for Skcin.
Further information & resources
- Sun Safe Schools: You can access the website and resources via www.sunsafeschools.co.uk and the app via https://app.skcin.org/
- Skcin: For more on the charity’s work, visit www.skcin.org or follow via @SkcinCharity