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 should 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 SunSmart website has lots of information about protecting you and your children 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 the glasses give 100% UV protection

Whether to use suncream or sunblock is becoming a subject of more and more debate. Some doctors and researchers think that sun creams could be harmful because they encourage people to stay out in the sunshine for longer. They think that the protection the creams give you against burning may not actually stop people increasing their 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.

Cheap sunblocks are usually just as good as expensive ones. They are all tested the same way and it is the the level of protection they give you against the sun that matters most. This is the 'sun protection factor' or SPF.

Do check the 'use by' date. Most creams will last about 2 or 3 years, so it is OK to use last year's, but not a bottle from 5 years ago!

Sun creams have changed a lot in the past 15 years. There is a huge range and it can be difficult to know what to buy. You should choose one that says it protects against both UVA and UVB radiation from the sun. This may be labelled 'broad spectrum'.

The SPF tells you the amount of protection the sun cream gives against UVB radiation. We recommend at least factor 15. There is no sun cream that can give you total protection. 98% protection (with factor 60) is about the best you will get.

UVA protection is shown by 0 to 5 stars. But, this is only a rough guide because it is also affected by the SPF. A cream with SPF 25 and 3 stars may give more UVA protection overall than a cream with SPF 10 and 4 stars.

Don't assume that because you have put on sun cream, you can stay out 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 sun cream because it is less likely to be sweated or washed off.

Firstly, you should put your sun cream 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 moisturiser, make up or insect repellent. It must go on before anything else so it is next to your skin.

Sun creams 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 more frequently if it is washed, rubbed or sweated off.

You must apply sun creams thickly. Nearly everyone puts them on much too thinly and so they don't get as much protection as is specified on the bottle. It is difficult to tell you how much to use, but as the Aussies say, slap it on. You should be able to see 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. We know it can be expensive, but it is important to get the protection that you should. It is better to buy more and put it on properly.

Usually, the higher the SPF, the more the product costs. We recommend that you use factor 15 or higher to get good protection.

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 on CancerHelp UK. The European Commission is looking at the information manufacturers provide on sun creams to try and make it easier for people to understand.

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.

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 safe to spend 20 minutes in spring sunshine in a short sleeved shirt or blouse. 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 more about vitamin D on Cancer Research UK's SunSmart website. 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.

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.

Babies and young children do 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 more information on the SunSmart website about protecting children. If you want to come back to this page you will need to click on your back button or click on any CancerHelp UK logo on the Cancer Research UK website.

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 abnormalities 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 page on symptoms and risk factors in this section of CancerHelp UK and make sure you know if you are 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, you may be referred to a rapid access suspected skin cancer clinic. The Department of Health have written guidelines for GPs so they know when to refer someone to a specialist with a suspected melanoma. You can look at these guidelines for seeing a specialist in this section of CancerHelp UK.

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 those carrying out the screening are medically qualified - they often are not. If you want a skin lesion checked, it is best to see your GP.