This July's CLL Global Newsletter includes a timely reminder for those of you at the bottom of the world (location is relative after all - see attached corrective map).
The article commences "Most of you do not need a reminder that it is summer. All you need to do is walk outside and feel the heat." and goes on to note that "...approximately 15% of CLL patients will develop skin cancer as a secondary malignancy."
"In general, skin cancer is often more aggressive in CLL patients compared with people who have never had cancer, and CLL patients are at a higher risk of developing recurrent skin cancer."
"We know that CLL negatively affects the immune system and is associated with deficient DNA repair. This DNA damage may be the culprit behind higher susceptibility. Patients who need treatment for their CLL are at an even greater risk because their immune system is further compromised. "
"...we remind you to protect your skin with protective clothing, sunscreen and shade. Be on the lookout for changes to your skin. Check your moles regularly for any changes in size, shape, color or texture. Have a yearly total skin check with a dermatologist."
Seems strange to me writing this from the dead of winter during a particularly cold spell. We've even had a rare dusting of show on the nearby hills!
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Has anybody read up on skin cancer, other than basics (or possibly basics I've missed).
I've bought some shirts that are SPF40 rated, some SPF50 sun spray, a Tilly hat and dumped my shorts. Always try to keep arms covered (even if it's no the new shirts). I'm hoping this approach gives me a bit of extra cover - does it sound reasonable?
Specific question (on the research), is it just being in sunlight that has increase danger or if you get burnt? On cloudy days like today is it reasonable to ease off? Off out and dont feel so much like 'oiling up' but will take it just in case.
Good to hear you've got some shirts with a good SPF rating. I actually went to the trouble of getting a UV light and checking how effective some of my tops were at blocking UV by seeing what current I could get out of a small solar cell. (I recognise this is only broadly indicative - the UV spectrum is quite wide and the UV LED light tests blocking at just one narrow frequency bordering the visible spectrum, but it was quite illuminating (excuse the pun) to see how widely different materials varied in their blocking capability. You really can't tell by visual inspection - visible black may be transparent at some UV frequency.)
Cloud cover does slightly reduce UV - but on days when there's a scattering of cumulus clouds around, you can actually get HIGHER UV (from the clouds reflecting more UV down). Same goes for other reflective surfaces like water. Glass blocks UV considerably - but it depends on the glass type + coating/tinting and where in the UV spectrum you are measuring.
I think it is fair to say that there is still a lot to be learnt about skin cancers and their causes. I've got a spot on my back that needs to be removed and it is decades since that has seen any direct sunlight. It is possible to get skin cancers where the sun doesn't shine too. Basically, energetic UV can be one cause of DNA damage in our skin cells and it seems that our less effective immune system may not destroy damaged cells as effectively, but it generally takes quite a long time for sufficient genetic errors to accumulate for a skin cell to become a problem. Hence some skin cancers can presumably have their origin in sun burn (or just accumulated damage from constant exposure and 'ageing') decades earlier.
Another disease that suppresses the immune system is chronic lymphocytic leukemia, a cancer of the lymph system said to have greater immune effects than other cancers. And several other types of cancer can put people at higher risk of developing skin cancer.
When the Immune System Weakens, Skin Cancers Can Skyrocket
Cancers present a double whammy, because in addition to cancer itself being immunosuppressive, so are the chemotherapies often used to treat them.
Arthritis, Lupus and Other Problems -
Rheumatoid arthritis, lupus erythematosis and other autoimmune diseases (where the body attacks its own organs) also increase the risk of skin cancer. The drugs used to treat them are part of the problem. For example, prednisone, a steroid used to treat such conditions as arthritis and allergic reactions, can cause significant immunosuppression.
Last, but Not Least — The Sun
The sun's ultraviolet radiation not only can lead to sunburn, premature skin aging and skin cancer, but also can decrease immune system function. It can add to the immunosuppression stemming from organ transplantation, cancer, and other diseases.
"The last thing an immunocompromised person needs is sun exposure," warns Dr. Otley. Sunscreen appears to help. A study from Queensland, Australia, found that daily sunscreen use significantly reduces the number of squamous cell carcinomas that people develop over time.
"What I Tell My Patients"
Dr. Otley doesn't stop there. "I recommend a complete sun protection program, with sunscreen, clothes including a broadbrimmed hat and sunglasses, and shade or sun avoidance during peak hours," he says.
"If patients worry that reducing sun exposure will cause vitamin D depletion (the sun is a vitamin D source), I advise them to take supplements and maintain a vitamin D-rich diet, including such foods as salmon, egg yolks and fortified milk. Then I emphasize early detection, monthly skin self-examination, and a professional skin exam on the schedule the physician advises.
"Taking all these steps correlates with a lower incidence of skin cancer," he concludes. "This improvement holds true for even the most severely immunosuppressed.""
As a caveat remember if you do supplement. do so with the support of your medic and have your blood serum monitored as often vitamin d3 supplements include calcium and excess calcium can be lethal.
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