Anyone watching my husband and I return from a fortnight in France last week could be forgiven for thinking we were on holiday in different places.
While I had the same pale, white skin as at the beginning of our trip, Sebastian had a rich mahogany tan.
In fact, whenever we come back from vacation, friends often ask, ‘Did you really go out together?’ Our tans – or in my case, the lack of one – tell such different stories.
The point is that we have very different attitudes towards the sun. I am a dermatologist and have dedicated my life to the treatment and diagnosis of skin cancer.
For me, the sun is the enemy. I wake up to a sunny day and think, ‘Yes, it’s nice, but it does so much damage to human skin.’
Anyone watching my husband and I return from a fortnight in France last week could be forgiven for thinking we were on holiday in different places. While I had the same pale, white skin as at the beginning of our trip, Sebastian had a deep mahogany tan
Even when it’s still dark outside, I never leave the house without a thick layer of factor 50. If I’m wearing makeup, I put a layer over the top — and I do this all year round. (I also make sure to supplement with vitamin D between October and April to make sure the lack of sunlight doesn’t leave me deficient.)
On vacation, I’m the type to wear an SPF 30 serum under SPF 50 sunscreen and put zinc sunscreen on my nose and ears. I also wear a UV protection shirt and a Panama hat. And yet I sit in the shade and never face the sun. I don’t want any sun on my face.
Sebastian, on the other hand, loves the sun. He says it’s good for you and it cheers him up when he’s out.
He can’t wait to perform in it on vacation. He won’t lie on a lounger, but wants to go straight into the water. He swims off into the distance or goes sailing or climbing – all in the blazing sun.
And back in the UK, when he’s not working he’ll be out in the sun, playing cricket or sailing.
Even though he loves the sun, and even though he’s also a doctor—an oncologist, actually—he doesn’t consider sun protection at all. I’m not sure he would have even considered it if I hadn’t scolded him.
Is he listening? In truth, I think I’ve said the same thing so many times over the years (we’re both 51 today and got together at 20) that it became white noise.
I think to make sure it didn’t burn. I follow him with my factor 50 spray like you did as a little kid. And just like with a baby, I only get a maximum of ten seconds where he sits long enough for me to spray him.
Very occasionally, he’ll wear a UV protection t-shirt – often because he can’t be bothered to slather on sunscreen. I don’t think you’ve ever bought sunscreen in your life.
And while Sebastian likes to wear his Lock & Co Panama hat, he finds it too pretty to wear by the sea.
He can’t wait to perform in it on vacation. He won’t lie on a lounger, but wants to go straight into the water. He swims off into the distance or goes sailing or climbing – all in the blazing sun. And back in the UK, when he’s not working he’ll be out in the sun, playing cricket or sailing
Of course, this approach to sun protection is not safe and occasionally burns. A few years ago we went to the Caribbean in the winter. Pale winter skin is especially prone to sunburn and you’ve been in the water a lot – which amplifies the amount of harmful UV rays you’re exposed to by up to 30 percent.
He’d been out all day shirtless and without reapplying sunscreen, and spent most of the next few days complaining about how much his sunburn hurt.
I had to fight the urge to tell him, ‘I told you so!’
It’s not even that he likes the aesthetics of a tan: he just doesn’t consider the dangers of the sun. This calm attitude towards the sun is part of him – but it worries me.
I spend every working day with people with skin cancer – the vast majority of which (unlike many other cancers) can be prevented simply by taking steps to protect yourself from the sun.
This message is starting to get through to many women, including younger ones, and most of the women I see now have clearly protected their faces from the worst of the sun, although they often forget about their arms, chest and neck.
But I’m afraid that’s not the case with men. And this is especially true for men in their 50s and 60s, who show many signs of sun damage by the time they see me.
Sun spots, areas of pigment change, and yes, sometimes skin cancer can appear.
I often think to myself, ‘If only I could have talked to you in my 20s, before this damage happened.’
However, this is not just anecdotal; it is reflected in the numbers. Take malignant melanoma — the most serious type of skin cancer. This forms in melanocytes, the pigment cells that give the skin its color, and often, though not always, starts with birthmarks.
Cases of malignant melanoma have doubled in women but tripled in men since the early 1990s, according to the latest figures from Cancer Research UK.
One in 47 women and one in 36 men will now develop this cancer, and more than 2,000 people in this country will now die as a result. While some cases are caused by genetics, 86 percent of these cases could be prevented.
Unfortunately, the symptoms can be very subtle – there can be subtle changes that are hard to spot in the early stages. In my NHS clinic, we find that 18 per cent of cases are caught by chance, as I tend to give all patients a full body check for skin cancer.
On men, I usually find them on their backs – a result of them walking around shirtless. Women are more likely to develop them on the legs.
Cases of malignant melanoma have doubled in women but tripled in men since the early 1990s, according to the latest figures from Cancer Research UK. One in 47 women and one in 36 men now develop this cancer, and more than 2,000 people in this country die as a result each year.
Why are men so resistant to using protection? I think it’s multifactorial.
For starters, some men take the macho view that they shouldn’t bother with their skin—or their health, for that matter. But they’re also not used to wearing cream like women – so they find it awkward and unnatural, especially when they have more body hair than women.
I always advise men to use a really liquid sunscreen that rubs in easily. (So many men like my husband can’t be bothered to put on a really thick cream.)
But I also think men underestimate the risk. Sebastian thinks he doesn’t have to worry about skin cancer because he has naturally pigmented skin and looks slightly tanned even in winter.
However, some research suggests that people with this darker skin type tend to spend a long time in the sun, and this cumulative exposure may put them at an increased risk of melanoma.
I think a lot of people think like Sebastian.
I’ve always been picky about our kids in the sun. And while our eldest, Grace, who is 20, and our youngest, Augustus, 13, are very good about using sunscreen and limiting their time in the sun, Bede, who is 17 and the only one in Sebastian’s coloring, also thinks that No. I don’t have to worry as much as the other two.
Another factor that plays a role here is that people underestimate skin cancer. I think most people think that since it’s not hidden inside them, it’s not as ominous as some cancers.
But that’s clearly not true—and unfortunately, I’ve lost more patients to the disease than I’d like.
And while most skin cancers won’t kill you, the most common forms, basal cell carcinoma and squamous cell carcinoma, can be horribly disfiguring. I have seen people need to cut off large sections of skin to get rid of cancer.
Basal cell carcinoma affects the deepest layers of the skin and forms red, often shiny spots and bumps that do not heal.
Squamous cell carcinoma forms in the outer layers of the skin and often appears as crusty, sometimes tender areas of skin with an inflamed base. (It can, although rarely, spread elsewhere in the body.)
Both of these skin cancers occur as a result of cumulative sun damage over the years.
I hope that such considerations will encourage everyone – men and women alike – to be more careful in the sun.
But there’s another reason to do it—and that’s because of the aging effects of sun exposure.
I spent some time in Australia at the beginning of my medical training and it was an eye opener. More than 80 percent of skin aging—by which I mean wrinkling and loss of elasticity—is caused by sun damage.
In Australia I met people who looked years older, sometimes decades older than they actually were, because they were so exposed to the sun.
From then on, I was covered in sunscreen, wore a long-sleeved t-shirt and a hat, and always sat in the shade. It was 30 years ago – it wasn’t fashionable to be in the sun then – and people were pointing at me and asking my friend, ‘Is she OK?’
It has paid off because people sometimes comment that I look younger than I am. Sebastian, surprisingly, doesn’t look too sun damaged right now. It’s usually more noticeable from the 50s onwards, so only time will tell.
I haven’t left the house since Australia without factor 50. I wish more men would follow suit – including my husband.
Dr. Hextall is a consultant dermatologist at University Hospitals Sussex and Tarrant Street Private Clinic, Arundel.
As told by: Lucy Elkins
The headache detective
Surprising causes of headaches. This week: Cooking smells
Osmophobia, a sensitivity to smells, affects 95 percent of migraine sufferers, according to the American Headache Society, and is known to trigger or worsen headaches.
Certain smells – particularly cooking, cigarette smoke and perfumes – “can cause stress on your olfactory nerves in the upper nasal passages,” explains Dr Andy Dowson, a headache specialist at King’s College Hospital in London. One theory is that the olfactory nerves then overstimulate areas of the brain known to be involved in migraines, leading to the release of inflammatory substances such as CGRP (calcitonin gene-related peptide), according to an analysis of studies in the journal European Neurology revised in 2017.