Halting the Skin Cancer Epidemic

As part of Sun Awareness Week 2015, Dr Girish Patel, an Honorary Senior Lecturer in the European Cancer Stem Cell Research Institute and Consultant Dermatologist for Hywel Dda Health Board, explains his concerns about the rise in skin cancer rates and what his team within the Institute are working towards to combat this rise.

The British summer is upon us and as a dermatologist I can't stop worrying about skin cancer.

Despite soaring sun-care product sales, the burden of skin cancer is overwhelming the NHS.  Skin cancer rates have continued to increase and over the last decade and the three common skin cancers (basal cell carcinoma, squamous cell carcinoma and malignant melanoma), which account for 99% of all skin cancers, have increased 34-55%; compared to a 6% rise in all UK cancers.  There are over 100,000 operations and 3,000 deaths from skin cancer in the UK each year. And skin cancer is now the second most common cancer between the ages of 25 and 50 (Cancer Research UK). In West Wales where I work, I am seeing younger patients with particularly aggressive skin cancer, most notably malignant melanoma.

Despite public sun avoidance skin cancer prevention campaigns such as: "Sunsmart" (Cancer Research UK), "Sun Awareness" (British Association of Dermatologists), "Care in the Sun" (Ulster Cancer Foundation), "Stay sun safe" (Tenovus), and Shunburn (Teenage cancer trust), sun bathing remains a national hobby. This is one reason why the 1992 Government pledged to halt the year-on-year increase in skin cancer incidence by 2004 has failed. I feel we need to do more, with alternative strategies, to halt and manage this skin cancer epidemic. 

Wales as a nation now has the highest number of new cases and deaths from skin cancer per population in the UK. New cases and deaths from malignant melanoma are at their highest since records began, like a tsunami sweeping over our nation, and both have continued to increase in Wales over the last decade.  This is what fuels my research group at the Institute and why we are seeking to prevent, understand and treat skin cancer.

It may come as a surprise, but we have recently nailed down that it is only 1-3% of the skin cancer cells (so called skin cancer stem cells) that drive growth; the rest of the cells that make up a tumour it seems are just "passengers". We have been fortunate in that we have identified cancer stem cells in two skin cancers and we are working on the third.

Currently Dr Simone Lanfredini (supported by a Cancer Research UK grant) is working on how everyday viruses that reside on our skin might sway normal stem cells to become skin cancer stem cells. Dr Kate Powell (supported by a British Skin Foundation grant) together with our undergraduate student Jasmine Gore are looking at how the cancer stem cells evade attack by the immune system. We recently received a Sêr Cymru Life Sciences Research Network grant  to discover drugs that can help the immune system to fight back and attack the skin cancer stem cells. Huw Morgan (supported by a Cancer Research Wales grant) for his PhD, is building on our earlier studies to look at how skin cancer stem cells escape killing by conventional treatments. While Dr Abdullahi Mukhtar (a Commonwealth Scholar from Kano State in Nigeria) for his PhD thesis together with Dr Sarah Harries (a junior doctor in Hywel Dda University Health Board), is looking to find new ways to target melanoma cancer stem cells.

We also have a number of other projects, some of which have grant applications pending outcomes, suffice to say getting grant funding is tough. What we are learning from skin cancer is readily applicable to other forms of cancer, and we are fortunate to work alongside some of the brightest minds at the European Cancer Stem Cell Research Institute.

The driving force behind our research remains my desire to improve the outcome for my skin cancer patients, many of whom participate in my research by giving tissue samples. It is estimated that by 2020 one in five individuals will develop skin cancer, almost all of whom will initially be seen by dermatologists such as me. Hopefully our work will have an impact and help buck the trend to improve the outcome for those who develop (skin) cancer.