Alison loved tanning her long legs – now they've been scarred by skin cancer
00:44 GMT, 8 May 2012
Sunworshipper: Alison Doughty with daughter Millie
Once a week, Alison Doughty makes a 60-mile round trip from her home in Hove, Sussex, to a reconstructive surgery clinic in East Grinstead. There a doctor injects saline into two inflatable bags that sit under the skin on either side of her right calf. Her leg looks as if a small dumbbell has been implanted in it.
In fact Alison, 52, a divorcee with two teenage children, is undergoing a procedure called tissue expansion, where her skin is being slowly stretched to produce enough skin to fill in a deep crater — five centimetres in diameter, two centimetres deep — that has disfigured her calf.
Alison has not been in a car crash or fire. Her leg was scarred by surgery to remove a cancerous mole — which doctors say developed due to Alison’s love of sunbathing.
With the incidence of malignant melanoma — skin cancer — rising faster than almost any other cancer, Alison’s story is a stark warning to sun worshippers.
‘I come from the age group who, when we were in our teens in the Seventies, had never heard of the dangers of too much sunbathing,’ says Alison. ‘I loved to lie out in the sun with tanning oil on and I took regular holidays to hot places such as Spain where I delighted in getting a tan.
‘And like many women, I thought my legs looked better brown. I occasionally even used a sunbed and if I did think about skin damage I consoled myself with the thoughts that I was relatively dark-skinned anyway.
‘I don’t remember a particular incident when I was badly burnt. But I certainly remember times when I felt a bit sore after sunbathing, which was probably a burn.’
As she got older, the messages about the dangers of the sun began to filter through and Alison began to be more careful.
‘As a professional make-up artist I often come into contact with people who have skin damage, and for the past ten years I have used factor 25 when sunbathing and covered up in strong sunlight. Sadly, by then the damage was probably already done.’
She first noticed that the mole on her calf had changed colour when she was in Portugal in August 2009, ironically while applying sun screen.
‘I had been born with this particular mole,’ she explains. ‘It was about the size of a one pence piece and had always been dark and flat, but now I could see lighter spots of pigment were coming through. As it wasn’t itchy or raised or bleeding — the classic signs — I wasn’t too worried.
‘It wasn’t until I went away for a weekend in October to Portugal again that I noticed the mole was by now two different colours, one half dark brown, the other quite pale.
‘It was a heart-stopping moment. As soon as I got back to the UK, I went to see my GP.’
Regrets: Alison wishes she'd never started sunbathing
Her GP referred her immediately to dermatologist Dr Bav Shergill, who she saw privately for more tests. ‘Just a few days later I was listening in horror as he told me he could see what he thought could be a cancerous speck in my mole,’ recalls Alison.
‘He removed the mole under local anaesthetic and told me to come back in a week for the results.
‘That week was the longest of my life. I told the children as little as possible, just that I’d had a mole removed and it was being looked at.
‘When I went back I could see straight away from Dr Shergill’s face that he had bad news. The mole was malignant. I had cancer.
‘To have it confirmed was just awful and I broke down. I was so shocked that it had happened to me.’
Rates of malignant melanoma in women have almost tripled from 1979 to 2008, with around 6,138 women diagnosed each year (5,584 men were diagnosed, a five-fold increase in the same period).
More than 2,000 people die of the disease each year. Although the most common age for diagnosis is over 65, more than a quarter of cases are diagnosed in the under-50s. ‘Skin cancer is almost always caused by too much exposure to ultraviolet (UV) light,’ explains Dr Shergill of the Brighton and Sussex Universities Hospitals NHS Trust and the Hove Skin Clinic.
‘And you don’t have to be sunburned to get it, although that of course does increase the risk.’
UV light disrupts the genetic code of the cells that make up the pigment of the skin. The cells try to repair themselves but over time this process can go wrong; and a skin cell can malfunction and turn cancerous.
‘Like most cancers, if a melanoma is caught early, the outlook is good. But melanomas can grow very rapidly, sometimes over just a few weeks, and once they reach the lymph system the prognosis is very poor,’ says Dr Shergill.
At stage 1 — where the cancer is contained within the mole and the mole surface is unbroken, about 80 per cent of patients are alive ten years later. However, at stage 4 — where the cancer has spread to other parts of the body, only between 7 and 19 per cent of patients are alive five years later.
Once Alison was diagnosed, she underwent a barrage of tests to see if her cancer had spread. Luckily, these came back clear and the cancer was classed as grade 1 — but she still needed a large amount of the skin around it removed. ‘After the surgery, when I first saw the size of the scar I was devastated,’ she says. ‘It looked as if a shark had taken a bite out of it. It seemed a high price to pay for sunbathing all those years ago.’
Statistics show the majority of melanomas — 40 per cent — contracted by women are on their legs, while men are more likely to get them on their torsos.
A recent survey by the British Association of Dermatologists found 92 per cent of people say they have been sunburnt at least once and almost a third recall burning on more than ten occasions. But even those who have never been burnt are at risk.
‘Many people delay getting a mole or suspicious pigment checked because they think they are not the type to get skin cancer,’ explains Dr Shergill. ‘But I have patients who have never sunbathed in their life — yet they are perhaps keen cyclists, or walk their dogs every day. Skin cancer can occur in a young person who spent their gap year in Africa, or an old person who has never left the UK.
‘We don’t really know why some get skin cancer and not others, although there can be a genetic susceptibility. ‘What we do know is that rates are soaring and are set to double by 2024. Even if your cancer is caught early it is still a very unpleasant and frightening disease to treat, as Alison will testify.’
Shortly after surgery, Alison’s doctors mentioned skin stretching. ‘Skin stretching, or tissue expansion, has been around for decades and has been used very successfully for facial wounds, large ulcerations, breast reconstruction — in fact in any situation where a large piece of flesh has been removed,’ explains Dr Shergill.
'I don’t think I will ever be completely free of the fear that it may recur'
‘You can cover a deep wound with a skin graft, taking the top layer of skin from another part of the body and grafting it over the wound, but all you get is the outer layer, the thin epidermis. The other layers of the skin, including the thick dermis which contains the sweat glands and the hair follicles, are missing.
‘However with skin expansion, you produce fully functioning skin with all the layers right down to the subcutaneous tissue — the fat. As the bag is slowly inflated over the weeks and months, a larger amount of skin is created and when we judge that enough of it has been created we bring the patient back in for an operation.
‘Under a general or local anaesthetic, we squeeze those newly produced layers of skin back down, so that the surface is flat again. The patient just ends up with a neat scar rather than the large contour that was there before.
‘It is not just a cosmetic procedure. You are also providing protection for the muscles which have been exposed by the surgery.’
The procedure is usually only available privately, although sometimes it can be considered on the NHS if the wound is particularly disfiguring and causing the patient physical or emotional distress, he adds.
Alison has been undergoing tissue expansion since January and it will continue into the summer when she will have the final surgery.
She will then be monitored for five years in case the cancer returns; every three months she has a check up of all her moles.
‘I know that I have been very lucky, but even so I have had cancer,’ she says. ‘I don’t think I will ever be completely free of the fear that it may recur.
‘I just hope my story makes other people think twice before they head out unprotected into the sun. If I could go back again and not sunbathe as I did in my teens and 20s, of course I would.’
The British Association of Dermatologists have launched an app to show what sun protection you need in any country in the world: bad.org.uk/sunawareness