Dr Barry Monk – Sunshine and Skin Cancer – Injury Rehab Network Event

Dr Barry Monk has been a consultant dermatologist since 1987 and is highly experienced in treating all aspects of skin disease in both adults and children. Barry qualified in medicine at Jesus College, Cambridge and Westminster Medical School, and trained in dermatology at Royal Free and King’s College Hospital in London. Dr Monk was a consultant at Bedford Hospital until 2012, and a consultant at Northampton General Hospital until 2020. He still undertakes private practice.

Barry’s presentation ‘Sunshine and skin cancer’ was the latest event of the Injury Rehab Network delivered in partnership with BASRaT. Over 110 professionals and students involved with sports rehabilitation joined live and contributed with a range of interesting questions.

Dr Monk has contributed to 5 textbooks, including writing the dermatology sections of the 14th and 15th editions of French’s Index of Differential Diagnosis. Dr Monk is the author or co-author of over 60 papers in peer-reviewed medical publications, as listed in PubMed and Google Scholar. A full list of publications can be provided on request. Dr Monk has a broad interest in dermatology, including skin cancer and skin cancer prevention, acne, psoriasis and eczema. He is also an expert on Laser treatment of the skin.

Dr Monk has recently published a book exploring the NHS. Lifeline: ‘Difficult questions, uncomfortable answers… A deeper look at how to save our cherished NHS’ would be of interest to anyone in the health field and is available to buy online now.

Dr Monk guided us through his presentation, ‘Sunshine and skin cancer’ which included what you need to know and how you can help to educate, prevent, and support the early identification of skin cancer.

The recording of the event is available here

Sunlight and Skin Cancer

Dr Monk provided a brief introduction to his work and significant experience as a Consultant Dermatologist from 1987 – 2012 at Bedford Hospital, 2012 – 2020 in Northampton and currently in private practice.

Barry explained that skin cancers are common, and the incidence is rising in most parts of the world. Sportsmen and women are at particular potential risk. Sports medicine professionals (physios, rehabilitators and therapists) can have an important role in education, prevention and early diagnosis; indeed, some professional sports such as cricket and golf have already taken the initiative in this field.

Sports rehabilitators have the potential to be lifesavers and have a duty of care for the health and wellbeing of the athletes they work with.

High Profile Cases

Barry described how some professional sports people have sadly lost their lives to skin cancer. Many athletes have made a good recovery through early diagnosis and treatment. High profile people can be good advocates through the support of public health education.

In cricket, Andy Flower had a skin cancer identified by the Australian Physio when on tour and American golfer Dustin Johnson was seeing an orthopaedic surgeon who identified skin cancer and made a referral for treatment.

Types of Skin Cancer

Dr Monk provided a background to the three types of skin cancer:

Malignant melanoma
Basal cell carcinoma
Squamous cell carcinoma

Barry explained that exposure to UV light is the main cause of skin cancer.

Malignant Melanoma

This is most common in fair-skinned subjects who may burn easily and is linked to past episodes of sunburn. Early diagnosis is essential as malignant melanoma is curable if spotted early.

Dr Monk described how rates of malignant melanoma have more than doubled in the UK in the last 20 years and are more common in men.

To identify a malignant melanoma Barry uses a simple ABCD method:

A = Asymmetry
B = Border
C = Colour
D = Difference

Barry would advocate that everyone checks their body twice per year for any changes and to be aware of any ‘ugly duckling’ moles that look different to other moles and may be changing.

Sports rehabilitators and their patients should ask for help when a mole has changed or looks different. Dr Monk advised that if in doubt it is always best to ask.

The Science of Sunburn

Dr Monk provided insight into the science of sunburn and the electromagnetic spectrum. Shorter UV waves are the most harmful. The earth’s atmosphere absorbs some UV rays, but the risk of sunburn is higher in the following environments:

At altitude where less UV rays can be absorbed by the atmosphere
On water or snow where UV rays are reflected
When the sun is at the highest in the sky (around midday) when the UV rays have a short distance to travel

Greatest Risk of Sunburn

Barry described those at greatest risk of sunburn are people who spend time in hot climates, outdoors all year round, have fair skin, may not protect their skin from the sun and may spend long periods of the day in the sun.

High-risk sports and activities include:

Water sports and skiing
Year-round sports
Altitude training
Outdoor sports and training

Sport is Taking Action

Barry described how the ECB are providing education and screening in cricket in the UK. Whilst in America the PGA has introduced annual skin checks for golfers following advocacy by Dustin Johnson after his treatment for skin cancer.

The Role of the Sports Doctor/ Physio

Dr Monk explained that professionals working in sports medicine and sports rehabilitation can play an important and potentially lifesaving role through:

Opportunist examination
Health education
Screening

Health Education

As is the case with many illnesses and diseases, prevention is better than cure. The battle against skin cancer can be tackled through health education and Barry described some simple steps to minimise the risk:

Clothing (is it possible to cover the skin?)
Timing of activity (can training take place in the morning or evening?)
Shade (can activity take place in the shade and is shade available?)
Sunscreens (UV protection, high SPF, applied regularly)

Sunscreen

Dr Monk stated that the simplest way to protect against skin cancer is to, as Baz Luhrmann said, “Wear Sunscreen”.

Regular applications are required, and important features include:

Water-resistant
UVA and UVB
Factor 50

Other Types of Skin Cancer

Barry provided information about other types of skin cancer to be aware of. Basal Cell Carcinoma has the appearance of a spot whilst Squamous Cell Carcinoma can be larger and grow rapidly.

Higher Risk Athletes

Athletes or individuals who have received an organ transplant have an increased risk of skin cancer due to the effects of immunosuppressants.

Summary

To summarise,

Rates of skin cancer are increasing with several high-profile sports people receiving treatment in recent years.
High profile people can support health education around skin cancer.
UV light is the main cause of skin cancer.
Sports medicine and sports rehabilitation professionals can play an important role in health education, early identification of skin cancer and screening.
Use the ABCD method to identify malignant melanoma. Look out for the ugly ducklings that may appear different.
The risk of sunburn is highest in environments where the suns UV rays are strongest.
Those at the greatest risk of sunburn are those with the highest exposure to the sun.
Sport is taking action.
Health education is key – prevention is better than cure.
Wear sunscreen!

Q&A

Dr Monk kindly answered several questions following his presentation:

Question 1 – Do athletes need some exposure to sunlight without sunscreen to benefit from vitamin D?
Answer – For sports people who train and compete outside, they should be able to get sufficient vitamin D, even with factor 50 protection.

Question 2 – Is it possible to get sunburn through a window?
Answer – For normal people without photosensitivity conditions, window glass should protect against UV.

Question 3 – Are sunscreens carcinogenic?
Answer – No. Not wearing sunscreen is more damaging.

Question 4 – What advice would you give to encourage strong characters to wear sunscreen?
Answer – Educate the whole team and make it a ritual that everyone follows.

Question 5 – Should people focus on the SPF or UV value of sunscreens?
Answer – SPF blocks UVB but the most important thing is what people will wear. The higher the protection the better.

Question 6 – How quickly can moles change?
Answer – People may notice a change in a period of a month or more. An exam is recommended to screen for any changes twice per year.

Question 7 – Are there any other signs or symptoms that sports rehabilitators and therapists should be aware of?
Answer – Any bleeding should be taken notice of. The most important thing is to look out for moles that are the ugly duckling and just look different to others. Moles that are smaller than 5mm are usually unlikely to be a problem.

Question 8 – Can drugs/ medication increase the risk of skin cancer?
Answer – Immunosuppressants are the main drugs to be aware of for an increased risk of sunburn and skin cancer.

Question 9 – How important is it to be aware of the shelf life and use-by date of sunscreen?
Answer – If using regularly, sunscreen should be used well before it passes its use-by date. It’s good practice to check the use-by date.

Question 10 – How would you recommend that sports rehabilitators screen athletes for skin cancer?
Answer – Examine carefully in good light. Easiest when standing if possible.

Question 11 – What post-diagnosis support is available?
Answer – Patients are the best advocates and can often provide the best support as they have been through treatment.

Question 12 – If a sports rehabilitator identifies a potential skin cancer in an athlete/ patient, what should they do?
Answer – The patient should see their GP who will make an assessment and make a referral to a specialist (within 2 weeks).

Follow

Follow Dr Barry Monk and find out more at the links below:

Website – https://www.barrymonkdermatology.co.uk/

Email – barrymonk@doctors.org.uk

Book – Dr Monk has recently published a book exploring the NHS. Lifeline: ‘Difficult questions, uncomfortable answers… A deeper look at how to save our cherished NHS’ would be of interest to anyone in the health field and is available to buy online now.

Recording

The recording of Barry’s presentation is available to view here.

2021 Injury Rehab Network Events

A full schedule of monthly events for 2021 is in place with the events delivered in partnership with BASRaT. The events include talks from exceptional guest speakers.

2021 Event Details:

20th Sep 5pm – 8pm at UA92 – Dr Ian Horsley (shoulder physio)
7^th Oct 7pm – Dr Imtiaz Ahmad (QPR FC)

Watch this space for registration details for each of the events. Read more about the programme of events for 2021.

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