‘I fell asleep on the beach in the sun. The next day I couldn’t walk’ – the melanoma epidemic in older men
David Uttley can almost pinpoint when his nightmare began. He was 15 and on holiday in Brittany.
“I fell asleep on the beach in the sun. The next day I couldn’t walk. The sunburn was too painful.” Today, aged 60, he’s living with stage four melanoma cancer.
Like a lot of men who grew up in the Sixties, Seventies and Eighties, he had little understanding of sun protection.
“I’d get sent out to play in the garden with no protection. I can’t blame my parents, it just wasn’t something you thought about back then,” he says. “But the damage was done, and once it’s done, it never repairs.”
Rates of skin cancer in the UK are at an all-time high, with a sharp rise among over-55s. Melanoma – the most dangerous type of skin cancer – reached 17,500 cases last year, the highest since records began, with a particular rise among over-fifties. This has been attributed to a boom in cheap package holidays in the 1960s. Case rates among this age group have risen by 195 per cent since the 1990s, with more men affected than women.
Experts predict similar to come from Gen X, a generation of sun worshippers serenaded by George Michael crooning “don’t worry, you can suntan,” while they crisped their skin in the Costas.
Uttley’s story is sobering. In 2013, when he was 49, he noticed a ‘rogue mole’ on his shoulder. It was diagnosed as malignant melanoma. After surgery he was discharged and told to regularly check his lymph basins (neck, groyne, armpits) for lumps.
“As far as I was concerned it was a near miss,” he says.
In 2017, he found a lump in his armpit and had his lymph nodes removed. “Melanoma loves soft tissue, and the lymph system provides a superhighway around your body. It can go anywhere it wants and once it gets there it has a party,” says Uttley.
He had regular scans and became well acquainted with ‘scanxiety’, the nervy wait between the scans and the results. In 2020, a routine scan discovered that cancer was having a party in his pancreas. Surgeons removed it, along with his spleen.
Today he lives with a diagnosis of stage four cancer. He is currently waiting to see if and where the disease will strike next. In the meantime, he’s an ambassador for Melanoma UK and raised £20,000 for the charity in 2023 when he climbed Kilimanjaro. He’s going up again in December this year and raising money via a GoFundMe page.
“A stage four diagnosis makes it a lot more real, and it focuses your mind on your own mortality,” he muses.
He has watched many fellow cancer sufferers die. “I always say that I’m lucky, my story is a stroll in the park compared to some of the poor souls that I meet.”
Uttley uses his story as a warning to others, and he can see a tsunami in the distance.
“People have such a blasé attitude to the sun and little concept of what damage UV rays can do. Skin cancer isn’t taken that seriously,” Uttley says. “It’s only skin cancer, right? That’s what they say. Snip it out and everything’s fine. It’s a massive misconception.
“Men’s attitude to sun damage is terrible. You see all these construction workers out in the sun stripped off when it’s hot. I feel for them. There’s so much at risk and they have no idea.”
Research suggests that getting sunburnt just once every two years can triple the risk of developing skin cancer, compared to never being burnt.
In Britain, melanoma rates have increased by almost a third over the past decade across all age groups and researchers have projected a record high of 20,800 cases this year. According to the American Academy of Dermatology, men are more likely than women to develop melanoma by 50 and twice as likely to develop it as women by 65.
Dr Paul Banwell, the former head of East Grinstead Melanoma and Skin Cancer Unit who now runs The Banwell Clinic, says: “Melanoma skin cancer among men in the UK has increased significantly more than rates of cancer for women in the last decade.
“There is, concerningly, an 8 per cent increase in death rates for men. Skin cancer is not only on the rise for men, but it is more common in men. In addition, men are more likely to be diagnosed at a later stage and are more likely than females to die of melanoma.”
Uttley laments British attitudes to suncare.
“In Australia or Brazil, they have a completely different psyche. There are sunblock dispensers all over the place and a common-sense attitude that you tempt fate if you expose your skin without protection,” he says.
But despite better awareness, in Australia melanoma is still the most common cancer among 15 to 39-year-olds. Every year, over 14,000 are diagnosed and two out of three people in the Oceanic country will end up with skin cancer in their lifetime. More than 50 per cent of Australian adults will have had at least one skin cancer by the age of 50, according to John Thompson, an emeritus professor of melanoma and surgical oncology, The University of Sydney.
“It’s a complicated story,” says Prof Thompson. “There’s an epidemic of melanoma in older males in particular which reflects attitudes to sun care decades ago.”
Today in Australia, awareness of sun damage and UV protection begins in primary school and continues through to high school. Youngsters at primary school can’t go out to play without a hat, while playgrounds and sports venues are designed with covered shady areas.
“Parents are very aware of the risk to younger children,” says Prof Thompson. “From the moment they are born, children are protected and that continues through kindergarten and school. Workplaces are also very aware — some provide containers of sunscreen and outdoor workers are encouraged to use it and wear protective clothing, such as hats and long-sleeved shirts.”
Employers are held liable, and many have been sued by workers who develop melanoma from outdoor working and haven’t been offered appropriate sun protection.
In Australia, sun safe messaging has been part of the public health landscape since the Eighties — when the Slip, Slop, Slap campaign was launched, advising citizens to slip on a shirt, slop on sunblock, and slap on a sun hat.
Vigilance was ramped up again in 1987 after the broadcast of a three-part television documentary, Goodbye Sunshine, about a young man dying of melanoma. In the three months after broadcast there was a 167 per cent increase in the number of melanomas diagnosed compared with the same period the year before. More recently, the country has banned sunbeds.
Despite all the public messaging, Australia still tops the global list for skin cancer, although rates are flattening. This is partly because, as Prof Thompson says, “people get to their teens and early adulthood, leave school and think they are invincible”. The attraction of the tan in a nation of beaches is just too much for many.
Jay Allen is trying to change that.
In 2008, at the age of 32, Allen was diagnosed with stage 3 melanoma. In January 2021, after being cancer-free for over 12 years, he found a golf ball-sized lump on the right side of his neck. This was diagnosed as a squamous cell carcinoma, for which Allen underwent radiation and chemotherapy. This month, he was given the all-clear.
Allen is the chief executive and founder of the Australian Skin Cancer Foundation, which he founded in 2021 to raise awareness and provide advocacy education and support. It operates a mobile free skin cancer screening service. On the side of the NGO’s skin check truck are photos of over 80 friends Allen has met through his work who have died because of melanoma.
Nurses on the truck see up to 200 people a day and queues for the service form in car parks ahead of its arrival. So far, they’ve checked over 7000 people in 52 locations. The service has found over 32 melanomas, over 600 basal cell carcinomas, and over 700 squamous cell carcinomas.
Allen has just finished a 13-day tour of Queensland where melanoma rates are the highest in the world.
By his reckoning around 40 per cent of the population in Australia are careful and recognise the risks, “but the other 60 per cent are still tanning and not getting regular skin checks”.
“It’s part of the culture over here to get a tan and look good. We’ve got to try and change that. In kindergarten and primary school there is lots of education but then it all falls apart at high school.”
Skin cancer is a slow burner. The damage hides and waits, and appears decades later. The impact of public health messaging in Eighties Australia is only becoming evident now, with the incidence curve having flattened in the past five to 10 years.
“It looks as though the public health campaigns have had some effect,” says Prof Thompson. “Whilst we are flattening out, the United States, Britain, and a lot of continental countries are catching up,” he adds.
“In the next ten years the incidence of melanoma in the white population of the United States, for example, will be roughly what it is now in Australia.”
Dr Banwell adds a sobering note: “Generation X and younger generations do seem to be taking sun safety more seriously, but there are at times worrying trends on social media such as the ‘anti-SPF’ trend or the ‘homemade sunscreen’ trend seen on TikTok. These can be incredibly damaging and can cause serious consequences once people get older.”
In addition, sunbed use in the UK is still alarmingly popular. A survey earlier this year by charity Melanoma Focus found that 28 per cent of Britons aged 16 to 65 use sunbeds, peaking at 43 per cent among those aged 18 to 25. Nearly 40 per cent of the 2,000 Britons polled did not know the risks.
Sunbeds are banned in the UK for anyone under 18. Chief executive Susanna Daniels says: “Sunbed use across the UK is alarmingly high and it’s shocking so many people don’t realise how dangerous they are.”
Without the historic buffer or public health awareness, in the UK we are not out of the fire just yet.
How to protect yourself
Beth Vincent, health information manager at Cancer Research UK, says: “To reduce your risk, seek shade, especially in the middle of the day, cover up with a shirt that covers your shoulders, wear a hat and sunglasses, and apply sunscreen with at least SPF 30 and four or five stars generously and regularly.”
Dr Banwell adds: “Men need to pay attention to areas that are commonly missed, such as the ears, eyelids, lips, back of the neck, tops of the feet and also the scalp, especially if they’re bald.
“It is also hard for men to spot and identify areas of concern on their back and they may need to ask a partner for help. I always recommend applying SPF 50.”
Choose a wide brim hat rather than a baseball cap. Women are more prone to sun damage on the lower legs.