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HEAD TO HEAD: Scott W Menzies Is sun exposure a major cause of melanoma? Yes BMJ 2008; 337: a763 [Full text]

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Panic over melanoma

John N Burry   (27 July 2008)

Panic over melanoma 27 July 2008
John N Burry, retired PO Box 7177 Hutt St Adelaide 5000 South Australia Australia Send response to journal: Re: Panic over melanoma	My aged Celtic skin reveals that if I had worn gloves as well as a hat when outside that the back of my hands would not be hyperkerotic in contrast to my face where there has been little damage, produced over fifty two years of living in Australia. The head-to-head articles by Shuster and Menzies convince me of little except of the inadequacies of an academic debate supported by thirty references on the side of the no-melanoma-is-not caused-by-sun-exposure argument and twenty six references on the side of the yes-melanoma-is caused-by-sun-exposure argument. My dermatologist's impression is, since living in Australia since 1956, that melanoma is caused by sun exposure. Surely there is a definitive epidemiological answer somewhere. Choosing the populations to be surveyed may be the problem. Celts were not chosen by natural selection to live in Australia. I see little doubt in that. Can you imagine a naked Celt hunting and gathering in sun-burnt Australia? What I did find convincing was Shuster’s argument that there is confusion when it comes to the differentiation between dysplastic naevi and melanoma. Dysplastic naevi became part of the debate in my recollection in the 1980s. Histological criteria were never convincing but what was convincing was the panic inherent in the diagnosis. If the histopathologist did not prognosticate accurately the potential for litigation was there. And what is more patients might panic too. Shuster's article, given as a reference, “Sun and the Skin; a violation of truth” in Panic Nation edited by Feldman and Marks perhaps reveals all, through the inclusion of the word “panic”. Shuster covinces me that there is lots of panic in all this. I intend to minimise my panic by staying out of the sun. There are however lots of people in my Australian-beach vicinity who show no signs of panic whatsoever and bath and surf without a seeming care. John N Burry retired dermatologist. Competing interests: none