Once you have been diagnosed with melanoma we usually advise you to avoid too much sun exposure. This is for two reasons:

• It reduces the risk of developing another melanoma.
• Any sunburn may stop your immune system working as well as it should.

Yet, we know sun exposure is generally important to health because it allows your body to make vitamin D, which is crucial for bone health. There is some evidence that vitamin D may also be important for your health after diagnosis of melanoma. This is very new information and we need the results from further studies before we can be sure it is right. However, vitamin D is necessary for many other aspects of your health, so there is no doubt that vitamin D levels are important.

So what is our advice to you?

The best advice we can give you is to avoid too much sun exposure.

Firstly, avoid sunburn

Secondly, when the UV index is at or above three:

• Avoid staying out in the sun for long periods.
• Avoid the sun between 10am and 2pm in particular.
• Use sun protection such as factor 30 SPF sunscreen with four or five stars UVA protection.
• Use appropriate clothing to protect your skin where possible.

The UV index will vary depending on where you live in the world, the season and the time of day. For example, people living in Sydney, Australia may need to practise sun protection for most of the year. For people who live in Northern England the length of time will be shorter. When UV levels are high, adequate vitamin D is quickly created in the skin so prolonged exposure is not necessary.

Thirdly, keep your vitamin D levels up.

You can do this in two ways:

• We think that the best advice is to take vitamin D3 tablets which can be bought from health food shops or on-line. We would recommend taking 400 to 1000 IU per day depending on your diet and sun exposure.
• Eat foods that are naturally rich in vitamin D (such as fatty fish and eggs) or that have been fortified with vitamin D (such as some yoghurts and cereals). If you eat reasonable quantities of these foods you may not need to take supplements every day. A portion of cooked salmon (3 ounces/85 grams) may contain 447 IU of vitamin D.*

How much vitamin D is enough?

The NHS Choices website now suggests that people who have to avoid the sun should take vitamin D.** They recommend up to 1000 IU (25 micrograms) per day. The Institute of Medicine in the USA has recently recommended 600 IU per day for most adults.

For cancer patients, it is not known what to suggest and some scientists have concerns that high levels of vitamin D in the blood might be harmful. Research is underway to find the right dose.

In the meantime, our cautionary advice is as follows:

• 200 IU (five micrograms) of vitamin D a day should be adequate for most people who do not need to avoid the sun. If you are over 50 years old 400 IU (10 micrograms) is probably more appropriate. Very high doses may be harmful.

For melanoma patients avoiding the sun, we believe that 600 to 1000 IU should be considered. It may be that the amount needed should be determined in discussion with their doctor and it may be necessary to measure the current level in their blood. The aim is to have a level of 60 and 85 nmol/L.

• If you have kidney disease, a high calcium level, kidney stones or heart disease speak to your doctor before taking supplements.
• If you are at all concerned please talk to your healthcare professional.

* NIH Dietary Supplement Fact Sheet: Vitamin D
** NHS Choices Website.

Information updated 23 March 2012.

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