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PATIENT
INFORMATION

Melanoma is a form of cancer that develops from the pigment producing cells of the skin. If untreated it can spread through the body with serious consequences.

In many parts of the world melanoma is becoming more common. However, it is still unusual to have more than one case of melanoma in a single family. When more than one person in a family has a melanoma, there might be something ‘running in the family’. That ‘something’ could mean other family members are more likely to get a melanoma than people outside the family.


Information on research studies based in Leeds, UK

Leeds University Logo
GenoMEL is an international research consortium coordinated by the University of Leeds
FP6 logo
GenoMEL is an FP6 project and as such is funded by the European Commission
National Institute of Health logo
GenoMEL also receives substantial support from the National Cancer Institute (NCI) of the US National Institutes of Health (NIH) (CA83115).

Sun protection and Vitamin D
after a diagnosis of Melanoma

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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Glossary

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Associated
When two things are associated they are connected or joined in some way. It may be that one thing causes the other but they could be linked in some other way. For instance, if both things were caused by a separate, third thing.
Clinical geneticist
A doctor concerned with the care of people with genetic conditions.
Dermatologist
A specialist 'skin' doctor.
Freckle
A small brown patch on the skin that becomes darker following exposure to sunlight. Freckles can vary from light brown to dark brown, and are often found on the cheeks and across the bridge of the nose.
Genes
Genes are pieces of genetic 'code': they are the instructions or recipes that our bodies use for growth and repair.
GenoMEL
The Melanoma Genetics Consortium: an international, collaborative organisation researching the genetics of melanoma.
High-risk genes
Particular genes can make us more susceptible to diseases. If we have changes in them called mutations, and if the mutation significantly increase the risk of a disease (as compared to someone who does not have a mutation in the gene), it is called a high-risk gene.
IU
International Units
Melanoma
Melanoma is a form of cancer that develops from the pigment producing cells of the skin. If untreated it can spread through the body and is potentially fatal.
Microgram
A microgram (mcg) is a millionth of a gram.
Mutations
Mutations are changes or faults in our genes. Sometimes mutations can increase our chances of developing a disease.
nmol/L
nmol/L stands for nanomoles per litre. A nanomole is an extremely small unit of measurement.
Nervous system tumours
The nervous system consists of the brain, spinal cord, nerves and other structures that control our bodies. A tumour is an abnormal growth, which can be cancerous (having the potential to spread around the body) or benign (the growth remains in a single spot but may continue to grow in size).
Pancreas
The pancreas is a gland that lies behind the stomach. It produces digestive juices and controls blood sugar levels.
Risk
We are using the word risk to mean the chances of something happening. For example, if something is more likely to happen to John than to Peter then John is at greater risk than Peter.
SPF
Sun Protection Factor
UVA
UVA is a form of ultraviolet radiation. It is sometimes called long wave UV or black light.
Uveal melanoma
Uveal melanoma is a melanoma that occurs either in the coloured part of the eye (the iris) or other tissues nearby. It is a rare type of cancer.
UV Index
The UV index is a measurement of how much ultraviolet radiation is reaching a particular place at a given time. UV index forecasts are sometimes given as part of weather reports.

References

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A deep intronic mutation in CDKN2A is associated with disease in a subset of melanoma pedigrees.
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Mutation testing in melanoma families: INK4A, CDK4 and INK4D.
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Pancreatic cancer and the familial atypical multiple mole melanoma (FAMMM) syndrome.
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A germline deletion of p14(ARF) but not CDKN2A in a melanoma-neural system tumour syndrome family.
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Variants of the melanocyte stimulating hormone receptor gene are associated with red hair and fair skin in humans.
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Melanocortin-1 receptor polymorphisms and risk of melanoma: is the association explained solely by pigmentation phenotype?
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24. Winsey, S.L., N.A. Haldar, H.P. Marsh, et al.,
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26. Clark, W.H., Jr., R.R. Reimer, M. Greene, et al.,
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27. Newton Bishop, J., M. Harland, R. Wachsmuth, et al.,
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28. Bishop, D.T., F. Demenais, A.M. Goldstein, et al.,
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Consortium Information References
1. Harland, M., et al.,
Mutation screening of the CDKN2A promoter in melanoma families.
Genes Chromosomes Cancer, 2000. 28(1): p. 45-57.
2. Pollock PM, et al.,
Mutation analysis of the CDKN2A promoter in Australian melanoma families.
Genes Chromosomes Cancer. 2001 32(1):p 89-94.
3. Liu, L., et al.,
Mutation of the CDKN2A5'UTR creates an aberrant initiation codon and predisposes to melanoma.
Nature Genetics, 1999. 21: p. 1-5.
4. Harland, M., et al.,
A deep intronic mutation in CDKN2A is associated with disease in a subset of melanoma pedigrees.
Hum Mol Genet, 2001. 10(23): p. 2679-86.
5. Randerson-Moor, J.A., et al.,
A germline deletion of p14(ARF) but not CDKN2A in a melanoma-neural system tumour syndrome family.
Hum Mol Genet, 2001. 10(1): p. 55-62.
6. Rizos, H., et al.,
A melanoma-associated germline mutation in exon 1beta inactivates p14ARF.
Oncogene, 2001. 20(39): p. 5543-7.
7. Gillanders, E., et al.,
Localization of a novel melanoma susceptibility locus to 1p22.
Am J Hum Genet, 2003. 73(2): p. 301-13.
8. Bishop, D.T., et al.,
Geographical variation in the penetrance of CDKN2A mutations for melanoma.
J Natl Cancer Inst, 2002. 94(12): p. 894-903.
9. Wachsmuth, R.C., et al.,
Heritability and gene-environment interactions for melanocytic nevus density examined in a U.K. adolescent twin study.
J Invest Dermatol, 2001. 117(2): p. 348-52.
10. Newton Bishop, J., et al.,
Genotype/phenotype and penetrance studies in melanoma families with germline CDKN2A mutations.
J Invest Dermatol, 2000. 114: p. 28-33.