Moles and Skin Tags: Testing for Cancer
(2 years ago)
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Bob Seely (Isle of Wight) (Con)
I am delighted to initiate this debate on melanoma in memory of my constituent Zoe Panayi, after whom “Zoe’s law” is named.
Zoe died of skin cancer in May 2020 at the age of just 26, after having an unusual mole removed at a private beauty clinic. She had trained to become a carer before finding a rewarding role as an assistant to the radiography and CT department at St Mary’s Hospital in Newport, in my constituency. She was the mother of two boys, Theo-Jay and Tobias.
On the night of 3 April 2020, Zoe went home from work feeling poorly. By 11.30 pm she had been admitted back to St Mary’s hospital, where she worked, and it was then discovered that she was in the late stages of cancer. Biopsy results four days later found that the melanoma, which had started in a mole on her back, had spread to her lymph nodes, liver, bone marrow, pelvis, and spleen. Very sadly, after the biopsy Zoe survived for just 55 days.
Over the course of the two years prior to her death, Zoe had raised numerous concerns with GPs about the unusual mole on her back. She had been told on multiple occasions that there was nothing to be concerned about, and after being advised to see a beauty clinic to have the mole removed, staff again raised no concerns about the removal of the mole. Tragically, it was later found that the act of removing the mole probably caused the cancer to grow and spread more rapidly. Zoe’s family, and especially her mum, Eileen Punter, to whom I pay tribute in this debate, have campaigned tirelessly since then to raise awareness of melanoma cancer and to ensure that others do not have to go through the same pain. I will make two suggestions to the Minister in the course of this speech.
By way of background, malignant melanoma is the fifth most commonly diagnosed cancer in the UK, and there are thought to be some 111,000 people living with malignant melanomas in this country. Approximately 16,700 cases are diagnosed every year, and about 2,300 people die every year from this cancer. This should not be the case, because the good news is that since the 1970s, the five-year survival rate for cancers of this type has increased from 52% to about 90%—nine out of 10— especially if they are caught early.
Chris Bryant (Rhondda) (Lab)
I congratulate the hon. Gentleman on raising this subject. As he knows, I had a stage 3 melanoma and I was told that I would have a 40% chance of living a year, but the science has moved on dramatically in the nearly four years since then. My biggest anxiety is that we do not have enough histopathologists and pathologists, and that people are getting their results slowly. There are also not enough dermatologists in the country, and lots of GPs are simply not trained in recognising potentially malignant melanomas fast enough. Do we not need to do far more to ensure that this cancer is fully understood, because it can kill, and to ensure that we have enough staff in the NHS to be able to treat it?
Bob Seely
I thank the hon. Gentleman for his intervention. I am going to follow up on several of those points, but I am delighted to see that he is one of the many people who have survived a malignant melanoma.
If Zoe’s mole had been diagnosed early—especially at stage 1 or 2, and possibly even at stage 3—she may have well survived. Just before I come to some of those suggestions, I must point out that these melanomas are a specific concern on the Isle of Wight, because we have one of the highest rates of skin cancer.
Jim Shannon (Strangford) (DUP)
I commend the hon. Gentleman for his assiduous attention to his constituents and to the family who have been bereaved. By his words today, we all recognise that he is deeply concerned and compassionate, and we thank him for that.
May I gently tell the hon. Gentleman—perhaps the Minister might take note of this as well—that in Northern Ireland a new mole mapping and melanoma service has been introduced in my local South Eastern Health and Social Care Trust? It is a nurse-led, two-year pilot project that offers an advanced mole mapping technique for specific patients identified by the clinical team as being at higher risk of developing melanoma skin cancer. I suggest that that should be a standard for everyone not just in my trust area but everywhere else, so that we do not have a postcode lottery. Would the hon. Gentleman be interested in that pilot scheme? If so, maybe the Minister will take note.
Bob Seely
I thank the hon. Gentleman for yet another excellent intervention, and I completely agree. In fact, I will come to those points now.
The Isle of Wight is a specific hotspot for skin cancer. I think it has the worst skin cancer rates in the United Kingdom, primarily as a result of certain factors. First, we still have a very white population, and the paler your skin, the more likely you are to develop melanomas. Secondly, we have an ageing population, and melanomas are cumulative. Thirdly, we have a very outdoors lifestyle on the Island, with golf, sailing, a lot of community activity and a lot of gardening. For the Isle of Wight’s retirement community especially, to be out in the sun aged 60 or 70 doing activities such as sailing, which is very harsh on the skin because of the interaction of sun and water, encourages melanomas. Fortunately, we have one of the best dermatology centres in Britain at Newport’s Lighthouse clinic, and I thank its doctors and staff for doing an excellent job. I have been there myself in the past couple of years, and I know what a great job they do.
In the NHS long-term plan, the Government committed that the proportion of cancers diagnosed at stages 1 or 2 will rise from about half to three quarters of all cancer patients, meaning that some 55,000 more people a year should survive cancer for at least five years after diagnosis.
Pilot schemes in various parts of the country are trying to improve the diagnosis of skin cancers and melanomas. One option to improve this still further is what, on the Island, we call Zoe’s law, but it would effectively be a change of practice within the NHS. Eileen, Zoe’s mum, and her family are doing it in memory of Zoe, and it would require all moles and skin tags removed from the body to be tested for melanoma. I am not expecting an off-the-cuff answer from the Minister on this point, but I would very much like her to write to me so that I can pass on her comments to Eileen and the rest of Zoe’s family. If that cannot be done now, I would like to know why not.
I would also like to know what more could be done in future, because thousands of people are needlessly dying every year. Skin cancers kill more slowly than many other cancers and are certainly more treatable than cancers such as lung cancer and pancreatic cancer. Eileen said Zoe thought of everyone before herself. When Zoe was dying, she said, “The most important thing is that other people do not have to go through this”—she left two young kids.
The idea of testing all removed moles and skin tags is potentially very popular, and a petition started by the family has now reached some 35,000 signatures. Tanya Bleiker, the previous president of the British Association of Dermatologists, recommended that all skin lesions, even if removed for cosmetic reasons, as Zoe’s was, should be sent for histopathological testing to confirm that they are benign—the hon. Member for Rhondda (Chris Bryant) also made that recommendation—because they might be deep rooted in the skin. Mr Ashton, one of our consultant dermatologists on the Isle of Wight, explained to me on Friday that innocent-looking moles can sometimes be the most deadly. They might look benign on the surface, but underneath they are malignant and hide melanoma.
I urge the Government to set out further plans on raising awareness of moles, as this is relatively easy to do. If I understand correctly, including this in nurse training and general practitioner training, especially in sunnier parts of the country along the south coast—places like Cornwall, Devon, the Isle of Wight and Hampshire—could be exceptionally valuable.
Chris Bryant
No one can see the back of their own head, but their hairdresser can, and quite often they are the person who can spot a melanoma.
Bob Seely
The hon. Gentleman reminds me of what Mr Ashton was telling me on Friday, because it is not only hairdressers but dentists. Dentists spend a lot of time looking at people’s faces, so they could potentially help to spot these things, too. Eileen, Zoe’s mum, spends a lot of her time trying to get this education process going, as she does not want other families to suffer as her family have.
At stage 1, a small and localised melanoma has a 97% five-year survival rate, which is extraordinarily high. By contrast, the five-year survival rate for a stage 2 melanoma is 76%, and it is 58% for a stage 3 melanoma, as the hon. Member for Rhondda had. By the time a cancer has spread from the skin to the lymph nodes, the bone marrow and other parts of the body, the five-year survival rate is only 15%. Sadly, Zoe was one of those who did not survive, because despite her worry, her visits to the GP and the fact that she had it removed, that cancer had been spreading all the time in her body.
I respectfully ask the Minister to write to me on the potential for 100% testing of moles for melanoma, cancer and whether they require further treatment. If there were such testing, some of the 2,341 people who died of the disease last year might have survived, including my constituent Zoe.
I pay tribute again to Zoe’s family, especially her mum for all the great work that she is doing. I ask the Minister to respond not only on the issue of testing for melanomas but on broader education for GPs, hairdressers, dentists and nurses, so that they are better able to spot cancerous moles before they spread.
The Minister of State, Department of Health and Social Care (Helen Whately)
I commend my hon. Friend the Member for Isle of Wight (Bob Seely) for securing this debate, and on telling us Zoe’s story so powerfully. It is a truly heartbreaking story of a young mum of just 26 with so much life ahead of her. It was harder still to hear because Zoe did the right thing and asked her GP about her mole, yet her skin cancer was not diagnosed until so late that she died just 55 days later. I pay tribute to Zoe’s family, including her mum, Eileen, who have campaigned to stop other people going through what they have gone through, and to Zoe herself. When I looked earlier this evening, more than 34,000 people had signed the petition.
Like Zoe’s family, as cancer Minister I want to stop people going through what they have been through. I want us to get better at preventing, diagnosing and treating cancer. Although we cannot remove the risk of skin cancer in its entirety, we can raise awareness of the things that increase the risk and help people take steps to protect themselves. Most skin cancers are caused by exposure to the sun. Getting sunburnt increases the risk—especially getting sunburnt as a child—as does using sunbeds. Those who have fair skin are at greater risk. As my hon. Friend told us, the lovely sunshine of the island he represents has its downsides, as does the healthy outdoor life that he describes.
As well as raising awareness of risks, we need to raise awareness of early signs and symptoms, and then what to do. We in Government are doing that. For instance, the NHS “Help Us, Help You” campaign has used TV advertising, social media and regional press to get the message out to people to get worrying signs checked out. We know that some people delay getting a check. That campaign has particularly sought to overcome those fears. If you are worried, it is always better to get checked out. Most people will get the all-clear, but the sooner you get a check, the better, because an early diagnosis improves the chances of successful treatment.
I know that Zoe did the right thing and asked her GP, which brings me to the importance of accurate diagnosis. For Zoe’s specific case there has been a full investigation locally, and I know the findings have been acted on. Specifically, teledermatology is now offered by all GPs on the Isle of Wight, and is increasingly available across the NHS. It involves a specialist medical photographer taking a detailed photograph of a skin lesion to check it for signs of cancer. That is a step on the path to more tests to confirm whether someone has cancer or is given the all-clear that no further tests are needed.
On the role of teledermatology, almost £1.5 million of our elective recovery funding has been allocated to seven cancer alliances to pilot self-referral for cancer symptoms, including skin cancer symptoms. I heard my hon. Friend’s argument for Zoe’s law to require all moles or skin tags removed to be tested for melanoma. I also heard him saying that he was not expecting an answer here and now, which I appreciate. I can assure him that I will take his argument away, look into it and then write to him with a full response on his proposal. I will also take away the suggestion from him and from other hon. Members about looking at the broader education of other people who might be able to spot something that might be an early sign of skin cancer. I recognise that people may not be able to see their back or the back of their head, for instance. Indeed, there may be opportunities to look at wider education. For sure, raising awareness overall of skin cancers and of what a person should do if they have a sign or a symptom will indeed mean that more people will know what to look out for.
Jim Shannon
I commend the Minister for her very positive answer and for what she said in relation to the nine centres across the United Kingdom, which is where the hotspots are. In an intervention on the hon. Member for Isle of Wight (Bob Seely), I referred to a pilot scheme in my trust area, the South Eastern Health And Social Care Trust, which seems to be having some good results. I always believe that the exchange of ideas is good for us all. It helps us to see what is being done here and it might help the Minister to know what we are doing back home.
Helen Whately
I thank the hon. Member for his intervention. I will look into the scheme in his area that he mentioned. One of the good things about the NHS is that all sorts of fantastic things are going on in pockets across the United Kingdom. One of the best things that we can do is find out what is working somewhere, and then spread that best practice more widely, so, indeed, I will look into what he suggests.
We are now seeing the most incredible advances in how we diagnose cancer as well as how we treat it. An example of this is the NHS-Galleri trial, which looks for blood markers to identify cancer risk. It can identify signs of more than 50 cancers and the trial has 140,000 participants. We should in no way limit our sights as to what can be achieved in the here and now. The crucial thing here and now is early diagnosis, which much improves the prospects for successful treatment. Zoe’s family wants those who do have cancer to get an early diagnosis so that they have the chance to survive and live their lives as, sadly, Zoe did not. That is something that I want, too. I want fewer people to get cancer, those who do have cancer to be diagnosed earlier, and, in turn, to be treated successfully so that they can live their lives to the full.
Question put and agreed to.