Melanoma: 'I never realised something so small could be so serious'
Evelyn Byrne discovered she had melanoma last May during lockdown. Photographs: Moya Nolan
A midweek evening shortly after the first lockdown started, and Ballinteer-based Evelyn Byrne was still getting used to working from home.
Married to Eoin and mum to six-year-old Conor, she works for a pension investment company. In a bid to cheer herself up and distract herself from the strangeness of lockdown, she headed to her bedroom to put on some fake tan.
“I twisted around to check I’d covered my shoulder and I caught sight of something very dark – on my shoulder under where my bra strap would be. I could see this small dark circle. Eoin was in the bedroom too – I asked him ‘did I always have that?’ He thought I had, that it had been there ages, but I felt I’d never had something so dark on my shoulder – or anywhere.”
Bryne recalls feeling “a niggle” of worry, particularly as her Australia-based sister has had basal cancer, which – along with squamous cell cancer – are the two non-melanoma skin cancers. Non-melanoma is the most common skin cancer type, though the least aggressive. Melanoma skin cancer, however, is less common but more aggressive.
A few days later, Byrne caught sight of the dark circle again and decided it needed checking with the GP. “I’ve a notes app on the phone and I put it on my GP list. I was nervous about going because Covid case numbers were very high. I just wanted to wait a while,” she says, explaining she’s on medication for an auto-immune condition.
It was two months later, towards late May, when she visited her GP, who said it didn’t fit the typical profile of melanoma skin cancer – “it was round, not misshapen, 4mm, where they’re usually 6mm” – but because of its colour referred her to a specialist.
“I’m so lucky she did,” says Byrne, aged 39 at the time, adding that she felt nervous but also optimistic. She met the specialist a month later and an appointment was set to have the mole cut out. Again, she was “positively reassured” – the specialist didn’t think it looked like melanoma.
Some weeks later, three days into a family holiday in Wexford, Byrne was on the beach when she got a phone call that “devastated” her. The specialist confirmed melanoma. “I needed to drive back up to Dublin the following Friday for a Covid test and have the operation on Monday – further skin excision to check it hadn’t spread.”
Heading in for surgery alone due to Covid restrictions on that mid-July morning, she felt very lonely. “At a time like that, you want your husband there.”
Prior to surgery, her melanoma had been staged at 2A. “If I hadn’t waited two months, would it have been 1A,” she wonders. This staging also required the removal of a lymph node to check for further signs of cancer.
It was August before she got the good – and bad news. “The melanoma hadn’t permeated through other layers of skin. But they hadn’t actually got the lymph node – it was in an awkward place. I needed a second operation.”
Removal of the lymph node in September left an extensive scar. “They found nothing alarming and they were able to largely say I should be OK. I got this news in early October just before my 40th birthday. It was the best present ever,” says Bryne, who’d taken time out from her job – everybody at work had been hugely supportive.
Conor started school last September. Minding him while attending hospital was tough, especially without support of both sets of grandparents – all are in their 70s and were cocooning. “The families of his friends were fantastic, looking after him whenever I had to go to hospital. I just told Conor I’d something on my shoulder and the doctors wanted to make sure it wouldn’t make me sick.”
Pale and freckled, Byrne isn’t a sun-worshipper, though she sun-bathed once or twice in Australia with her sister. “I wouldn’t generally sit out in the sun.”
Bernie Carter, assistant director of nursing at Marie Keating Foundation and an oncology nurse, warns against deliberately trying to get a suntan.
Skin cancer’s the most common type of cancer in Ireland, with more than 13,000 cases diagnosed annually. It accounts for over one-third of all cancers diagnosed here each year. According to the most recent National Cancer Registry statistics, we now have twice the number of cases we had 10 years ago – and it’s expected to double again by 2045 from what it is now.
Carter would like to see sunbeds banned outright in Ireland as they are in Australia. “Just one sun-bed session a year increases risk of melanoma by 20% - each additional sun-bed session in that year adds an extra two per cent.”
Young people are at particular risk – the WHO says the risk of melanoma increases by 75% when sunbeds are used before age 30. “Average skin cancer risk from sunbeds can be more than double that of spending the same length of time in the Mediterranean summer sun at midday,” says Carter.
Signs of non-melanoma skin cancer include any new lesion in the skin that’s present for three weeks – or any change in a lesion you already have. These always warrant a GP check. For melanoma red flags, think A, B, C, D, E (A-symmetry, Border, Colour, Diameter, Evolving) in relation to moles or birthmarks. Watch out for changes in symmetry, border, colour and diameter. Is it evolving in any way – growing, sticking out more, oozing, itching or bleeding?
Carter says melanoma – the most aggressive type – if caught in time has a very good cure rate: 91% five-year survival. “We’re not the best in Europe but we’re getting better all the time.”
Byrne, who now has consultations with her dermatologist every three months, urges everybody to get to know their body and not to delay visiting the GP with any health concern. “Until I went to the specialist, I never realised something so small could be so serious.”
*Marie Keating Foundation ‘Talks Cancer’ podcast series is free – a safe space for people navigating cancer. It covers topics including risk reduction, diagnosis and treatment. It offers straight-talking conversations with professionals working in cancer, as well as patient stories. This season, ‘Talking Melanoma’ explores Ireland’s most dangerous skin cancer type. The eight-episode series features dermatology specialists, as well as a psycho-oncologist. It launches in May – available to stream wherever you listen to podcasts. Visit www.mariekeating.ie/podcast
- Know the UV index: check out exa.mn/UV-index. If it's under 3, you don’t need sun protection (get your Vitamin D now); 3 and above you do.
- With sun-screen, think UVB protection (factor 30 or above for adults; factor 50 for children) and UVA protection – look for ‘broad spectrum’ or UVA logo printed in circle on tube. Water-resistant doesn’t mean water-proof – reapply every two hours, more often if swimming in sea/pool or exercising. “There’s no once-a-day sunscreen other than a tent,” says oncology nurse Bernie Carter.
- Clothing – cover as much skin as possible. Choose closed woven material, especially for children. Kids’ beach clothing should have a UVA stamp. Wear a wide-brimmed hat. Skin cancer’s common on the face, backs of hands, ears, neck and top of head for bald men.
- Seek shade especially when UV index is 3+ and between 11am-3pm. Ensure child’s buggy has a shade. Wear wraparound sunglasses that provide UV protection.
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