Dermatology - Vitamin D and Sun Protection

This leaflet provides advice on the importance of a good level of vitamin D supplementation after a melanoma diagnosis.

Why do we need vitamin D?

Vitamin D is essential for bone, tooth and muscle health. It also has a role in reducing inflammation and supports immune function.
The sources of vitamin D are diet and sunlight exposure, with sunlight being a major source in most people. However, the ultraviolet radiation in sunlight is the main cause of both melanoma and non-melanoma skin cancer.

Why is vitamin D important after melanoma diagnosis?

As part of their melanoma guidance in 2015, NICE recommends that all patients who have a melanoma diagnosis should have their vitamin D levels checked. This is because if vitamin D levels are low at diagnosis, then it is likely that they will decrease further post diagnosis, as patients are often advised to cut down their sun exposure.

There is also a small amount of evidence that suggests vitamin D may be important for your health after a diagnosis of melanoma and improve survival after diagnosis.

What is the right level of vitamin D and how is it measured?

The dermatology team would usually do a blood test that measures your serum 25-hydroxyvitamin D3 level. The laboratory will compare this to normal range data to find out whether you have low levels or not. If you did not have your Vitamin D level checked at diagnosis, we can do this at your next follow up appointment.
 
The measurements below are Salford laboratory measurements and may vary between hospitals:

●    Low levels of vitamin D are considered to be below 50 nmol/L
●    Normal levels of vitamin D range between 50 and 125 nmol/L
●    High levels of vitamin D are considered to be above 125 nmol/L

High levels are more difficult to define, as levels after a sunny holiday would fall into the higher category. Similarly, if you are taking vitamin D supplementation already, your levels may be on the higher side.

What is the advice if my blood vitamin D levels are low?

If your levels are low, the Consultant Dermatologist or Skin Cancer Specialist Nurse will advise you on what to do.

We will advise patients with low levels to buy vitamin D supplements over the counter or ask the GP to prescribe vitamin D in some circumstances.

The dosage that we usually advise is 400 international units (IU) equivalent to 10 micrograms per day. Some patients with very low levels may be advised to take 800 IU equivalent to 20 micrograms.

Some food sources include vitamin D i.e. oily fish and cod liver oil, egg yolks, liver and fortified drinks and foods.

What is the advice if my blood vitamin D levels are normal?

Those with vitamin D levels that are within range, do not necessarily need to take vitamin D. However, if the levels have been checked after a sunny holiday, then you may be advised to have the level re-checked after 6 months. As per NICE and NHS guidelines, from October to early March, it is recommended that everyone (including pregnant and breastfeeding women) in the UK takes a daily vitamin D supplement.

What is the advice if my blood vitamin D levels are high?

After a sunny holiday, a high vitamin D level may be normal and the levels will slowly come down. If you have high levels and have not been on holiday or taking vitamin D capsules, you can discuss the next steps with your healthcare team.

Why is sun protection advised?

People who are diagnosed with a melanoma are advised to reduce their sun exposure. When the skin is exposed to sunlight/UV rays, skin damage can occur.

Damage caused by repeated exposure to sunlight in younger years, in particular, can lead to skin cancer developing later in life. However, melanoma skin cancer can also occur in younger adults.

The reasons for sun protection are:

●    Concerns sunburn might affect the body’s natural defences against melanoma by stopping the immune system working as well as it should
●    Sun protection can reduce the risk of developing another melanoma as patients with a history of melanoma have an increased risk of developing further melanoma

The following links are references:
https://www.nice.org.uk/guidance/ng14/chapter/1- recommendations#managing-suboptimal-vitamin-d-levels-2
 
If you have any queries or would like any more information, you can contact the Skin Cancer Nurse Specialists below.

For Stockport/High Peak patients please contact the Skin Cancer Specialist Nurse based at Altrincham Health & Wellbeing Centre and Kingsgate House:
Sister Kelsey Simpson
Work mobile: 07395799983
Altrincham HWB office: 0161 206 6847
Kingsgate House office: 0161 204 4765 Email: kelsey.simpson@nca.nhs.uk

For Salford patients please contact the Skin Cancer Specialist Nurse based at Salford Royal Hospital:
Office: 0161 206 0897. However, please temporarily contact Kelsey or Melanie on the numbers listed.

For Bury/Radcliffe patients please contact the Skin Cancer Specialist Nurse based at Radcliffe Primary Care Centre:
Sister Melanie Casey Office: 0161 724 2160
Email: melanie.casey@nca.nhs.uk