Vitamin D deficiency is associated with a worse prognosis in metastatic melanoma
Genome-wide association study of circulating vitamin D levels. Role of key- regulator genes in melanoma susceptibility and. Does the association of low vitamin D levels and poor outcomes in melanoma patients point to supplementation as a potential intervention for. Previous research has demonstrated an association between vitamin D deficiency and advanced melanoma stage, but investigations of vitamin.
We know that we make most of our vitamin D when our skin is exposed to the sun. Once a patient has been diagnosed with a cutaneous melanoma, medical teams usually advise them to reduce their sun exposure. Significantly reducing your amount of sun exposure will however reduce your Vitamin D level.
Sun protection and Vitamin D after melanoma
How do we get Vitamin D? Vitamin D is a fat soluble steroid hormone and surprisingly few foods naturally contain it Table 1. Oily fish is our main food source of Vitamin D, however dermal skin synthesis following sun exposure is our predominant source of the vitamin. Exposure to the ultraviolet UV rays in sunlight range nm, UVB spectrum enables the skin to synthesise vitamin D3 from the pro-vitamin 7-dehydrocholesterol, mostly present in the epidermis top layer of the skin.
Vitamin D3 then undergoes successive hydroxylation in the liver and kidneys to yield its active metabolites: This system is exceedingly efficient, and relatively brief exposure of the arms and face approximates to the ingestion of international units 5 micrograms of vitamin D3 per day.
Why do we need Vitamin D? Vitamin D and its metabolites play a pivotal role in bone health.
Is vitamin D important for melanoma patients?
However, subclinical vitamin D deficiency is common even in developed countries and can be associated with osteoporosis, increased fall risk, and fractures.
Vitamin D has also been recognised to have a role in auto-immune diseases, cardiovascular disease and susceptibility to infections. It has also been shown to play a protective role against certain cancers via anti-proliferative effects on cell growth and apoptosis cell death.
One UK study has revealed that melanoma patients in the north of England often had a low serum hydroxyvitamin D3 active vitamin D level at the time of their melanoma diagnosis.
Skin types I and II tend to have lower levels of vitamin D than those with skin which is less prone to sunburn, probably because they tend to cover up in the sun. A UK cohort study reported that patients with low levels of vitamin D at diagnosis had both thicker melanoma tumours and a poorer outcome even in data adjusted for thickness. Nor is it clear if post-diagnosis supplementation is beneficial in terms of survival expectation. There are even some theoretical concerns that high levels of vitamin D might be harmful.
Vitamin D supplementation has been shown to increase the Vitamin D3 levels in melanoma patients but compliance taking vitamin supplementation can be variable even in clinical trials. Uncertainty surrounding the advice necessary to reduce melanoma risk by avoidance of sunburn and yet still synthesise sufficient vitamin D was reflected in the draft NICE Sunlight exposure guideline February The only consistent message is that the risks can be reduced if people never expose their skin long enough for it to redden or burn.
Even though we have not proved that vitamin D has any effect on melanoma, because vitamin D is necessary for many other aspects of your health, we would say that having enough vitamin D is important. If you were to significantly reduce the amount of sun exposure you get now, then this may reduce your chance of another melanoma but could damage your health by reducing your vitamin D levels.
So what is our advice to you? The best advice we can give you is to avoid too much sun exposure whilst avoiding vitamin D insufficiency and below we explain how.
Most importantly, avoid sunburn Secondly, when the UV index is at or above three: Avoid staying out in the sun for long periods. Avoid exposing unprotected skin to the sun between 10am and 2pm in particular. Use appropriate clothing to protect your skin where possible. The UV index will vary depending on where you are in the world, the season and the time of day. For example, in Australia people may need to practice 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. However in the UK, in practice ,most people do not have sufficient sun exposure to make enough vitamin D much of the year round.
Thirdly, avoid becoming deficient in vitamin D Whilst avoiding low levels of vitamin D is important, some scientists have concerns that melanoma patients should also avoid high levels of vitamin D in the blood. Research is underway to find the right dose. In the meantime the NICE Clinical Melanoma Guideline suggested that newly diagnosed melanoma patients should have their blood levels tested and should take supplements as advised by their medical teams if their levels are judged to be low http: