Kathryn:       Hi everyone, this is episode five of season four and today I have Matt back with me.  How are you doing, Matt?

Matt:            Very well thank you, Kathryn.  Yeah.  Looking forward to this morning’s session.  It’s one of those cancers that is rather close to my heart, as you know, so looking forward to the chat.

Kathryn:       Absolutely.  Well today, as Matt’s just alluded to, we are going to be talking about skin cancer and how it can potentially influence insurance applications and something that I think can sometimes surprise people quite a bit is to how much it can influence things.  So this is the Practical Protection Podcast.

So getting straight into some statistics Matt, I know some of us like statistics, different things like that.  Obviously, doing quite a bit of research on this, in terms of, you know, there’s so many people that do have skin cancer or have experienced it and obviously I think sometimes people are quite surprised at the different types and what the different types can mean.  But, just for general information for people, there’s roughly 15,400 cases of skin melanoma that are diagnosed every year in the UK and it’s actually the fifth most common cancer.  One of the things that I found quite surprising actually, when I was sort of like looking more specifically for the statistics was that the amount of people that have been diagnosed with skin cancer has in a sense grown more than any other cancer in the last decade.  So it is something that is becoming – it’s kind of like, spiralling a little bit in terms of getting it.

I think it’s really quite apt at the moment, especially seeing as though obviously today in Filey there’s absolutely no sunshine, it’s awful. But it’s been really, really sunny and I’ve been taking my kids to a cricket club every day and they absolutely love it.  And obviously straight away, I have to do the suntan lotion and with my nine-year old, I’ve said to him – well I’ve said to both of them, my nine-year-old and seven-year-old, “Right, you must suntan lotion yourself midday at least.”  And they’ll come back and obviously my nine-year old, who’s a very, very good boy, obviously, he’s just like, “I have done it.”  He’s very proud of himself, “I have done it and I’ve done it like this and I did it here and when the person told me to, I did it straight away.”  And my seven-year-old just kind of pulls a face at me and sticks his tongue out.  And I’m like, “Did you do it?”  And he’s like, “Naahh.”

And it’s obviously it’s very boring for a seven-year-old to do suntan lotion, so I’ve had to do the threat of, “Well if you don’t do it and if your older brother tells me that you haven’t done it, then you don’t get to go again.”  Which feels terrible, but it does feel like – but obviously it worked, because last time he did do it.  He did do it, I think, almost around the time they were due to come home, which was slightly out of timing.  But I thought, ‘No, it’s okay, he’s done it, you know, I can’t have a go at him for that.’ And today as well, the worst thing for me, in terms of getting suntan lotion on is my Mum.  My Mum is absolutely atrocious for it.  I’ll say it to her – and she burns and I’m just like, “Have you put suntan lotion on?” and again, she just grumbles at me and growls a little bit.  I’m trying to get her to do it and every now and then, I’ll just sneak up behind her and put some on her back and force her to have it on, on like top of her shoulders and everything.  But she’s the biggest whiner, I have to say, my Mum, when it comes to the suntan lotions.

But also in terms of what’s quite apt, is there was somebody that was – it was recently – it went onto the BBC, there was a gentleman and I believe he’s an ex-footballer, I don’t know football much, so apologies if I’m going to mention someone’s name who’s like some kind of a football god and I just have no idea.  But a person called Mark Lawrenson, who used to be a former Liverpool defender.  And he was on the BBC speaking recently and a GP happened to be watching and emailed into the BBC and said, “Look, I know you don’t know who I am, but please pass on this message, I think that guy might have skin cancer, he should really get it checked out.”  And luckily, you know, the guy listened and went and got it checked out and it was in fact skin cancer so obviously absolutely amazing that, you know, things like this are happening.  But also as well, I think the story was that this guy had been kind of like, “Well – ”, I think he’s in his 60s and he’d been kind of like, “Well, it’s just a little bit of a blemish, it’s just, you know, my skin, I’m just getting a bit older, it’s just changing a little bit, it’s nothing, it’s just one of those things.”  But actually, it was a case of ‘no, we really do need to keep an eye on these things.’  It’s possibly quite easy for people to overlook it in some ways, maybe.

Matt:            Yeah, you’ve touched on a number of things there.  I mean, I would also add – and without wanting to get everybody very scared, especially those runners in the world and I can see your pupils dilating Kathryn, as I say that, with Alan obviously.

Kathryn:       Yes.

Matt:            Football players and so on and so forth.  There was another very, very famous case of a chap, who I’m sure you will know the name, although I know you’re a very young person, called Bob Marley –

Kathryn:       Yes.

Matt:            The famous Jamaican reggae star and he actually died of skin cancer and it initially presented itself as a black lesion underneath his toenail.

Kathryn:       Oh.

Matt:            Bear in mind, the chap is of colour anyway.

Kathryn:       Yeah.

Matt:            And he put it down to a football injury, you know, kicking the ball in the wrong way, which just jarred his nail and either which way, he had it checked out, rather scarily, but they didn’t treat it and eventually it spread and killed him.  At the tender age of 36.

Kathryn:       Oh wow.  My age.

Matt:            So, you know, it’s – anything that’s unusual, even though I think somebody might easily say, “Oh, it’s down to this or down to that,” it is worth getting checked out.  I know Marley did, but either which way, it’s important to get these unusual blemishes, in Mark Lawrenson’s case or changes in colour, rashes, just give them the once over.  GPs and obviously, if the GP was concerned, they would refer it to a consultant dermatologist but, you know, don’t take these things lightly at all.

Kathryn:       I think that’s really important and as well, like you say, about the fingernail thing because obviously I’ve had it before where I’ve ended up with like, you know, kind of like a bit of a blood or a bruise spot underneath the fingernail and I don’t think people – I mean, I certainly don’t think of cancer underneath the – sort of like, I wouldn’t think of that if I saw something under my fingernail.  But again, when I was doing the research, I saw something about, I think it was on This Morning with Philip Schofield, they’d mentioned, they were saying something and the presenters were shocked about the fact of actually something under your fingernail could actually be a sign of it as well, so that’s a really good one to bring up and I have to say –

Matt:            If these things clear up quickly, don’t concern yourself, but if you have bruised your foot or whatever, and it lingers, always worth five minutes with your GP.

Kathryn:       Absolutely.

Matt:            GPs are pretty experienced these days in looking at these things.

Kathryn:       Absolutely.  I was going to say as well, another sort of like helpful tip and I’m sure my beautician – I like to go for facials every now and then and she’s always saying that people, you know, even if it’s sunny in the – sorry, even if it’s cloudy in the UK, no matter what, you should have some kind of suntan lotion on when you’re going outside.  And I do think that’s something a lot of us probably don’t do which really we should do.  Okay so –

Matt:            Sorry Kathryn, on that particular note about looking after yourself and wearing suntan lotion, I would completely and utterly agree and I said earlier on in this session that this was quite personal – skin cancer to me.  And my brother was diagnosed with a malignant melanoma when he was 32.  On the side, lower side of his trunk, the main part of his body.

Kathryn:       Okay.

Matt:            And then sadly died at 38 of skin cancer which had metastasised everywhere and when he entered into hospital, he only lasted about a week.

Kathryn:       I’m so sorry, Matt.

Matt:            No of course, what one does with that is say, “Well how on earth did he get skin cancer?” and so on and so forth, but the family put it down to maybe my Mum and Dad, when they were maybe in their twenties, my Dad moved over to – well my family, the three of them, moved over to Singapore because he was with the Civil Service.  And, you know, Chris probably would have got burnt, we’re talking here in the 1950’s, early 1960’s and would have got burnt in that type of tropical sun and lo and behold, all those years later, it caught up with him. And there are statistics around to say that skin melanoma when you – if you are burnt, obviously, not every child who gets sunburnt turns out to have skin melanoma, but if you do get burnt when you’re young, when your skin and your cells are multiplying rapidly, as you get older, your cells don’t then, you know, you can see the damage much later on.

Also, just talking about that, my mother-in-law, sorry to be a bit of a harbour of doom and gloom, Bob Marley, my brother, now my mother-in-law.  Now my mother-in-law has survived, God bless her.  But she had skin cancer eventually diagnosed on the back of her calf.  If you think of the ladies in the Fifties and Sixties all wearing skirts, you know, not necessarily putting suntan lotion on their legs, that’s probably how she – and she’s of very dark skin – but had melanoma as well.  Thankfully as I said, she’s still with us.  So, you were talking about protecting suntan lotion on the young –

Kathryn:       Yeah.  Well yeah, absolutely everybody.

Matt:            That’s why I bring this in now by the way.

Kathryn:       Yeah, no of course.

Matt:            And also of course the – you mentioned it’s a recurrent issue and yeah, it’s all down to sun exposure, it’s down to sunbathing and exacerbated by those people who go on sunbeds.

Kathryn:       Absolutely.

Matt:            And the number of areas, the common areas, are around your neck, where your clothes – from your clothes to where your neck is exposed, your face, hands, backs of your legs.  And there’s the old analogy, certainly when I was growing up with the great Dr. Brackenridge of the term – excuse me if your viewers find it distasteful, but, ‘builders’ bum’ –

Kathryn:       Oh, yeah.

Matt:            Do you remember?

Kathryn:       Yeah, builders’ bum.

Matt:            The lower back was exposed and the number of melanoma cases that came out of that, specifically for builders, just around the jean line, or trouser line, was absolutely amazing.  So in effect, all the causes, well not all the causes, but the majority of causes, were right on the head and absolutely, protection is absolutely key to it all.

Kathryn:       Absolutely.  Thank you for obviously sharing Matt, I didn’t know about your brother and your mother-in-law, so thank you so much for sharing that.

Matt:            No problem at all.  I do have a particular – yeah, very interested in cancer to say the least.

Kathryn:       Yes.  I was going to say, I mean I’ve – touch wood I’ve not experienced that and I have to say sometimes, I’ve possibly been a bit naughty.  I mean, I am quite fanatical with suntan lotion, but I am also – possibly when I was younger, a little bit naughtier in some ways, because I don’t tend to burn.  Even though I do look very pale, my skin does actually tan usually extremely well.  But that in itself is in the sense of burning, it’s just not the red, angry version of burning, so it is something that I really try and take on.  And I know Alan always grumbles at me, because I’m a case of, I will say to him, “No, I just want all of us to have factor 50 on, it doesn’t matter,” I know that obviously when you’re younger and I think you used to go on holiday and you’re like, I’ll put on factor 10 and I’ll get a lovely tan, whereas now, I’m just like, “No, everyone’s going to have on factor 50, I’m not messing about, you can all have that.”

Matt:            Especially if you’re young.

Kathryn:       Exactly.  Oh yeah, the kids are covered.  Absolutely.  So I remember obviously, when we were chatting previously and preparing for this, is that it something that sort of put in my mind as well, is that when I have spoken to people before that have had skin cancer and different things is that they always – they kind of think, you know, “Well, it is something that’s going to come into the insurance kind of conversation,” but I always get the instinct, and I think it’s possibly something even in the back of my mind in some ways that my instinct is to possibly feel as if skin cancer wouldn’t be as strong a risk as say like a – more of like a cancer that’s been within the internal organs or something.

Matt:            Sure.

Kathryn:       And I think, you know, some people can be quite surprised at how much it can influence things.  Obviously I was going to ask you if you can tell me about the risks associated with skin cancer, but obviously you’ve just completely shared some incredible examples of where the risks lie.  But I suppose from an underwriting point of view –

Matt:            I’ve gone off brand, apologies –

Kathryn:       No, no, no, absolutely, that’s what my mind does as well, so I like it!  But from an underwriter’s point of view, when you’re – sort of like when you’re hearing something about skin cancer, I suppose what are the kind of things that you’re thinking of like in the future?  You know, obviously if this is somebody who’s had it treated before and obviously has come out the other side so not somebody with active skin cancer right now.  So we’ve had somebody who’s had the treatment and everything like that and they’re coming now for insurance, so what is the – what are the main kind of risks that are kind of popping into your mind?

Matt:            Okay, well thanks for that one.  Really, the first thing would be what type of skin cancer that person had or had suffered from.  So, you’re quite right in that some forms of skin cancer are relatively benign and I have to say, as soon as I use the term cancer and I use the term benign, it does seem a mismatch in words.  However, the type of skin cancer that we do see a lot of is something called a basal cell carcinoma or a BCC.  Pretty common, very common in terms of the face, from sunburn and you’ll quite often see them in older people who have gone on their English holidays every year and got skin damage.  And often these will be seen as basal cell carcinomas.  Now, the chances – and this is where an underwriter will use a judgement, is the chances of actually a basal cell carcinoma becoming malignant – and what I mean by malignant in this context is that it has the ability to spread –eat into the skin and get into the internal organs.  And with a basal cell carcinoma, it is known that these things can turn malignant but it is extremely rare.

So the BCC that has been treated, often excised, either through surgery, a scalpel, very quick, very, very quick operation if you like, local anaesthetic.  Or there is something called cryothermy, where they actually freeze the lesion away.  An underwriter – once treated and I do note your guidelines earlier, if treated then we wouldn’t be too worried about a BCC at all, particularly for life insurance.  That’s not to say that basal cell carcinomas should be ignored by the public because you do see people who have had untreated basal cell carcinomas where they’ve had to have parts of their nose removed, their ears removed and so on and so forth.  So quite disfiguring or they can be if not treated.  But from a mortality perspective, generally not a problem if treated and excised.

The second one, just to take a step back, I’m talking about knowing the actual diagnosis of the skin cancer.  The second most common is the squamous cell carcinoma, SCC as it’s often known, and these also appear in the epidermis, that’s the upper layer of the skin but unfortunately do have a tendency to become malignant and, as I said before, spread.  So a squamous cell carcinoma from an underwriting perspective simply cannot be ignored and the underwriter will need to know the classification of any spread as associated with that particular type of carcinoma.  So again, carcinoma, basal cell carcinoma, squamous cell.  Of course, the most concerning diagnosis from an underwriting perspective, and more obviously a member of the public as well, is the melanoma, malignant melanoma.  And this type of skin cancer does have a very high level of penetrating through the skin and into other organs eventually.  So malignant melanoma is certainly the worst and certainly that’s the one my brother suffered from and also the one that my mother-in-law suffered from, malignant melanoma.

So from an underwriting perspective the diagnosis is obviously very important.  If the diagnosis was in the last five years and this is my comment as a generality – but in the last five years, then the underwriter is likely to ask, certainly for the basal cell carcinoma and the squamous cell carcinoma, for a report from the GP which hopefully will have the confirmation of that diagnosis on there.  Basal cell, as I say, will be very rare that there will be any problems, squamous cell rare, but a definite level of problems and melanoma, then even at the lowest levels, you’re looking at a postponement period from the date of the – let’s say, in its lowest stages, excision, which is relatively superficial.

The other terms from an underwriting perspective is obviously the date of diagnosis/the date of the cessation; the ending of the actual treatment that was required and you’ll see this with all the cancers, which we might have discussed before, that it’s really much the date of the end of the treatment but if you have to go into things like chemotherapy, chemotherapy can last for quite a relatively long time and it’s the date when you finalise that that underwriters will start counting up the years or months, years generally, that they will take into account.  So, does that help in terms of what underwriters will look for?

Kathryn:       Yeah.

Matt:            As I say, diagnosis is the key because that sets an expectation of the level that impacts on life expectancy.

Kathryn:       Yeah, absolutely that helps.  I think the next thing I was going to ask is sort of like what are the main differences between the main types?  But I think I’d just like to in a sense, to summarise, to make sure I’ve picked it all up in the right way.  So you’d have the malignant melanomas and they’re the ones that are more likely to spread and probably seen as the more serious.  I mean obviously all cancer is serious, but that one is the one where we need to be really getting on top of that soonish, kind of situation.  You then have your non-malignant melanomas, which would be your basal cell carcinoma and your squamous cell carcinoma.  So the basal cell carcinoma is the one that’s in a sense probably going to be the one that has the last risk associated to it but again, it is cancer, so I’m not saying it isn’t risky but just saying that that’s the one that’s probably considered to be in a sense the lighter of the three that we could potentially be having.

And then you would have the squamous cell which is kind of in the middle of the two which is in a sense – if it’s not necessarily malignant at first but it does have that – possibly a slightly higher potential than the basal cell to start potentially spreading.  Are there any other types of skin cancers that we would potentially hear about?  Because I know these are kind of like the main ones.

Matt:            There are other types but those are the three most general.  I mean, the one that I would come across, not very often to be absolutely fair, is something called a Merkel cell carcinoma which, if we can just get away from the carcinoma, because I think it’s pretty confusing to be honest with you.  This is a very aggressive form of melanoma.

Kathryn:       Okay.

Matt:            So if you see that, sorry, if an underwriter sees that, then the red flags will certainly be flying.  You get all types of, I would call them interesting, very interesting in fact, benign dysplasia, dysplastic syndrome and where people are covered in moles.

Kathryn:       Yes.

Matt:            And effectively there is a chance that some of those moles can turn malignant and depending on what type of syndrome it is, it has to be said and there are a good number, a dermatologist – a member of the public should always see a dermatologist and get regular follow ups.  And certainly I’ve seen them in GP notes and so on and so forth, a dermatologist will actually take photographs of the moles, a selection of the moles and see if they’ve – compare them on a computer to see if they’ve changed.  Because there are so many, it’s sometimes quite difficult to catch.  So there are other forms certainly but the – and if somebody does have one of those forms, is contact their specialist IFA, like your good selves, who can then get to the bottom of the challenge and talk to the underwriters at the various offices.  So, those are the three main ones and over 40-odd years, it’s pretty rare to see Merkel, but you certainly do see the benign dysplastic syndromes come up now and again but they’re not common.

Kathryn:       Okay.  I think one of the things that I find quite useful, so like if I was to come across something like that and it’s a name that I’m not – it’s not the one I’m massively familiar with, I go onto Google and I put it in and if possible straight away, if there’s something to do with the NHS, you know, straight away, look at that one, that’s going to be a really good place for you to find out some of the core information that you need.  You can obviously as well – a really good place is looking at charities.  It’s sometimes quite hard sometimes to figure out which charities are maybe absolutely legitimate information that you’re getting from because obviously, as with anything with the information that you have out there, you just don’t know sort of like who’s saying the right thing.  You know, I certainly wouldn’t go necessarily by Wikipedia, even though it’s really useful, you know, I wouldn’t want to use that as the absolute – try and make sure as well, especially for people listening, probably going to be UK advisors, try and make sure that you look at a UK-based charity, just so you can make sure as to sort of like – as well understanding what the treatment might be here, so you can get really useful information.

I sometimes find incredibly useful information, especially maybe within like American charities or different things from looking stuff up, but then obviously their treatments might sometimes be a little bit different, the way that the procedures would be done or like the timeframes in which the procedures would be done potentially.  So it’s just useful anyway, if you can do that.  We’ve spoken about things like the cancer before, obviously previously we spoke about the bowel cancer and a few things and we spoke about that terminology of the staging and the grading, so a bit of a quick recap.  We’ve obviously got – stage zero is that the cancer is pretty much stayed where it is, stage one and two it’s started to spread a little bit, stage three, it’s started to go in towards the lymph nodes and stage four is that is has gone into the lymph nodes and it has metastasised elsewhere.  And I think that’s probably, like we were saying before, you know, the whole thing of skin cancer possibly underneath your fingernail or it’s a mole,  I think people probably, you know, I think lots of us would think of it as like, ‘Well that’s it, it’s a mole.’

But they wouldn’t necessarily think about what’s going on and like what’s spreading from that mole elsewhere and how that could actually end up, you know, some of those cells could go somewhere else and then you’ve got then something much, much more intense internally.  It may not be the case, but is there any particular kind of area of the body where, if you were to get skin cancer in that place, that it’s sort of like maybe more dangerous in terms of like the metastasising or anything?

Matt:            Yeah, that’s a very, very good question and the high level answer because all, you know, with any form of cancer it’s about catching it as early as possible and that’ll be well known to all our listeners.  But with skin cancer, as I say, a high level – if the lesion is on your trunk then there tends to be or can be a worse prognosis than if it was on an arm or a leg.

Kathryn:       Okay.

Matt:            And that is because the lesion and any metastasise doesn’t have far enough to travel –

Kathryn:       Yeah.

Matt:            To a major organ like a liver – for, as an example, if in my brother’s case, the lesion was probably, in terms of duration, from the area on his trunk to his liver was very, very small.  If he’d had had it on his foot, you can see that – I’m using this as an example by the way, but if it was on his foot, it’d have an awful lot longer to travel.  So trunk lesions tend to be – can be more serious than ones on the arms and the legs, if that helps at all.

Kathryn:       It does.  I think one of the things that I kind of find, because I’m very visual, and one of the things I find quite difficult is the – sort of like imagining how that cell in a sense moves.  So say like, if I imagine blood cells or something, maybe this is a good example, so if I imagine blood cells, I can imagine like graphics from when I was little of like, you know, sort of like a vein or something and there’d be a little circular blood cell kind of swimming through the vein –

Matt:            Yeah, absolutely, absolutely –

Kathryn:       Is that kind of like the same for the lymphatic system with these cells?  Are they just kind of having a little jolly along kind of like a little lymph river of some sort and then ending up in another place?

Matt:            Yes, is the very straight answer to your question.  Once they get into say the lymph system – but of course, they have to get into the lymph system in the first place and that is where you get, using the vernacular stories of cancer eating through soft tissue and that is in fact what they do need to do until they enter – they find a canal system if you like that travels round the body.  But they have to lodge somewhere of course and, you know, part of that is, dare I say it, luck of the game.

Kathryn:       I was going to say, imagine it’s a case of, like you say, you know, for your brother, it probably felt, “Ooh, the liver’s here, I’ll just,’ – not necessarily thought it  but it was just like – yeah, but it could have – in many ways, it could have just carried on, in a sense, swimming and gone up to the brain, or anything.

Matt:            Yeah.  And as you know, I mean, truly metastatic cancer, you will get people – in fact Chris had – he did get brain cancer at the end of the day, it had spread to his brain.  So you can see that, you know, cancer cells don’t necessarily stop in one part of the body, they will spread – as we know, from cancer, in all types of ways, it’ll spread to your lungs, it’ll spread to your brain, it can spread to all types of areas.  So yeah, in broad terms, what you’re saying is right, what you get though is the cells, the cancer cells, effectively attacking healthy cells and spread or eat, if you want to really use a crude term, through the body until they can find an easier way of travelling and that’s what you just outlined, ultimately.  So yeah, you know, in broad terms, that can happen.

Now with Breslow, sorry with staging it can be quite confusing because dermatologists, particularly in the cancer arena, will often use two – I don’t know if I can call them technical –, but they use two classifications, one is Breslow, I don’t know if you’ve ever come across that with any of your clients and one’s Clarks.

Kathryn:       Okay.

Matt:            Now, I’ll talk about this now because you raised the staging one, two, three, four.  Okay?  Now, it can be confusing but if anybody listening does have a client who knows their Breslow or Clarks score and people who have had skin melanoma, note, they quite often will, if they’re interested in these things, I have to say, they will know what their Breslow or Clarks score is.

Kathryn:       Yeah.

Matt:            Now, the Breslow score is actually a measurement of the physical depth or the thickness of the tumour.  And it’s always measured in, or tends to be measured in, I should say, most of the time in millimetres.

Kathryn:       Okay.

Matt:            Okay?  Where the Clarks level is pretty simple in a way, it really just measures how many layers of skin the tumour has penetrated, noting that the tumour will sit on top of the epidermis and eat its way, sorry, eat, I use that term again.

Kathryn:       I know.  It’s a good way to visualise it though, because –

Matt:            It is, you’re absolutely right, it will penetrate down.  So what effectively you can get, when you can’t use – I’ll use Breslow’s, because I can see it’s the most common in my experience – people may disagree with that, you can get a Breslow’s, which is a level four under the Breslow’s, but is in fact, it can be a stage one in the category that you use of one, two, three, four.

Kathryn:       Okay.

Matt:            So a level is certainly – can’t, shouldn’t be mistaken to a stage that you spoke about five minutes ago, okay?  So a level four can be a stage one and ultimately, a stage one, two, three, four will be the guide to the underwriting, the medical prognosis, the underwriting prognosis.  But nevertheless, why oncologists, dermatologists have devised Breslow schemes, is that it can give them an insight into how to treat, clinically, the patient.  Okay?  Overall prognosis will generally – certainly in underwriting terms, because they are broad categories for underwriting, they will use one, two, three, four but you can convert a Breslow into a stage.  Have I – does that make any sense?

Kathryn:       No, it does, it’s interesting.

Matt:            I’ve just explained it because people might go away from here, thinking, “Oh my God, I’ve got a level four, it’s the end of the world.”  That’s not the truth, it’s a stage and if they’re worried about that at all, talk to their GP.

Kathryn:       Absolutely and I think that’s really useful as well for advisors because again, you know, obviously as an advisor, you tend to hear sort of like stage one, you know, we’re potentially going through options, obviously the higher you go up in the staging, the fewer options there’ll be for insurance.  So if somebody just hears level four, they may automatically think, “Oh, stage four,” and then think, “This is going to be very, very difficult to get insurance for.”  Which probably couldn’t be further from the truth, in many ways.  So that’s really helpful, thank you.

So, when it comes to skin cancer, what would be kind of like the usual treatments that you would expect?  And I do appreciate obviously, we’ve talked about lots of different types here.  But what are the kinds of treatment levels, where you think like an underwriter is going to sit up a bit more and go, “Hello there, that’s something that probably indicates this cancer is a bit of a strong one.”

Matt:            Yeah, no absolutely.  You did mention, or we have mentioned and talked about and you just said that different types of cancer, the chances of them becoming malignant are different for different types of skin lesion.  Certainly from – to answer your question directly, radiotherapy and chemotherapy are the bigger ones that an underwriter would look for.  That’s not say that radiotherapy is not used in some of the – if I can use the term non-malignant carcinomas that we’ve spoken about before.  But radiotherapy – I mean, excision is nearly always going to happen, in one way or another, whether that’s surgical or whether it’s through freezing or creams, anti-cancer creams or goodness knows what else.  Okay?  That, without even a BCC, a benign – sorry, a basal cell carcinoma, an underwriter would look for it to have been treated successfully –

Kathryn:       Yeah.

Matt:            Okay?  Even though there’s a very, very small chance of it becoming malignant, in broad terms.  But certainly radiotherapy would perk the ears, if I can use that term and the mention of chemotherapy certainly would be a concern.  Generally, we’ll go back to staging, because I know it’s very confusing levels, but in terms of the staging, as you know, from your own, not personal experience but experience working in the industry, chemo normally comes in at three and four.

Kathryn:       Yeah.

Matt:            Other treatments would ensue.  Two certainly – not every cancer but will often come with radiotherapy.  So as soon as you get to chemotherapy, you can broadly equate to – you’re looking at stage three or stage four.

Kathryn:       Yeah.  So generally, there’s going to have been a stronger cancer.

Matt:            There is more chance that the tumour itself would have eaten through the – wherever it’s placed and gone into the lymph system and the chemotherapy is required to obviously go across all of the body to find those cancer cells that have escaped from the original tumour.

Kathryn:       Absolutely.  One thing that’s just very interesting for me to pick up there as well, so sometimes we’ve had a – and obviously this is jumping a little bit but – so we’ve had people with heart conditions where they’ve maybe had like an ICD fitted.  And what we’ve actually found is that the person’s had it done on the private medical insurance and sometimes you’ll find that people – so maybe some things or maybe immediately – initially seem quite like, you know, that thing where an underwriter would think, “Well hang on a minute, if this has been done, then that probably means that this was like – the symptoms and everything were a bit stronger than expected because –” but in actually fact what it is, is because the person had private medical treatments, they were actually given possibly a stronger – like having the surgery more almost as like a preventative in some ways.  Whereas they wouldn’t have got that on the NHS, because you actually need to – I don’t know if I’m making sense with that, so sometimes with private treatment, you’ll get a treatment whereas you wouldn’t get it on the NHS, because you need to be more ill on the NHS, to be able to get the treatment.

And I was just wondering if that would potentially be the same with the cancers, you know, could it be, I know you were saying about chemotherapy typically stage three or four, but could it be if someone has private medical treatment that they would actually – may be potentially given chemotherapy at stage two, or something?  Do you think that would happen?

Matt:            I think with the way that medical – I would probably – two things here, I would say that the way that people’s understanding, what I mean by people here is the specialists, the oncologists, etcetera, etcetera, the way that their understanding of developments of some cancer is gaining pace so, so fast, that I don’t believe that the standard treatment for cancers today is anywhere near as it was 15 years ago.

Kathryn:       Yeah.

Matt:            Okay, so I think to answer your question directly, never say never.

Kathryn:       Okay.  No, I thought that might be the case but I just thought if there was any that stood out.

Matt:            I mean, it’s a good point, because I think you can draw the analogy across a lot of medical conditions.  A lot of medical conditions.  And it’s where the underwriter needs to keep up to speed with modern treatment.  Also, you know, talk to the clients and better understand, “Well, I didn’t really have any symptoms, but my doctor said it was worth –”

Kathryn:       Yes.

Matt:            And rather than just take it as read, well they’re underestimating their condition, look into it a little bit more.  Ask some more questions.  Don’t take it as read.  And I think as an advisor, there are some insurers out there who will look into it a little bit more and some insurers who won’t bother.

Kathryn:       Absolutely.  Okay.  So we’re coming towards the end of the podcast, so I’ve got a case study for us all to listen to, if that’s okay.  So this is somebody that we arranged the policy for, it started about a month ago.  So sort of like just at the beginning of summer in 2021.  With this person, they were in their early forties, they were a non-smoker and they had what is known as atypical mole syndrome, so probably something that you’ve touched upon a little bit earlier there, Matt.

Matt:            Yeah.

Kathryn:       So, atypical mole syndrome.  So it was somebody who obviously had developed moles.  And they’d had – two of the moles had been identified as early stage skin cancer, so the malignant melanomas.  The last one had been about three years ago and there were other moles, but they were all non-cancerous.  So, the treatment had been – sort of like just a need for surgical removal, so the excisions.  There’d been no need for the chemotherapy or radiotherapy.  And what was interesting with this and it’s kind of like one of those things we’re saying for advisors, you know, make sure that you do really shop around, is that we’ve got such a mix of decisions and indications from this.  So this was all starting, you know, as I say it was starting beginning of the probably, you know, a couple of months before we started obviously doing all the research and everything.

Then at the time, we had a number of different decisions because it was still kind of where there was a lot of Covid restrictions on insurers.  So we were getting, you know, they were getting some saying, “Well, we could maybe do this, but the rating is just a bit higher than what we’re able to do at the moment,” which, you know, was happening with quite a lot of people at the time.  But regardless of that and also just saying to them, “Right, well when you can actually do it, what’s going to be available?”  We were getting a mix.  So we were seeing some per mille ratings, which is something that I think I’ve discussed before and if anybody hasn’t, if you listen to the life insurance masterclass with Alan Knowles that was done in an earlier season, he goes into that and explains it in far more detail than I can.

And then we also had – we did have somebody that would indicate it 100%.  So I always think it’s really strange sometimes, how you can go from some insurers say decline, some say per milles and then another person says 100% premium increase.  But then ultimately that person did decline when they were seeing the medical information.  But obviously, we’re still continuing on and still chatting with other people as well.  I mean, we did end up actually getting them the insurance with a 50% increase on the premiums.  So, you know, we’ve gone from per milles, to a 100%, to a 50%. And the 50% was the one that actually went ahead.  So around about £450,000 of decreasing life in cover, over 29 years, was just under £40 per month for this person, which I think was a really good outcome considering what a lot of insurers were suggesting.

But something that really stood out for us with this, was the fact that obviously there was – for the critical illness cover, it was declined everywhere.  And it comes back to that thing of me and sort of like my mindset, sort of like saying in a sense, “Why?”  You know, why, if somebody’s had this and obviously they – I mean, obviously this is possibly where you could teach me something, Matt, you know, very much so.  You know, could we not give somebody in that situation critical illness cover, but maybe with a cancer exclusion?  And I know cancer’s a massive exclusion but it doesn’t stop this person having the risk of a heart attack or a stroke or developing Parkinson’s, you know, so many other things that are covered by these policies.  I think it would be interesting to know in a sense and I know obviously you can’t speak for every insurer or every underwriting development team and philosophy sort of like set up and maker, but is there any sort of like particular glaring reason why we couldn’t do that?

Matt:            Well I have to say my view is that I don’t see why a cancer exclusion could not be made available.  I can’t ultimately give you even a technical view.  As you know, underwriting is a mixture of technical, medical and all types of risk and also commercial factors as well.  There are commercial things around and that potentially I think would explain why you got declines and plus fifties.  But in terms of the actual exclusion, then particularly as there’s been no radiotherapy which of course can cause tumours in its own right, particularly if it was done a while ago when they weren’t quite as rigorous with their radiotherapy as they are today, then chemotherapy as well potentially – but without those two, then I can’t really see the reason why they shouldn’t or somebody should not provide an exclusion.  Unless they’re saying that there is a potential risk in the future for radiotherapy and chemotherapy and that therefore, you know, they can’t provide cover.  But I think I’m going round in circles a little bit and almost talking aloud.  But I would have said I can’t see why not.  Did the team dig a little bit further into why cancer couldn’t be given?

Kathryn:       Umm, no, no I’m not sure.  It’s one of those things of, you know, you do ask but, you know, then sometimes you do get just a hard and fast no.  We can do specialist critical illness cover, which is fine and, you know, we can potentially do that but, you know, it’s just that kind of thing that sometimes pops in my head sometimes.  And I do – there is obviously that other argument as well, of sort of is it actually fair to put an exclusion on a policy?  But a big thing that I always go back to is that for me the only fair option is to give choice.  So to give people the choice to say, “Well, you can’t have it, but if you do want it, you can have it with an exclusion.”  You know, is it better for them to walk away with a cancer exclusion on a policy than to walk away with no critical illness cover at all?  But I think that’s the – I do appreciate the comment, obviously the fact that they may need chemotherapy, radiotherapy in the future.  The only thing that – again a potential counter-argument to it would be that, you know, this person is obviously very aware that they have this condition.  If they develop a mole or a mole changes, they’re immediately to their GP and possibly are far, far less risk than a lot of people who may just ignore something like that because they are so heightened to watching for skin changes.

So it’s an interesting one.  I’m sure there’s plenty of potentially underwriters or different – like you said, technical people out there who are a mix of possibly thinking, “Hmm well maybe she has a point,” or maybe, “No, not having that,” kind of thing.  I think there’s a –

Matt:            It’s one of those cases where I would like to know the – I would love to better understand the thinking.  And that’s exactly why you raised the question, of course.

Kathryn:       Yeah.

Matt:            It does seem – on the face of it, it seems harsh.  On the face of it, it sounds as though it needs a better discussion.

Kathryn:       Absolutely.  Well hopefully we’ll get there.  It’ll be an extra thing to add to my Access to Insurance queries.  So, just to sort of like round up the podcast then.  So, when I was doing this research, I was looking quite a bit at the British Skin Foundation.  And what they do is they do provide details on their website of an app called ‘Miiskin’.  So that’s Mike, indigo, indigo, skin, all one word.  And you can download that and it can give you guidance on what to do in terms of taking pictures of any changes to your skin, how to record it and show sort of like – it’ll prompt you to also sort of like do a let’s check that area of the skin again type of thing, on a picture.  I downloaded it last night.  At the moment there wasn’t a charge for it at all, so I do think it’s probably a good thing for people to have, if they are prepared to have that.  You can also as well order lots of skin cancer booklets through them.  Again, I went on and sort of like ordered some for the team last night.  There was no charge or anything, but again, you just never know when that could – might just be something that triggers in somebody’s mind, “I need to do this.”  And as we’ve said, skin cancer isn’t just about having a mole on the skin, it is potentially life threatening.

So, as always, thank you so much for your insights, Matt.  Thank you for joining me.

Matt:            Absolute pleasure, absolute pleasure.  Thank you for inviting me.  Particularly on a subject like skin cancer.  Thank you.

Kathryn:       Absolutely, absolutely.  Well, we’re going to be back in a couple of weeks with Roy McLaughlin and just so it’s in mind for everybody, if you want to have a reminder for the next episode, just drop us a message on social media or you can contact us on the website, practical-protection.co.uk and don’t forget to claim your CPD certificate on the website that is available thanks to our sponsors Octo Members.  So thank you again Matt and I’ll speak to you soon.

Matt:            My pleasure.  Thank you.  Bye.

Kathryn:       Bye.