Professor Nicola Ralph on Newstalk: Skin Cancer in Ireland and How to Protect Your Skin

Professor Nicola Ralph, Consultant Dermatologist and Co-Founder of the Institute of Dermatologists, joined Pat Kenny on Newstalk to answer listener questions on skin cancer, melanoma, and sun protection. Ireland ranks ninth in the world for skin cancer rates, yet many people remain unaware of their risk. Here is what Professor Ralph wants you to know.

Why Is Ireland at Such High Risk of Skin Cancer?

Our fair-skinned population is the primary reason. People with Type 1 and Type 2 skin, characterised by red or light hair, pale skin, blue or green eyes, and a tendency to freckle and burn rather than tan, are at the highest risk of developing skin cancer over their lifetime.

While those with sallow or darker skin tones found in sunnier climates do have some additional natural protection, no one is immune. The key difference is that when your skin tans, it is a sign of damage, not health.

When Does the Damage Actually Happen?

The answer may surprise you. The majority of sun damage that contributes to skin cancer occurs in childhood and adolescence, up to around the age of 20. Young skin is more susceptible to DNA damage from UV radiation.

Professor Ralph highlights that modern sun protection has come a long way. For children, UV-protective swimwear and rash vests offer excellent coverage without the struggle of applying layers of sunscreen on an active child.

What Are the Types of Skin Cancer?

It is important to understand the distinction between melanoma and non-melanoma skin cancers, as both require different approaches.

Non-Melanoma Skin Cancer

Non-melanoma skin cancers are actually more common, with Ireland seeing between 11,000 and 12,000 cases per year. These typically present as a pink spot or scaly patch that simply does not heal. If you have something persisting for more than four to six weeks that is pink, scaly, or not going away, Professor Ralph advises getting it checked without delay.

Melanoma

Ireland sees approximately 1,200 cases of melanoma per year. Melanoma is the more serious form of skin cancer and most commonly presents as a new or changing mole. The earlier it is caught, the better the outcome. Caught at Stage 1A, when the cancer is confined to the top layer of skin, the 5 year survival rate is between 97-100 percent.

How Do You Spot a Suspicious Mole? The ABCDE Guide

Professor Ralph recommends using the ABCDE framework to assess any mole or pigmented lesion on your skin:

A is for Asymmetry. A healthy mole should  be a mirror image if folded in two.

B is for Border. Look for irregular or jagged edges.

C is for Colour. Multiple colours or any change in colour is a warning sign.

D is for Diameter. Anything 6mm or larger, about the size of the top of a pencil eraser, warrants attention.

E is for Evolution. Any mole that continues to change in shape, size, or colour over time needs to be assessed by a doctor as soon as possible.

Is the Irish Sun Really Dangerous? Understanding UVA and UVB

This is one of the most common misconceptions Professor Ralph encounters. The UV is there all year round in Ireland. People were sunburnt on St Patrick's Day this year, despite overcast skies.

There are two key types of UV radiation to understand:

• UVA is present every day of the year, and the rays can pass through glass. It penetrates deeper into the skin, damaging DNA, and is responsible for 80 to 90 percent of the wrinkles we develop over time.

• UVB are the burning rays. In Ireland, it peaks between May and the end of September. These are the rays associated with the visible redness and burn you feel after too much time in the sun.

Both contribute to skin cancer risk, which is why daily sun protection is recommended 365 days a year.

What Happens If Melanoma Is Diagnosed?

Treatment depends on the stage at diagnosis. Early-stage melanoma caught at Stage 1A is treated surgically by removing the lesion. Patients then return for regular skin checks and are shown how to monitor their own skin between appointments.

For more advanced melanoma that has spread internally, treatment has changed dramatically in recent years. Immunotherapy, which the patient receives as an infusion roughly every three weeks, has transformed outcomes for people with advanced disease. Many patients continue working and living normally throughout their treatment. As Professor Ralph notes, the advances in this area have been phenomenal.

Should You Have Your Moles Mapped?

For people with a high mole count, anywhere between 100 and 200 or more, Professor Ralph strongly recommends regular professional mole checks. Mole mapping technology is advancing rapidly, with AI now playing a growing role in supporting image analysis. That said, medical oversight remains essential. A trained doctor must interpret the images, not technology alone.

For moles in areas you cannot easily see yourself, such as the back, Professor Ralph advises asking someone you trust to keep an eye on them in between your check ups and to use your smartphone camera regularly to document how they look over time.

Questions from Listeners: Professor Ralph Answers

During the interview, Professor Ralph answered a range of questions from Newstalk listeners covering everything from Becker naevus to scalp eczema, hormonal acne, actinic keratosis, and recurring folliculitis. A few standout points from those questions:

• On seborrhoeic keratoses (the brown marks  which occur over time): these are harmless but can look concerning. They sit on the surface of the skin and you will not cause damage if rubbed with a towel. They can sometimes be itchy but mainly are an aesthetic annoyance and can be treated with cryotherapy if bothersome.

• On perimenopausal acne: hormonal acne in women in their 40s is very common but sometimes can overlap with rosacea therefore the treatment may differ compared to treatments used in the management of teenage acne. Treatment options are available and worth discussing with your GP for an onward referral.

• On actinic keratosis (pre-cancerous scaly patches on sun-damaged skin): these can be treated if more isolated with cryotherapy or with a topical chemotherapy cream if they are more diffuse. It is not a comfortable process, but it is effective in clearing pre-cancerous cells.

• On recurring folliculitis: if a patient previously responded well to isotretinoin (Roaccutane), a second course may be the best option, given that long-term antibiotic use carries its own risks for gut health.

Key Takeaways

Skin cancer is the most common cancer in Ireland and our population is among the most at risk in the world.

Most UV damage is done before the age of 20, making sun protection in childhood critical.

UVA is present all year round, including through windows. Daily sun protection is not seasonal.

Use the ABCDE framework to monitor your moles. If anything is changing, see your GP promptly.

Melanoma caught early is highly treatable. Early detection is everything.

Concerned About Your Skin?

The Institute of Dermatologists is Ireland's leading consultant-led dermatology centre. If you have concerns about a mole, a persistent skin lesion, or your skin health generally, contact the clinic to find out about the services available to you.

Professor Nicola Ralph spoke with Pat Kenny on Newstalk on 2 May 2026. Our thanks to Pat Kenny and the team at Newstalk for the opportunity to share this important conversation.

Listen to the full interview: Ask The Expert: Dermatologist Nikki Ralph, Newstalk