A question of health: Stunned by the sun

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I HAVE a rough patch of red skin on the forehead which always seems to be on the verge of healing but never disappears. Could this be skin cancer?

This is most likely to be a solar keratosis (also known as actinic keratosis). It is an effect of sun damage to the skin. It is not skin cancer but it could develop into skin cancer - and it is therefore important to have it treated.

Solar keratoses are most common in fair-skinned people who have had a lot of exposure to the sun. They often appear on the face, the ears and the back of the hands - all areas that are exposed to sunlight. The risk is that it could develop into a potentially serious form of skin cancer known as squamous cell carcinoma if it is not treated early. Solar keratoses are usually treated with freezing by liquid nitrogen, with excellent results. The best way to prevent this form of pre-cancer is to stay out of the sun and use a sunscreen with a high protection factor (at least factor 15).

I HAVE recently noticed that my breasts are secreting milk, even though I am not pregnant and not breastfeeding a baby. What could be causing this?

This is known as galactorrhoea, and it can affect both men and women. It can be caused by an excess of the hormone prolactin, which is produced by the pituitary gland. But it can also be a side-effect of some drugs used to treat schizophrenia and other mental disorders, blood pressure medications, antidepressants, anti-nausea preparations and contraceptive pills.

Occasionally it is caused by an underactive thyroid gland and it is associated, although rarely, with a tumour of the pituitary gland that results in the production of too much prolactin.

It is important to discover what is causing galactorrhoea, and you should see a doctor who can do the necessary tests. If it is not being caused as a side-effect of a drug you are taking, you will probably need both blood tests and X-rays to look at your pituitary gland.

I AM suffering from obsessive compulsive disorder and have found out about a pioneering clinic at the Maudsley Hospital, in London. However, a referral is needed from my GP, whom I don't wish to contact for fear that it may damage my promising career.

I can understand your reluctance to see your GP. You probably think that if the label "obsessive compulsive disorder" is attached to your medical records it will follow you around for the rest of your life. But I think the risks to your career from being unwell with obsessive compulsive disorder are probably greater than the risks of having this diagnosis entered into your medical records. Arrange to see your GP, but, before you go, write a note saying that you would like to begin the consultation with an "off-the-record" discussion about what is going to be entered into your medical records. Be honest about your fears. You will probably be able to find a compromise that allows you to be referred to the clinic without jeopardising your future career prospects.

Please send questions to A Question of Health, `The Independent', 1 Canada Square, Canary Wharf, London E14 5DL (fax: 0171-293 2182; e-mail: health@independent.co.uk). Dr Kavalier regrets he is unable to respond personally to questions