Among Carole Meehan's most treasured possessions is a snapshot from her wedding day. Sparkling with happiness, she is being twirled round the dance floor by her husband, Neil. The back of his head is to the camera, and a medium-sized mole is just detectable through his hair. "Every so often someone would comment on it," says Carole, 37. "But we were never concerned enough to seek advice."
Five years later, that seemingly innocuous birthmark, just 2cm in diameter, would devastate the Meehan family. Neil, a broker, died of malignant melanoma in 2006, aged 35, widowing Carole, and leaving two boys, Thomas, then aged four, and Patrick, 18 months.
"Neil rarely sunbathed," says Carole, a clinical scientist in radiotherapy at The Royal Marsden. "But he played rugby, cycled and loved running. He spent his childhood outside, and had been burnt a couple of times."
Melanoma will affect 1 in 50 people in Britain in their lifetime, and has a very high death rate. It is responsible for more than 74 per cent of skin cancer deaths. Those with an outdoor lifestyle are particularly prone, and this cancer is more likely to be fatal in men.
With his fair skin, and lack of awareness of melanoma, Neil was particularly vulnerable. "With hindsight, the mole had grown. And another one had popped up on his neck," says Carole. "But they didn't look strange or unhealthy."
Besides, the couple had other concerns. In 2001, Thomas had been born very prematurely at 28 weeks. Complications left him needing to wear a stoma bag. Patrick, born in 2004, had also been premature at 36 weeks.
In July 2005 Neil started to feel tired all the time. "He wasn't particularly ill," recalls Carole. "I presumed it was a chest infection, and told him to go to the doctor. As an afterthought I added, 'And get those moles checked.'"
The GP immediately referred Neil to Lewisham Skin Clinic, who took a biopsy. "Two weeks later, he went for the results by himself," says Carole. "That's how unconcerned we were. I'd taken the boys to the park. He phoned and said it was cancer – a huge shock. But we both believed everything would be OK."
Carole felt optimistic. After all, she had treated skin cancers with radiotherapy. "The patients were 80-year-old men, who'd been out in the desert as soldiers. But they'd had basal cell carcinoma. Neil had malignant melanoma, which is resistant to radiotherapy. Catch it early enough with surgery, fine. If it spreads, nothing works."
Carole knows this now, but at the time she admits she was blasé. "I never knew of anyone who had died from it. I just thought, it's a bit of surgery. It'll be fine."
Neil was referred to the local centre of excellence for dermatology, Guy's and St Thomas', and put under the care of consultant Dr Mark Harries. The cancer had spread to Neil's right lymph node and to a mole on his neck. The doctor explained the diagnosis was stage three melanoma, with a six in 10 chance of survival.
"Dr Harries called it an evil cancer because it's so resistant to treatments," says Carole. "But Neil wasn't the kind of man who'd sit in pity. We told ourselves Neil was fit, young. We were positive. He'd be one of the six survivors for sure."
The surgery was performed at the beginning of September. "It was quite major as the mole was deep and needed a 5cm incision. Neil opted to have both sides of his neck lymph nodes out just in case. Then he had skin grafts taken from his leg."
Tests gave the rest of his body the all-clear, and he came home to recover. "The consultant said there might be some slight advantage to having radiotherapy," says Carole. "That's normal for most cancers, to kill off anything that might be missed, but not , as I knew by now, for malignant melanoma. Still, Neil wanted to do everything he possibly could to recover."
Neil began radiotherapy at the end of October. "Things seemed to go well," said Carole. "Neil went to the hospital every day. He even started cycling again."
In November, Neil's shoulder started to hurt. Then his lower back began to ache. As he was having weekly blood tests, the couple were unperturbed, and believed he'd just been overdoing it. But he became progressively weaker.
At the beginning of December, Neil suffered an agonising headache, with visual disturbances. Carole phoned NHS Direct, who said they believed it was a migraine. "Just hours later, he had a massive seizure," says Carole. "The paramedics came, and he continued to have fits in the ambulance. It was terrifying. Thankfully, the boys were with their grandmother."
Tests showed that the cancer had progressed to his bones. "Neil's immediate reaction was 'What treatment now?'" recollects Carole. "We just thought of somehow surviving."
But there were no beds at Guy's and St Thomas'. Carole admits it was frustrating to be away from his usual doctors. "This is where it's a disadvantage to be an NHS worker," she observes wryly. "People have asked why we didn't push to get back to Guy's. But when there's no bed, there's no bed. I know that's the way it is."
By mid-December, Neil had returned to Guy's and St Thomas', but had another seizure. "They didn't think he'd survive," says Carole. "But he clung on, and came round. Afterwards, though, he was aggressive – like he had Tourette's syndrome."
A few days later, Neil's usual placid personality returned, but Carole was unsure if he'd remembered what the doctors had said, and asked him. "He nodded, and said, 'I always knew I'd die young.' His dad had died of a heart attack when Neil was 15. It must have always played on his mind."
The family spent Christmas in hospital. "The kids were remarkable," says Carole. "They never questioned it, just got on with it."
By now Neil was very frail. His kidneys weren't working, and he could only walk 50 yards. But he came home, to see Thomas start his first day at school in January. "Neil wanted to fight," says Carole. "We planned to go to Center Parcs in February, we had Neil's sister Katie's wedding coming up. But we knew it wasn't for ever."
In mid-January, Neil had another seizure and returned to hospital. "Thankfully, Thomas was enjoying school. He was spending half an hour a day with Neil. Our aim now was to get Neil home to die."
At the beginning of February the doctors agreed that Neil could go home. "I told Thomas on Wednesday the 5th, 'Daddy's coming home tomorrow.' He was bouncing with excitement."
When Carole went to stay with Neil on Wednesday night, she noticed his breathing had changed, and called his brother, Brian, and sister, Katie, to the hospital. "His last words were, 'I'm tired I'm going to go to sleep now.' He died at 1pm on Thursday."
Carole left the hospital to pick Thomas up from school at 3.15pm. "He was expecting to go home and see daddy," she says. "And I broke his heart. I told him his daddy had died. He has since said to me, 'Mummy, I hate you. You said my daddy was dead. You should have said he was back at home.' I'll never forgive myself for that."
Carole knows earlier detection could have saved Neil. "If Thomas or Patrick asks me whether their daddy's life could have been saved, I will say to them, 'Yes, if he'd had his moles checked earlier.'"
Naturally, Carole is vigilant about protecting her children from the effects of the sun. She knows this will lower their chances of contracting melanoma later. She also wants adults to be more aware of the condition. "If you're worried about a mole, go to your GP or local skin clinic immediately," Carole urges. "It could save your life."
For more information, contact The Myfanwy Townsend Melanoma Research Fund, which aims to raise awareness of malignant melanoma, and make diagnosis more available: www.melanoma-fund.co.ukFor general information about malignant melanoma and other cancers, contact Backup: www.cancerbackup.org.uk
Melanoma: the facts
One of the first signs of malignant melanoma is a new mole, or a change in appearance of an existing one. Melanoma develops from cells in the skin known as melanocytes. These grow and divide more quickly than usual and start to spread into the surrounding surface layers of skin.
Most people with a melanoma less than 1mm in depth are cured by surgery. If the melanoma is not removed, the cells grow down into the deeper layers of the skin. If the melanoma cells go into the blood vessels or lymph channels, they can travel to other parts of the body in the blood or lymph system, making it harder to treat.
About 8,100 people in the UK are diagnosed with melanoma each year, and malignant melanoma is the country's fastest-growing cancer, with rates tripling in the three decades to 2003. In 2004 there were 1,777 deaths from the disease.
NHS Scotland has released figures covering the year 2005, showing cases of malignant melanomas among men rose by 43 per cent from 10 years before.
Pale and fair-haired people are particularly at risk and need to be aware of any changes to existing moles or new moles or marks. Cancer Research UK run a SunSmart campaign that gives advice on the prevention of the disease.