The harsh reality of melanoma: 'There's no ambiguity about the word cancer'

Josie McNaught and daughter, Zoe Lewis. Josie is a second-generation melanoma mother and worries her daughter will be the third. Photo / Michael Craig

She lost her mum to melanoma. After being diagnosed with the same disease at the same age her mum was, Josie McNaught faces her future - and her fears for her own daughter.

Cancer loves a good statistic, especially if it translates into a gripping headline that screams "double" or "triple" an increase in detections and death rates.

Unless cancer comes calling, what effect do these statistics have anyway? Until skin cancer came and banged on my door, I had only a vague idea how many people were diagnosed with melanoma each year in New Zealand, let alone how many died. You could say I was numbed by the numbers, despite my mother dying nearly 40 years ago from a malignant melanoma.

But in June this year, my complacency around melanoma was brought up short with the results from a Covid-delayed biopsy on a stubborn dark brown mole on my right cheek. The usual pleasantries over, the specialist brought up the results on his screen, cleared his throat and dropped his voice: Uh oh…. despite having had a few biopsies on other moles that all came back clear, my run of luck was over…

"It is one – a melanoma, yes, this time it is." And just like that, I had some statistics of my own to reflect on:

My mother was 55 when she was diagnosed with skin cancer.
I turned 55 in April and was diagnosed in June.

I was 22 when she died, five years after her diagnosis.
My daughter is 23.

I have now lived for more than 30 years without my mother – longer than the 22 years I did have her.

I'm a second-generation melanoma mother – will my daughter be the third?

Josie McNaught's mother, Annette McNaught, was first diagnosed with skin cancer at age 55. She died five years later. Photo / Supplied

I am also one of about 2550 registrations of melanoma in any year. In 2017, 310 people died from it. A total of 480 died from melanoma and other skin cancers combined.

Putting the numbers into context, more people die from skin cancers each year than from road crashes – but skin cancer gets a fraction of the coverage that car crashes attract.

From my own observations I know that come Labour Weekend and a bit of grunty sunshine, our local beach

in Herne Bay will be dotted with young women in bikinis, lying flat on their backs like skinny breakfast sausages, frying in the sun. No hats, no sunglasses (they cause white patches around your eyes, I'm told) no cover-ups, just an overwhelming and potentially deadly desire for an all-over tan.

The sun behaviour of young men is equally bizarre: they wear huge, baggy, long swim shorts and underwear, but their backs and chests are bare, their ears and necks are equally exposed even if they don the ubiquitous baseball cap.

So why isn't the message getting through that this sort of overexposure to the sun is just as bad for you in your late teens and 20s as it is when you are a young child? This is the generation brought up on compulsory hats in schools, shade cloth and bottles of sunscreen on every teacher's desk, after all.

Andrea Newland of Melanoma New Zealand is equally concerned. She says a "DumbBurn" campaign run by Te Hiringa Hauora/Health Promotion Agency last summer targeted this age group.

"It's all about behavioural and attitudinal change. A tan doesn't make you 'look' prettier or more handsome, or make your legs look skinny. Sun exposure not only can lead to a melanoma, but it can give you wrinkles, sunspots and prematurely age your skin."

But try telling someone in their 20s to think about the consequences in 30 years of something they are doing right now.

Melanoma NZ trustee Dr Rosalie Stephens agrees. The message she wants to get across is stark: "The word melanoma is confusing. That word should be used less than the word cancer. If you are diagnosed with a melanoma you have a cancerous tumour living under your skin. There is no ambiguity about the word cancer."

Another myth, says Stephens, is that a melanoma sits on your skin.

"It doesn't stay on your skin. If left untreated it goes into your blood. From there it can travel around your body leading to more tumours."

Stephens says it's frustrating that we still have high rates of skin cancer in people over 50. She blames the "brown skin is healthy" message that is used in advertising targeted at young women especially.

"It's so pervasive. I treated an Irish woman for skin cancer. She had red hair and very fair skin and she was beautiful, but even while I was treating her, she used fake tanning products. It is just incongruous given she was never born to have a tan."

Josie McNaught's complacency around melanoma was brought up short in June this year when a biopsy came back positive. Photo / Michael Craig

Stephens says the development of "fake tanning" products is problematic in the fight to improve people's sun-smart behaviour. Cue the rush on spray tans during school ball season.

"Even though a fake tan is obviously better for your skin than exposure to the sun, it still reinforces the message that a tan is desirable."

Which brings us to sunbeds. Despite lobbying by Melanoma NZ and medical experts, New Zealand is yet to have legislation banning the use of sunbeds for cosmetic purposes.

Sunbeds push the line that they are a "safe" way to tan. But there is no evidence this is the case. All forms of UV radiation can contribute to skin cancer and a sunbed tan is caused by UV radiation.

According to the Cancer Society, sunbeds tend to emit much higher concentrations of UV radiation than the sun, often three times as strong as the midday summer sun. And the cancer division of the World Health Organisation has classified tanning beds as "carcinogenic to humans" so they are up there with tobacco, asbestos and arsenic.

It's enough to make me want to picket the four sunbed joints that operate in and around Ponsonby, just around the corner from my home. The World Health Organisation encourages governments to enact legislation and regulations to control the operation and use of sunbeds.

But in New Zealand, no training is required to operate and work in a sunbed clinic, nor is the equipment regulated. In March this year Standards New Zealand withdrew the voluntary sunbed standard (AS/NZS 2635:2008 Solaria for cosmetic purposes). This was despite submissions opposing the change from Consumer NZ and other organisations, including the University of Otago Social and Behavioural Research Unit.

At the same time, Consumer NZ published the results of a sting operation

on sunbed clinics across the country. They exposed clinics that didn't check the ages of customers (you have to be over 18) or provide a consent form and didn't stop fair-skinned people from booking a session. The study provided clear evidence that the lack of regulation means consumers don't have sufficient protection and led to Consumer NZ calling for a ban on sunbeds. They are already banned in Brazil and most Australian states,

which also have high rates of skin cancer.

And as it does in many health responses, Australia trumps New Zealand when it comes to improving sun-smart behaviour, resulting in lower rates of melanoma registrations and deaths, relative to the population.

How did they achieve this? They showed melanoma the money. Over the past 30 years, there has been significant government funding into education and awareness and the importance of early detection. By contrast, the DumbBurn campaign appears to be a one-off and is not happening this summer.

Josie was 22 when she lost her mother, Annette McNaught, to skin cancer. Photo / Michael Craig

You can hear the envy in Newland's voice when she describes how far ahead the Aussies are in this field. Yet we could match them – even beat them, she says, if we too showed melanoma the money.

"We need to invest government funding in existing infrastructure to deliver a comprehensive and cohesive skin cancer prevention and early detection programme. Sustained public investment in skin cancer primary prevention programmes show strong potential for economic as well as health benefits."

According to a recent Australian study (there are no New Zealand studies), a comprehensive skin cancer prevention programme has a potential return of A$3.20 for every dollar invested.

Newland and Stephens are calling for skin cancer to be included in early detection public awareness programmes.

"Skin cancer can be successfully treated if it is caught early and even in some advanced cases. Australia has spent the money on public health campaigns and research, and they are doing a better job than us as a result," according to Stephens.

Meanwhile, organisations like Melanoma NZ receive a small amount of public funding - just $15,000 in the past year - and rely almost solely on donations, grants, sponsorships and fundraising. Imagine relying on donations to fund campaigns around smoking and exposure to asbestos.

I ponder all of this daily as I dab rosehip oil on the scar on my right cheek. My cancer was "in situ", which means its long tentacles didn't get the opportunity to spread. This time. But that's not the end of my cancer connection, or the list of statistics.

I need twice-yearly specialist visits -more if I detect anything alarming.
And I have to wait five years for the all-clear.

I'll be 60 by then, the same age my mother was when she died – and that's one statistic I'm not planning on matching.

How to look after the skin you're in:

• Slip on a shirt/top with long sleeves and a collar
• Spend time in the shade
• Slop on sunscreen that is at least SPF 30, broad-spectrum and water-resistant
• Apply 20 minutes before going outside and reapply every two hours
• Slap on a broad-brimmed hat that shades your face, head, neck and ears
• Wrap on close-fitting sunglasses
• Don't use sunbeds
• Protect your skin during the time of the day when UV radiation is highest. This is between 10am and 4pm during daylight saving
• Check your skin regularly and seek advice if there are any changes

Melanoma Awareness Week starts tomorrow. To donate to Melanoma New Zealand, go to melanoma.org.nz/donate