Our love of the outdoors and Northland's high levels of ultraviolet radiation contribute to the melanoma rate. Photo / Michael Cunningham
We need to treat harmful sunlight in the same way we treat cigarettes if we want to reduce Northland's high melanoma rate, a skin cancer expert says.
The region has the third-highest melanoma death rate in the country - 6 per 100,000, compared to the national average of 5 per 100,000 - and just behind Taranaki and Bay of Plenty.
And a skin cancer initiative that could help improve diagnosis of melanoma by almost 50 per cent and help reduce Northland's high mortality rates is to be expanded.
Melanoma among Māori is a fifth of the rate of European/other ethnicity, however, the percentage of melanomas with thickness larger than 2mm were greater for Māori (17.7 per cent) compared with non-Māori (12.5 per cent) despite the lower age-standardised rate in Māori.
The programme will help upskill hundreds of Kiwi GPs in the use of specialised diagnostic technology, which could improve early identification of the disease by almost a half.
Northland skin cancer doctor Dr Christian Wieser said people needed to respect the sun, and its harmful rays more and get any melanoma signs checked as soon as possible.
New Zealand has a strategy in place to reduce the damage from smoking - the Smokefree 2025 target - and Dr Wieser wants UV radiation from the sun treated in the same way as the Government views smoking, with strategies in place to reduce the harm.
Among those countries with the greatest incidence of melanoma, New Zealand has the highest mortality, followed by Norway, Australia, the Netherlands and Denmark.
Early diagnosis of skin cancer can be difficult with New Zealand lacking a sufficient number of dermatologists and properly trained health care providers available to check suspicious skin lesions, particularly in rural areas.
Dermoscopy is a relatively new technique used for examining and diagnosing skin cancer, however, a lack of training standards has meant there is significant variation in the diagnosis and treatment a patient could receive.
The use of a dermatoscope allows the lesion to be magnified and viewed under polarised light, helping to identify subtle changes in the lesion.
Kiwi doctor Franz Strydom, Fellow of the Skin Cancer College Australasia (SCCA), said the organisation has a training and accreditation programme to ensure there is a consistent standard for all health care providers using the technology.
"It's important that we identify skin cancer early as it provides a significantly improved prognosis for the patient, and if caught in the initial stages, we have the ability to treat it.
"We need to ensure there are more consistent standards across the health sector when using a dermatoscope so skin cancer patients have the best chance possible.
"Currently many health care providers attend a short course on skin cancer including basic training with a dermatoscope. This has been proven to help with diagnosing skin cancers, but more formal dermoscopy training can result in a 49 per cent improvement in a doctor's ability to diagnose a problematic lesion," he said.
Skin cancer continues to be a major health problem in this country; the direct healthcare costs of treating skin cancer are estimated at $NZ123.10 million.
Dr Strydom said already more than 100 New Zealand general practitioners have taken part in the training.
"Increasing the number of GPs who are well trained in diagnosing skin cancer and supporting them with adequate government funding will encourage Kiwis to get their skin checked," he said.
He said doctors who participate in the Accredited Skin Cancer Doctor programme must complete five exams and submit more than 50 clinical case studies for assessment.
The Northern Advocate asked Northland skin cancer doctor Dr Christian Wieser some questions in relation to the region's melanoma rate and what could be done about it:
Why is Northland's melanoma rate so high?
This is likely due to multiple factors, including our high levels of ultraviolet radiation here, our population being significantly older than the national population and our love of the outdoors lifestyle.
What can individuals, parents and caregivers etc, do to prevent melanomas?
Protecting the skin from ultraviolet radiation (the sun) - especially for children and adolescents, is the most important thing we can do. It is best to think about UV index rather than temperature. When the UV Index is above 3, skin protection is required and there are lots of phone apps available, such as to know when they need to protect their skin.
There are lots of apps available, such as "UVlens" that will tell you what the UV Index is at a particular time and as such when to protect your skin.
Keeping out of the sun in these times is the best option, if that is not possible then covering up with a brim (not peak) hats and clothing. For areas of skin that can't be covered, e.g. face/neck/upper chest and back of hands then a broad spectrum (UVA/B) 30+ sunscreen is recommended.
What does the Government/Ministry of Health need to do, to prevent/lower melanoma rates?
Regulating sunscreens to meet their advertised claims, providing more shade in public places, and providing funded sunscreen for people with fair skin types will help reduce our melanoma rates.
However, it is not just about preventing melanoma, it is also about recognising them when they are in their early/thin stage before they have a chance to spread.
Public health messages encouraging everyone to scan their own skin (look for spots that are sore, changing, abnormal or new), and to get anything concerning checked by a trained professional would be useful.
The Government should also consider funding GPs to attend training to upskill in skin cancer diagnosis and management would be helpful - particularly for GPs in rural areas.
They could also consider funded skin checks for fair risk skin types or those with personal history of melanoma or a first degree relatives with melanoma.
How does having a melanoma impact on the people you treat?
I see a variety of responses when someone is diagnosed with melanoma. When identified early most patients are so grateful to have these removed from their body and that they have prevented potential problems down the line.
When identified in a late/advanced state there is a significant toll on both the patient and their support people. Patients report a variety of responses including denial, depression, anxiety, fear. Then there are the physical aspects of disfiguring surgery, wounds to heal, side effects to treatment and the not knowing of if the melanoma will respond to treatment or not.
Is Northland's "Winterless North" moniker part of the problem - we tend to worship and welcome the sun in summer and flock to our beaches, without also giving its rays the respect they deserve?
Our sun-loving behaviour and lack of respect for the harms of UV radiation certainly contributes to the skin cancer problem we face. Generations before us did not have the knowledge we have now about these harms. Perhaps we should view UV radiation in the way we view smoking.
At the start of this summer I had countless sunburnt and peeling patients coming to see me for a skin check. I was astounded they allowed themselves to get so burnt with the knowledge they were seeing me shortly thereafter.
How much exposure to the sun is okay?
To my knowledge there is no clear answer to this. It also depends on skin type. Clearly we need some sun for vitamin D production and the general recommendation is 15 minutes of direct sun exposure three times per week. Most people get far in excess of what is required. I tell my patients to avoid the sun when the UV index is 3 or above.
How important is the Slip, Slop, Slap and Wrap message?
I believe public health measures encouraging us to cover up and protect ourselves are great, however I worry not enough people are translating these messages into action. I still see plenty of men with their bald unprotected scalps out walking or mowing the lawns and people sunbathing with little clothing on at the beach.
The slogan "only pigs look good pink" is a particular favourite of mine.
Any other comment in relation to this issue?
There are a shortage of highly trained professionals to adequately diagnose and treat skin cancer in Northland.
GPs are patients first point of call but there is a significant shortage of GPs in Northland also. Often there are delays to get an appointment with a GP here and a lot of practices are not taking on new patients.
When speaking with the receptionist to book an appointment for a skin/spot check - ask if the clinic has a particular doctor there who has further training and knowledge in skin cancer and ask to see them - this may not be your regular GP.
I would also recommend not to hesitate to get a second opinion if you are not comfortable which may mean travelling to a dedicated private skin cancer clinic.
A great place to find a doctor with extra skills in diagnosing and treating skin cancer is to use the "locate a doctor search" on the skin cancer college of Australasia website (skincancercollege.org). The NZ Skin Cancer doctor society also has a directory of doctors who are expert in the field (nzscd.org.nz)
Signs and Symptoms of Melanoma Skin Cancer:
Unusual moles, sores, lumps, blemishes, markings, or changes in the way an area of the skin looks or feels may be a sign of melanoma or another type of skin cancer, or a warning that it might occur.
Normal moles:
A normal mole is usually an evenly coloured brown, tan, or black spot on the skin. It can be either flat or raised. It can be round or oval. Moles are generally less than 6 millimetres (about ¼ inch) across. Some moles can be present at birth, but most appear during childhood or young adulthood. New moles that appear later in life should be checked by a doctor.
Once a mole has developed, it will usually stay the same size, shape, and colour for many years. Some moles may eventually fade away.
Most people have moles, and almost all moles are harmless. But it's important to recognise changes in a mole – such as in its size, shape, color, or texture – that can suggest a melanoma may be developing.
Possible signs and symptoms of melanoma:
The most important warning sign of melanoma is a new spot on the skin or a spot that is changing in size, shape, or colour.
Another important sign is a spot that looks different from all of the other spots on your skin (known as the ugly duckling sign).
If you have one of these warning signs, have your skin checked by a doctor.
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