Protection from UV exposure is the best way to peg back New Zealand’s alarmingly high melanoma mortality rate. By Nicky Pellegrino
The news that this country has the world's highest rates of melanoma cases and deaths hasn't come as a huge surprise. We have been vying with Australia for that unenviable top spot for years. We share high UV light levels, an outdoor lifestyle and a population that includes lots of fair-skinned people who are vulnerable to sun damage. Now, with skin cancer rates predicted to rise steeply over the next 20 years, there are concerns that New Zealand is lagging behind when it comes to prevention and treatment.
Needless to say, the situation was on the agenda at the MelNet Summit, a two-day online gathering of health professionals involved in melanoma prevention, diagnosis, treatment and research. Palmerston North dermatologist Louise Reiche says although multiple areas of concern have been identified, so have many measures that could help tackle the problem.
A place to start may be tanning salons. Since 2017, it has been illegal to allow under-18s to use commercial sunbeds because of their increased risk of developing melanoma. However, Consumer NZ mystery shoppers funded by the Ministry of Health have found some salons ignoring the regulation and others failing to properly explain the risks to fair-skinned customers. Reiche would like to see a total ban on commercial sunbeds.
Nail salons that use short bursts of UV light to set gel manicures concern her, too. "You are getting intense UV under the nail bed," she says, "and we are starting to see more squamous cell cancers as well as melanoma in and around the nail area, which is usually a less common site. Unfortunately, it has a worse prognosis, perhaps because it tends to be picked up a little later, or because of a more aggressive pathology at those sites."
Creating more shade in public places is another priority. Schools, parks, athletics fields and town centres all need more spaces where people can enjoy the benefits of fresh air without exposure to harmful levels of UV light.
Tightening sunscreen standards is under way. Sunscreen is classified as a cosmetic in New Zealand and some products have been found not to meet their sun protection factor (SPF) label claims. The Cancer Action Plan advocates reclassifying sunscreen as a therapeutic so it is subject to more stringent quality control. In the meantime, the Sunscreen (Product Safety Standard) Act has been passed, which means makers of products that don't provide the protection promised on the label can be fined under the Fair Trading Act.
When patients visit Reiche, they tend to get a long spiel about UV protection, and sunscreen doesn't get a mention until near the end. Her focus is as much about creating personal shade.
"We need to get used to putting a layer between our skin and the sun," says Reiche, who advises wearing long-sleeved clothing and a broad-brimmed hat that provides better protection for the neck, face and nose than a baseball cap. "And then an SPF50 broad-spectrum sunscreen as well, because the sun will still get under your hat. So we ask people to use several measures."
It has been more than 40 years since the launch of the "Slip-Slop-Slap" campaign and Reiche says there is a need for more public education about sun protection and risk factors for melanoma. "People need reminding."
Although there is no denying that being active outdoors is good for us physically and mentally, it makes sense to seek shade when UV is at a peak, usually a few hours either side of midday.
"In some of the more northern parts of Australia, it gets so hot in summer that people will stay inside. Here, the UV levels are similar but the temperature is cooler, so it's easier for us to be outside for longer."
For many of us, the damage has already been done. New Zealand has an ageing population that sunbathed in their youth or worked outdoors with little protection.
The health system is already struggling, and to deal with the coming melanoma surge will mean more funding for an increased workforce and the latest immunotherapy drugs.
