We need to talk conversations on wellness with Coast FM's Tony Street.

Hello, it's great to have you with us today on we need to talk.

New Zealand has one of the highest rates of melanoma in the world, but despite being preventable and treatable of court early melanoma still accounts for sixty five percent of all skin cancer deaths in alted or.

I think most of us know that our son is particularly harsh, but key We's are also sun lovers, so how do we strike that right balance?

So why is the message not getting through and what can we change in our own lives, hopefully small steps to avoid becoming a statistic doctor.

Lorna Claydon is mole NAP's New Zealand chief medical officer and she's here to educate us on all things skin cancer and melanoma.

And my first question is I get a little bit confused with the different types of skin cancer and melanoma and which ones relate to the sun and which ones don't.

Can you just clear that up for us?

Hi, Tony yep, thank you so much for having me on.

And that is a really great question to start because it is confusing for a lot of people.

Most people have heard of melanoma skin cancer because that's the scary one and it's the one that makes the news headlines and sadly in New Zealand and Australia, as you know, we are world leaders, not a title we want.

But so if melanoma is like the shark of the skin cancer world, it's fast moving and it can be deadly, we also have a goldfish.

We have basl cell skin cancers.

They're way more common, but they tend to stay where they are and slowly grow larger on the skin until they start to cause a problem.

And in between the basil cell skin cancers and the melanomas sit the squamer's cell skin cancers and they can spread and they can be deadly, but they're much less so than the melanomas.

So those are the three common types of skin cancer that you'll hear about in New Zealand.

They are all related to sun and exposure in the majority of cases.

But you are right to say that there are some melanomas that can occur on skin that hasn't had any sun exposure, on the soles of the feet, under fingernails, back of the eyeball, and even in our intestinal mucosa, they're much less common.

More than ninety five percent of melanomas are related to sun exposure.

And who is particularly at rusk here in New Zealand Is there a particular age group or demographic.

So as we get older, our risk of cancers always goes up, So most skin cancers are in our older patient But we are seeing a worrisome trend in our under thirties of getting more melanomas diagnosed.

We're not really sure why that is.

It could because we're getting better at diagnosing them, it could be related to trends in sun related behavior, that kind of thing.

It's a real worry for us because that's a frightening statistic, one that we're keen to see people change their risk factors.

One of the things about New Zealand is that we have a large population of very fair skin people whose skin tends to burn in the sun very easily, and they have a very higher risk of skin cancer.

Every time you get a sun burn, your risk of skin cancer goes up quite significantly, and particularly when they happen in your early like between under twenty wow.

So making sure our kids are protective from sunburn and we're teaching them about sun's safety is super important.

It's really interesting and I want to talk about my own example here with the trend side of things.

So I've got a twelve year old going on thirteen and the other the other day we were on holiday and she goes, oh, yes, I've got a tan line, and I win, oh, because it just took me by surprise, because I know that I was like that at her age.

I mean, gosh, I come from the era of sun bedding and all of those horrible things.

And you know, in the era before me was putting the oil on to burn faster.

I thought that had changed and there was a complete flip that they didn't go near the sun.

But it's obviously not the case.

It's an interesting trend, and just in the last year or two, we've seen this kind of micro trend really of young adults and teenagers wanting to tan for a visible tan line that shows, you know, when they change swimsuits.

It breaks my heart because you know, all day with patients who are often older and say, if only we'd known, And now we have a generation that do know and still can't see the risk.

And it's really hard when you're young to take a risk that mostly to affect you and you're older and make it immediate.

But what I say to parents is, look what you're doing.

Your education that you're doing will eventually have an impact, and it will change behavior.

And every change in behavior makes it different.

It is never too late to improve your sun smartness around it only sunsafe behavior.

People often ask me, you know I've got all this some damage.

Is it too late to start using sunscreen?

And the answer to that is no, It's never too late.

And one of the reasons is not only are we accumulating some damage from sunlight, but when the sun shines on our skin, it makes the immune cells in our skin sleepy and sluggish.

And so when we protect our skin from sunlight, we allow those immune cells to wake up, look for damage in our skin, and be more effective at dealing with that damage before it becomes a skin cancer.

So, yes, you are a parent to teenage children who are finding it hard to be sensible in the sun.

Just to hold in there, keep going with your sun smart messages and your role modeling super important, and they will come.

They will come to see the wisdom of your ways in time.

How do you balance that messaging around not being the sun and all the positives with the mental health messaging.

Often get outside.

You need some fresh air, you know, you need the vitamins from the sun to make you feel better and not get into that I forget what the condition's called when it's in the middle of winter and you haven't had any sunlight.

Seasible effective disorder.

Yeah, because that's the real epidemic that's affecting our young people with mental health issues.

So it just comes to being a bit aware of good times to be in the sun.

So you know a lot of young people have trouble with sleeping as well, right, So what you want to do is get out in that sunshine early, gets sunlight on the back of your eyeballs earlier in the day, so when they wake up, go outside, maybe have their morning that you know, serious outside and get your dose of sunlight.

Then that's really going to help you go to sleep at the end of the day.

Especially important also for menopausal women and other people that might struggle with sleep.

Early morning the UV index is pretty low, so that's a safe time to be out getting some sunshine.

Making small doses of sunlight through the day is much safer than prolonged exposure.

And you know, if you do want to get out and have a walk in nature, then getting in under the shade of the bush, you know, that's a perfect place to go for a walk.

Clothing can be really important helping protect us from sunlight whilst enjoy the benefits of being outside so longer sleeves, you know, wearing a hat, being just a little bit smart about what we do.

The old slip stop slap is just as relevant today as it ever was.

You know, we can have the best of both worlds.

Yeah, so we've I talked about this trend and I'm glad you knew about it as well, with those visual visible ten lines.

But on the flip side of that, I feel like the beauty industry is helping in a way because there are so many products now if you want to have that sort of tend or glowy look you can put on out having to go and the sun.

I'm guessing from your perspective you'd be quite pro that.

I am.

I really like those kind of products.

That means that you can have the best of both worlds.

The only thing we do say is if you're coming in for a skin check, just try not to use them in the immediate run up to the skin check because it makes it a little bit difficult for us doing our job when we're looking with the demanoscopes the magnifiers for looking at skin.

But as a way of giving you that kind of glow without the harm, definitely that's a good way to go.

The other thing is just shifting Western society perception that brown is necessarily you know what we're aiming for.

We have a natural skin color.

It's different from one person to the next, and can we just learn to appreciate that natural skin color.

Yes, that would definitely be the messaging you brought up the skin checks, So let's talk about that now.

When should you be getting them?

At what age and at what frequency?

So that very much depends on your skin type.

Who in your family has been affected by skin cancer.

So you know, as I've mentioned, skin cancers are so common in New Zealand that two out of three New Zealanders are going to have a skin cancer in their lifetime.

If you've got a family where that's affecting people in your family, then you should start thinking about having a skin check when you become an adult.

If your skin boons easily in the sun.

That puts your higher risk.

If you've got more than one hundred moles or freckles, that puts your higher risk.

If your moles or freckles are slightly funny looking, so you've got larger ones, ones that look different from each other, that puts your high risk.

Anyone who falls into that higher risk category, so think about getting at least a baseline top to toe skin check done and then your practitioner will talk to you about how frequently you should do skin checks after that.

But for most people who fall into that slightly higher risk group, it should be an annual skin check.

In between that you can be doing self checking.

A self checking super important in picking up things early, and that's as simple as using a full length mirror and a handheld mirror just to look at the skin on your body.

You're going to look at the front of your skin, use the handheld mirror to look at your back, the top of your scalp if you can.

Don't forget to check palms of your hands, soles of your feet, in between you and tone under toenails, and you're just really looking for anything that catches the eye.

I use the acronym scan your skin.

It's it's a really good simple acronym for knowing what to look out for on self checking.

The S stands for sore spots, So anything that's itching, bleeding, not healing.

Pimples that don't heal within six weeks, they should get a check.

The C stands for changing.

Any spot that's changing in color, shape, sized, texture needs to check.

The A stands for abnormal.

We sometimes call it the ugly duckling or the standout.

This is the one the family members pick up on.

They're really good at farnding skin cancers.

You know when Nana says to you, oh, if you had that one check, do you pay attention to that.

Platners are really good too, they need a check.

And N stands for new moles.

So any new mole in someone who's over forty probably just needs to check more often than not.

They're not a skin cancer.

But that's how you pick skin cancer up early, and that's how you make it treatable.

Now that and we need to talk with Tony Street.

And you mentioned that it's high in New Zealand.

Is that purely down to our ozone.

Layer combination of factors, the tilt of the Earth's axis means that we get closer to the sun, so we get high intensity UV.

The ozone layer is a bit thinner over New Zealand and Australia, so we get more penetration of those UV A and B rays coming through that ozone layer.

We also just love the outdoors.

You know, we just won an award for being the top work life balance country of the world.

You know, we spend a lot of time outdoors.

We have a big farming population, big horticulture population, fishing, all the things we love to do give us high exposure.

And then we have that fair skin portion of the population that we're a little bit more vulnerable anyways, so combination of effects.

Let's talk about sunscreen now.

I feel like over the last three or four years there's been quite a lot of negative press around sunscreens and them not doing the right job, and them saying they're fifty plus but they're actually not.

Instead alarming for you in the field you work in.

It's certainly a challenge on a number of basis.

The first one is trying to educate people, encourage people to use sunscreens as a hard job already, and you know, people often come and say, you know, what's the best sunscreen to use, and we'll the response is usually whatever works for you.

Everybody's needs for sunscreen are slightly different, everybody's issues with sunscreen are different, but you know, coming to someone a skin doctor is a really good way to kind of that person can help you direct you towards the right product for you.

In terms of testing, there's a couple of factors.

One is that the difference between an SPF fifty at an SPF thirty in protection is only one or two percent difference in terms of how much UV it blocks out.

So sometimes you'll see testing where it claims to be an SPF fifty and it's falling a little bit below that, but not significantly.

That is still going to give you really good protection.

The difference between an SPF thirty and an SPF fifteen is significant.

It's a big drop.

So it's not a flat line, it's a curved line, okay, And so you really want to be buying sunscreen that is an SPF fifty your plus because you've got a much bigger safety margin.

And the biggest factor in sunscreen is not actually production variability, it's our ability to put it on well and as per the instructions on the packet, right.

Do you know how they test for SPF and how they do these lab testing?

No?

I don't, but I've always thought to myself, why would you not just get the fifty SPF.

I know, initially it was all white and thick, and that's why I maybe didn't.

But it's changed now you can get a fifty plus and it glides on nicely, so there's no excuse now, and I.

Feel no excuse.

Yeah, I mean I was fascinated to find out how they do these tests.

Basically, they take human volunteers and they find a little bit of non sun damaged skin, which is usually low down on the back, and they put a circle of sunscreen on it, a particular dose two milligrams per centimeter square, and then then they leave the other skin unprotected and then they shine UV lights on it and they see how long it takes that skin to start to go red on the tected skin and how long on the area with sunscreen.

So that's how you do SPF testing.

It's not it's not a lab and a culture cells in a dish.

It's humans, right, So there is some variability in how often and when this testing was done, and on variability and on who.

But the biggest variability is we don't sit there and go I'm going to put two milligrams put send me to Squared on us.

We put a little screw it in our hands, we rub it, we make it go as far as we possibly can, and we're out the door.

We forgot to do the back of the neck.

We forgot to do the back of our arms.

We don't even think about putting sunscreen on our lower legs.

For some reason in New Zealand, it's like we finish at the waist, we don't do our legs, and so out the door we go.

It's a concern, but the quality of the product is not as big of an impact as the ability of people to actually put it on right, reapply it after two hours, put it on fifteen minutes before you go out, use it every day, you know, even for that minor sun exposure when we're hanging out the Washington and getting the shopping in and running the kids to and from school, those factors are probably more important.

Going back to what you just said about where we apply sunscreen, and I absolutely agree with you.

I think people know it's most precious on their face, probably for aging, selfish vanity reasons, and then you sort of move down the body and the leagues do get forgotten.

So do you see then a clear link in the statistics around where the melanoma is found because of that.

Yeah, So melanoma in men most common on the back, melanoma in women most common on the back of the legs.

It's really interesting, it's frightening a yeah, And that's theory we forget.

Now you'd mentioned faces.

Get outdoor exposure three hundred and sixty five days all year round.

We see the most of our non melanoma skin cancers on the faces.

So your squamous cell skin cancers and your basal cells of by far the most common there.

And so sunscreen is not only protecting from melanoma, it's also about protecting you from those skin cancers which are much less related to burns and much more related to that low grade everyday exposure.

So not only is that sunscreen great for preventing aging, it's also going to stop you getting your square my cells and basil cell carcinomas.

And a lot of times when people think about skin cancer, they're thinking about their parents, their older parents or their grandparents who might be missing half an ear or had quite disfiguring souderi on noses and things, and that is usually those non melanoma skin cancers.

So it's super important we don't need to get those ones.

We can we can protect ourselves with good practices.

How much of it is genetic?

Basil cells a little bit more than square cells.

They SQUAMU cell is almost entirely related to your skin type and your outdoor exposure.

Basil cell less, so it has some stronger genetic components.

If you've got family members whove had basil cells, you're much more likely to get them.

And for people who have that genetic tendency to basil cells, it could be hugely boodensome because they can literally be growing half a dozen basil cell skin cancers between every skin check.

I mean, it's huge for those patients, and it's really really challenging to manage when they're growing skin cancers at that frequency.

What would you say to the people that are a little bit reticent to get the check because they feel like it's invasive and the process is going to be hard.

There are different types of skin checks and I totally get that.

I remember putting off my first skin check myself because I didn't want to stand in a paper pants and stand in the different poses and have the photographs.

Look, if you talk to your practitioner, they'll make your skin check fit you and fit what your needs are.

But you don't always have to be fully exposed.

We can use gowning blankets to cover up the skin and just expose the section that we need to.

And at the end of the day, catching things early means you're spending a lot less time with you in the doctor's clinic in places where you don't necessarily feel that comfortable.

So it is one of those things where you kind of have to bite the bullet and go and get it done.

But do talk to your practitioner, tell them that it makes you feel like just an uncomfortable and they will do everything they can to make you feel comfortable.

It's what we do every day, and so I think we'd a pretty good job of making it easy for patients.

I know I've certainly had people feedback to me, Oh gosh, I've been so nervous about coming to see you, and now I'm so pleased I come it was nowhere near as bad as I thought it was going to be.

It was really easy and I've learned a lot, So.

Yeah, I feel like that was my experience.

I had a molemet done maybe two years ago.

Now, can you just talk us through the process of how you make it easy for people to get checks?

Like do you get text follow ups?

How does that process work?

So we're getting more and more ability to book online now, which I find that really helpful.

I'm terrible at making phone calls.

I'm pretty good if I can click and book online.

So you can do all of that now.

Then you'll get a text reminder about your appointment coming up, and then you chin up on the day and you come in your skin check.

Now there's different types of skin checks, obviously, but if you're having a full body check, then you usually will undress down to your underwear and you'll have a gown or a blanket to cover up the skin that's not being checked.

And basically what we'll do is photograph each section of your body, which records where the spots and moles are.

And then with the dematoscope, so the magnifying lens that looks into the skin, we'll look at individual spots and moles, and we'll often photograph those through that lens, and that records exactly how the appearance of that looks at that time, can identify risk features if you like off skin cancer, and you'll get recommendations on the basis of that.

But those photographs are then stored and when you go for your next skin check, we're comparing those sets of photographs.

We're looking for new moles and we're looking for changes in existing moles, and that's one of the ways that we can pick skin cancers up early.

Laurna.

Just finally, if you had one message to give to people listening today, whether it's for them or their kids, what would that be.

Two things, so smart, slip, slop, slap, all of that stuff's really important.

It's important to teach our kids and to model it for our kids.

And two is, if you're in that high risk group, go and get a skin check done.

Just get your first one done and then you'll know whether you need to be doing regular checking or not.

So don't be shy about it.

If you've got a family member who's been affected by skin cancer, you will know the heartbreak that that causes.

And there is you know, we just don't need to.

We need to be getting out there and preventing cancers from progressing, treating them early.

Well, thank you so much for joining me today and for the refresh and the reminder I think for a lot of people that think they know the risks but perhaps aren't following through entirely how we should be.

Thank you so much for having me, Tony.

We need to talk with Coast FM's Tony Street.

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