New Zealand has one of the highest rates of melanoma – a serious type of skin cancer – in the world. Thanks to our constant exposure to ultraviolet (UV) radiation from the sun, nearly all New Zealanders will have a skin cancer scare at some point in their lives.
Most skin cancers, especially those detected in the early stages, can be cured. But some are harder to treat, and may even be fatal if they spread to other parts of the body.
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Regular self-exams, skin checks by specialists, prompt screening and early treatment are key to beating skin cancer. While some risk factors for skin cancer are genetic, others are related to lifestyle and can be modified. Taking extra steps to protect your skin can go a long way towards lowering your risk of developing skin cancer.
Many skin cancer treatments and medications are publicly funded in New Zealand. However, some newer Medsafe-approved drugs are not covered by our government’s Pharmac funding, which means patients need access to health insurance benefits or to find other ways to fund expensive treatments.
Skin cancer in New Zealand
Melanoma is one of the most common cancers among Kiwi men and women, and the number of new cases and deaths continues to rise. In 2011, there were 2,211 new melanoma registrations in New Zealand and 359 deaths. In 2020, melanoma accounted for 2,801 new cancer cases and claimed 472 lives.
New Zealand’s high number of skin cancer cases are caused by a number of factors:
-
many inhabitants with fair skin or light skin tone
-
predominantly outdoor lifestyle
- high ultraviolet (UV) radiation levels
- low ozone levels
What is skin cancer?
Skin cancers are malignant tumours formed by mutations in skin cell DNA. These mutations cause uncontrolled growth of the skin cells.
Types of skin cancer
There are two main types of skin cancer: Keratinocyte carcinoma (nonmelanoma) and melanoma.
Keratinocyte carcinoma (nonmelanoma)
Nonmelanoma skin cancers include basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), which are the most common types of skin cancer. These usually form on parts of the body that get the most sun exposure, such as the neck or head. They don’t spread as aggressively as melanomas, and are generally less life-threatening.
Basal cell carcinoma (BCC)
Among skin cancers, BCC is the most common and the least dangerous, but if left untreated it can spread to other parts of the body.
Though BCC usually occurs in older adults, it can also develop in people in their early 40s or even younger.
BCC often starts in parts of the body that are most exposed to the sun, such as the face, neck and ears.
BCC can appear as a:
-
pearly white or smooth lump
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waxy bump or scar
- flat, flesh-coloured or brown scar
- recurring sore that bleeds and crusts over
Squamous cell carcinoma (SCC)
SCC can develop on sun-exposed parts of the body such as the face, forehead, ears, lips, nose, neck, hands, and forearms. These SCCs may be hard to see on darker skin tones.
SCC is more common among individuals over 40 years old who have spent a lot of time outdoors. It is curable, especially if detected and treated at the early stages. If it progresses to an advanced stage, it can be life-threatening.
SCC may look like a:
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red swelling
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lesion that refuses to heal
- thick, wart-like growth
- skin growth that bleeds and crusts
Bowen disease (squamous cell carcinoma ‘in situ’)
Unlike invasive SCC that spreads inside the body, Bowen disease develops on the skin’s surface. It appears as scaly red or pink patches which may be flat or raised and can be easily mistaken for a rash or eczema.
Melanoma
Melanoma is the most dangerous type of skin cancer. It starts from melanocytes, which are the cells responsible for our skin colour. Melanoma is able to spread very quickly throughout the body and can become life-threatening.
Melanoma can:
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start from an existing freckle or develop as a new spot, possibly a different shape or colour than others
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begin as a benign mole that grows or changes its colour or shape
- appear as an irregularly shaped lesion, with shades of pink, white or blue-black
- develop as a shiny, raised growth
- sometimes feel painful or itchy, and may bleed or weep
- develop anywhere in the body, even those areas that are not exposed to the sun, such as toes, fingertips, palms, soles of the feet, and mucous membranes in the nose, mouth, vagina or anus.
Who gets skin cancer: causes and risk factors
The main cause of skin cancer is ultraviolet (UV) light, primarily from sun exposure or tanning beds. Other factors that can increase your risk of developing skin cancer include:
- Age – melanoma is more often diagnosed in people who are in their 50s or older.
- Fair skin – light-skinned people with blonde or red hair have less melanin to protect their skin from the harmful effects of UV radiation.
- Lots of moles (50+) or large, abnormally shaped moles.
- Family history of skin cancer.
- Personal history of skin cancer (have been treated for skin cancer in the past).
- History of severe sunburn.
- Living at higher altitudes and/or in sunny climates
- Compromised immune system (e.g. those with HIV/AIDS or on immunosuppressant drugs)
- Exposure to arsenic, coal tar and other cancer-causing chemicals
- History of radiation treatment
- Human papillomavirus (genital warts)
- Smoking
- Precancerous skin lesions
- Persistent skin diseases, wounds, or scars
- Genetic conditions such as albinism, Gorlin syndrome, and Cowden disease
What are the symptoms and warning signs of skin cancer?
Skin cancers can start out as changes to existing moles or spots, or as new lesions or growths.
Visit a skin specialist, GP, or a skin check service when you notice moles, freckles, or spots on your skin that:
- are new
- look different to other moles or marks on your body
- bleed, and/or won’t heal
- Thicken, grow in size, or change colour or shape
Importance of regular skin checks and self-examinations
Early detection and treatment are key to beating skin cancer. Specialists can give you regular skin checks or you can do monthly self-examinations.
Regular skin checks are even more crucial for Kiwis who are over 50 years old, those who have had skin cancer in the past, or anyone who identifies with the other higher risk factors for developing skin cancer.
Becoming familiar with your own skin will improve your chances of spotting possible cancers, and getting them seen and treated while still in the early stages. Do thorough self-examinations at home and check every inch of your skin for unusual spots.
Skin cancer self-examination
When doing self-exams, start at your head and scalp and work down. To check hard-to-see areas like your scalp, neck or back, use a handheld mirror or ask someone else to examine these areas for abnormal spots.
Keep in mind that skin cancer can develop even in parts of your body that are not exposed to the sun. So be sure to examine ‘hidden’ areas like your armpit, groin, inner leg, the soles of your feet and the skin between your fingers and toes.
When doing a self-exam, keep in mind the ‘ABCDE’ of skin cancer:
- Asymmetry: does one half of the mole look different to the other half?
- Border irregularity: are the borders of the mole irregular or blurred?
- Colour: is the mole different shades of colour, or has it lightened or darkened?
- Diameter: is the mole’s diameter bigger than a pencil eraser?
- Evolution: is the mole’s size or colour changing, has a flat lesion become raised, or is there itching or bleeding?
Medical tracking apps such as SkinVision (some elements of which are free but others require a small fee) let you take photos of spots or lesions so you can monitor changes in their size or appearance. Some apps also send notifications to remind you to perform regular skin exams.
Skin cancer screening and diagnosis
Skin specialists or doctors can do a full examination to check for moles or patches. If they find a suspicious spot, they may take a tissue sample (biopsy) to confirm the diagnosis or to identify the cancer type.
When staging or determining the skin cancer’s severity, doctors consider several factors such as:
- the size of the tumour
- if it has affected the lymph nodes
- If it has metastasised (spread) to other parts of the body
Stages of nonmelanoma skin cancer
- Stage 0: the cancer cells are only on the epidermis (the skin’s outermost layer)
- Stage I: the cancer has entered the dermis (inner layer of the skin), but the affected area is about 2cm or less
- Stage II: the tumour’s diameter is over 2cm but the cancer has not affected surrounding areas
- Stage III: the tumour is over 3cm in size and has affected tissues, muscles, lymph nodes or bones around it
- Stage IV: the cancer has advanced beyond the original cancer site and reached other parts of the body
Stages of melanoma
- Stage 0: the cancer is confined to the epidermis (the skin’s outermost layer)
- Stage I: the cancer cells have reached the dermis (inner layer of the skin).
- Stage II: the tumour is contained within the original site but has grown larger and developed other symptoms, such as bleeding
- Stage III: the cancer has spread to nearby lymph nodes or surrounding tissue.
- Stage IV: the cancer has spread beyond the original site and affected distant lymph nodes, tissues, and organs such as lungs, bone, liver and brain
Skin cancer treatment
Early-stage skin cancers can often be treated successfully. Advanced skin cancers are harder to cure and can be life-threatening.
Most skin cancers can be treated through surgery. The treatment plan may also depend on factors like:
- the type of skin cancer
- the tumour size
- its location
- The number of tumours
- the stage of skin cancer
Skin cancer treatment options include:
- excision biopsy
- wide local excision
- Mohs micrographic surgery (MMS)
- cryosurgery
- laser surgery
- electrosurgery
- topical therapy/medications
- radiation therapy
- photodynamic therapy
- oral medications/targeted therapies
Melanoma treatment may include:
- surgery
- chemotherapy
- radiation therapy
- immunotherapy
- targeted therapy
Several treatment options, including immunotherapies, may be funded by Pharmac. But other life-prolonging medications are not publicly funded. Patients with non-funded medications cover on their health insurance plans can use their benefits to fund these often very expensive medical treatments.
To find out more about non-Pharmac funded treatment cover, book a FREE consultation with a Policywise adviser.
Skin cancer complications
Skin cancers can develop complications or become aggressive if they are not treated early. This may lead to:
- ulcerations
- bleeding
- damage to surrounding areas or tissues
- metastasis, where the cancer spreads and reaches the lymph nodes, muscles, organs like the brain and liver, or other parts of the body that are distant from the original tumour
Prevention: reducing your risk of skin cancer
Regular self-exams can help you catch precancerous lesions or any suspicious spots before they spread.
Most skin cancers are due to UV damage. Keep in mind that the sun’s UV rays can still damage your skin even on cloudy days. So always protect your skin, whether under the hot sun or on a winter day.
There are many ways to enjoy the outdoors while minimising your risk of developing skin cancer.
- Avoid sun exposure when UV rays are strongest in New Zealand, particularly from September to April between 10am and 4pm. You can also download apps that show UV index forecasts in your area so you know the hours when you most need to use skin protection.
- If you can’t avoid being outdoors, find a shaded area.
- Avoid sunburn.
- Avoid tanning or using tanning beds or sunlamps.
- Use a broad-spectrum sunscreen and lip balm with a sun protection factor (SPF) of 30 or higher year-round. Apply 15-20 minutes before going outdoors, especially on areas that won’t be protected by clothing, like ears, neck and the back of hands. Reapply every two hours, or more often if you’re swimming or sweating.
- Wear close-fitting sunglasses with 100% UVA and UVB protection.
- Wear a wide-brimmed hat that shades your head, face, ears and neck.
- Wear clothing that offers protection, such as collared shirts, long-sleeved tops and long trousers.
And if you are taking prescription or over-the-counter medicines, ask a pharmacist or doctor if they increase your sensitivity to light. If they do, take extra steps to protect your skin from the sun.
Worried about skin cancer and the cost of treatment? Health insurance can give you peace of mind
While many skin cancer treatments and medications are publicly funded in New Zealand, other life-prolonging drugs are not. Long wait times in some hospitals also add to patients’ stress. It’s not uncommon to wait eight weeks to receive a first specialist assessment, and closer to nine weeks to get a first round of treatment.
Patients who want to access private hospitals, where waitlists are shorter, or to access Medsafe approved non-Pharmac funded drugs have to pay for these out of their own pocket if they don’t have appropriate health insurance cover.
Below is some general information on the costs of treatment without health insurance.
Cancer treatments
1 AIA Health Claims Data, 1 July 2019–30 June 2020. 2 Thomas, R & Mussen, D. “Desperate Melanoma Patients Forced to Fundraise for Life-Extending Treatment.” Stuff, 16 Feb. 2016. stuff.co.nz/national/health/76886372/desperate-melanoma-patients-forced-to-fundraise-for-life-extending-treatment. 3 Goodwin, E. “Melanoma Drugs Come at a Cost.” Otago Daily Times, 30 Apr. 2015, odt.co.nz/news/dunedin/melanoma-drugs-come-cost.
Health insurance can give you more options to shield your family from the financial burden of cancer. Having better healthcare alternatives – such as being able to afford life-prolonging non-funded medications, or to access private facilities instead of sitting on public hospital waitlists – can give you peace of mind and more quality time.
Your health insurance may cover your:
- medical consultations
- treatment procedures, including surgery
- treatments not funded by Pharmac
A Policywise adviser can help you compare health insurance plans and the scope of their cancer cover benefits and inclusions.
To help you choose a plan, we summarise and compare products from top-rated health insurance companies. Download the full chart or contact us to request a quote comparison today.
Some life insurers also pay out lump sums to critically ill patients. Book a call with a Policywise adviser to discuss how life and health insurance plans can help with the financial toll of cancer.