Spot on: How I swallowed my fear to get a skin cancer check
It’s still tiny, the spot on my shoulder, but lately I’ve been worrying it’s getting bigger. By ‘‘lately’’, I mean for the past few years and by ‘‘worrying’’ I mean mostly ignoring it. A bit like sorting the dog’s registration or opening the bills, it’s become just another thing to avoid until it’s 3am and I’m looking for something to fret about.
So when a doctor finally presses a dermatoscope lightly against my skin I’m surprised at just how anxious I feel. It turns out I have been freaked out about the spot, which is exactly why I’ve ignored it.
I am a New Zealander after all. New research by specialist centre Skin Institute reveals the famed Kiwi attitude of ‘‘she’ll be right’’ also applies to our skin health.
A survey of 1000 people shows 84% of respondents haven’t had a skin check in the past year and more than half have never had one at all. Just 16% get checked annually, the frequency recommended by skin specialists.
Dr Sam Mayhew, Skin Institute’s skin cancer specialist, says the statistics are concerning, especially for a country with the highest incidence of skin cancer in the world.
Melanoma is Aotearoa’s thirdmost-common cancer and accounts for 80% of all skin cancer deaths, with 6000 people diagnosed every year.
Despite that, 43% of those surveyed said they just hadn’t thought about getting a check, while 40% didn’t believe they needed one and 33% considered it too expensive.
Mayhew concedes it can be expensive, though says there are multiple options; from the specialist full body checks at his clinic, to its free single spot check – and many GPs are trained in detecting skin cancer.
We should all be checking ourselves monthly as well. Asymmetry, border irregularity, uneven colour and change are among the things to look out for.
Kiwis live under the ‘‘perfect storm’’ of factors contributing to skin cancer, Mayhew says. Those include the country’s high UV intensity, the outdoor culture and our historical attitude to sun safety.
Like me, he grew up in the decades where a tan wasn’t only encouraged but recommended as a way to stop future sunburns and peeling skin. These were also the days of the sunbed, and while much has changed with modern sun-smart messaging we’re yet to see the full extent of the damage.
‘‘We’re not going to see that for another 30 years when they’re in the high risk group. Rates are going to get worse before they get better.’’
Another looming worry is how the pandemic saw Kiwis delay or entirely ditch health appointments; early detection makes a massive difference in skin cancer outcomes.
‘‘Are we going to have a big backlog of skin cancer? That’s my concern; we don’t know what we don’t know right?’’
According to the survey, we not only don’t know, we don’t really want to.
Despite the low numbers getting regular checks, one in five Kiwis have had skin cancer or skin concerns themselves, while one in five have a familial history of skin cancer.
That’s coupled with more than half of respondents admitting they wouldn’t feel confident identifying a skin concern and 14% having no idea how to identify early melanoma signs.
Of those who did get checked, about half were prompted to do so only after becoming concerned about a skin issue.
That’s all well and good, says Dr Shona Dalzell, but again the only thing better than prevention is early detection.
In a comfortable room at Wellington’s Skin Institute I’m undergoing what’s described as a ‘‘gold star’’ skin cancer consultation. First come the questions: is there a
particular skin issue you’re concerned about? Did you grow up in New Zealand? Have you had skin cancer before? A family history?
‘‘Yes, yes, yes, no,’’ I say, and then we get down to business.
The dermatoscope is a little handheld instrument that uses light and magnification to look at skin in ultra-close details.
Later, when I get a go looking through it at my own spots everything looks suspicious but Dalzell assures me she knows what she’s searching for.
She begins with my scalp – no mean feat with hair like mine – before moving onto my face, behind my ears and so on.
She checks my chest, which is a risky area for women because of the low-necked tops we tend to wear; under my bra strap and the backs of my thighs. Skin cancer can also develop on the genitals but we’re not going there today.
My feet don’t escape
examination though. Not only do Kiwi love our jandals, we often forget to apply suncreen to our feet; another perfect storm of risk factors.
After checking my soles, the top of my feet and even inbetween my toes, Dalzell says all is well.
And for the spot I’m now very much worried about?
The good news is it’s perfectly normal and something the doctor calls a ‘‘wisdom spot’’. The bad news is that’s just a polite way of saying ‘‘age spot’’ but nonetheless I’ll take it.
With a clean bill of skin-health and promising to get another check in a year’s time I walk straight past the reception desk without paying a thing. If the Skin Institute hadn’t comped it, this gold-standard treatment would have left my bank account about $257 lighter.
As it was, the only thing lighter was my worries.