Twenty-five people die of melanoma in the Bay of Plenty each year, according to the Cancer Society, and one Bay doctor says his youngest patient was just 15.
They report that our region has higher skin cancer and melanoma rates than the national average, possibly due to an ageing population and high sun exposure.
Because New Zealand sits close to a hole in the ozone layer, the sun's rays shine more directly on our skin. Geography and lifestyle are good reasons to stock up on sunscreen - but what kind?
Sarah Speight remembers basting herself in coconut oil and broiling in the sun. As a teenager, she says being brown and tan equated to healthy and attractive, though she always burned first.
"Growing up in the Bay of Plenty, it was the thing to do," she says. "I was 13 when my GP said it wasn't a question of if I'd get skin cancer, but when."
The combination of the doctor's warning and seeing her father "get bits chopped off" sent Ms Speight for annual skin checks, where her physician discovered basal cell and squamous cell carcinomas. Then, last year, at age 44, Speight was working as a consultant in Indonesia when she got very sick.
"They thought I had dengue fever, I was so unwell. I was admitted to hospital when I got back and they discovered a metastasized melanoma on my liver and lungs."
Doctors never found the primary melanoma spot.
Ms Speight says she was told she'd survive three to six months. That was last December.
Today, she credits immunotherapy and drug trials with prolonging her life. And she never leaves the house without sunscreen.
"I use the best darned sunscreen I can get - Neutrogena 85+, It's very, very good."
We checked, Kmart-branded sunscreen (SPF 50) which costs two cents per millilitre, Cancer Society sunscreen which costs seven cents per millilitre, and Clarins' brand (SPF 20) which costs 22.5 cents per millilitre, 11 times more than the Kmart version. Bay of Plenty Times Weekend spoke with local skin doctors and compared prices to learn what kind of protection is best.
Dermatologist Dr Neil Mortimer from Tauranga's Skin Centre said a minimum SPF (sun protection factor) of 30 is necessary in Australasia. He underscores the need not only for sunscreen, but other 'sun safe' practices including covering up with hats, clothing, wearing sunglasses and avoiding sun exposure during peak times of UV intensity in summer. Dr Mortimer said, "Basal cell carcinoma and Squamous cell carcinoma are prevalent in the Bay of Plenty. The region has one of the highest rates of malignant melanoma in the world. Reducing sun damage reduces the risk of developing skin cancer."
Dr Mortimer said children's skin is particularly vulnerable to damaging effects of ultraviolet light. "The same principles apply to sun protection but covering and avoiding sun exposure at those peak UV [ultraviolet] intensity times is even more important" [10am - 4pm from September to April].
Dr Franz Strydom, founder of Skinspots Skin Cancer Clinic in Mount Maunganui, said his practice sees hundreds of people each month. He said their youngest melanoma patient was 15 years old. "I've sent over 1800 samples to be analysed by Pathlab in just over a year, and that's one person. We have four doctors working here and we're not keeping up."
Dr Strydom said sunscreen must be reapplied every two hours and after swimming or sweating. Most importantly, don't go in the sun during peak times. If you do, you need to be covered up." Dr Strydom said he wears an invisible zinc formulation. "The more chemicals in the preparation, the more likely it will be uncomfortable and cause a reaction. You don't have to go for the most expensive one. Find one with a good protection factor that won't wash off that's comfortable to wear." Dr Strydom said some people react negatively to certain sunscreens; for them, finding the right one means trial and error.
Dermatologist Dr Ben Tallon of Tauranga's SKIN Dermatology Institute said sunscreen quality can vary widely. "For example, there are differences in the stability of the UV protection, as some products deteriorate rapidly when in the sun while others have been prepared to be more photo stable." Dr Tallon said major brands are better-researched and SPF matters. "SPF is measured at the lab at much thicker applications, so in reality what we put on is very thin." He said the increment can make a difference.
There are two main kinds of sunscreen - those with organic (chemical) blockers and those with inorganic (metal) blockers. "I tend to suggest the inorganic blockers (titanium/zinc) when people think they have irritation from sunscreens."
A scholarly publication called Research Review states "the most expensive sunscreen is not necessarily the best."
The New Zealand Cancer Society recommends products that meet joint New Zealand/Australian standards, labelled AS/NZS 2604:2012. Sunscreens degrade with age and should be tossed out 12 months after opening regardless of the expiry date. The Cancer Society said SPF 30 filters 96.7 per cent of UV radiation and SPF 50+ filters 98 per cent. According to the CS website, both "provide excellent protection as long as they are applied properly".
Research shows the younger someone gets burned, the more likely they are to get skin cancer later.
"If I see kids outside getting burned, it borders on child abuse, as far as I'm concerned," said Dr Strydom. "Parents need to encourage kids to wear long sleeves in the summer; clothing is far better protection than sunscreen. Get rash shirts - nylon shirts are better than anything else."
Administrators at several Bay of Plenty schools we surveyed say they stock up on sunscreen by the litre. Papamoa Primary School principal Phil Friar said his school bought 15 litres of Help It Ultra Block SPF 30+. Each classroom has a container, which also goes on excursions. And Mount Primary principal Damien Harris said the school is working with the Cancer Society to meet requirements to become a 'Sunsmart School.' The designation allows schools to buy discounted sunscreen from the Society. Supervisor of Papamoa and Te Puke Sandbox Preschools, Trudi Ann More, said the centre uses Cancer Society sunscreen (SPF 30+), and parents can also provide their own. Just as in schools, sunhats are required during terms four and one, and kids are sunblocked up to three times per day. More said slopping cream on 40 children at once takes time, and babies pose special challenges. "Especially for infants who may take their hats off, we sunblock their scalps, as well."
Dr Strydom said the best sunscreen is one you'll use and reapply often. He said common mistakes are failing to apply enough lotion, not applying it evenly, failing to reach all exposed skin, and forgetting to reapply.
No matter how high the SPF, Dr Strydom said sunscreen is not a primary shield. "They should be using something else like shirts, hats, going inside, sunglasses Sunscreen is the last line of defence. It should never be the first line. People shouldn't be dying of melanoma. It's one of the most dangerous cancers to get, but also one of most treatable if you get it checked."
Unfortunately, Sarah Speight says her melanoma was found too late, and it's unlikely she'll enter remission. "The average life span for diagnosis at stage four is nine months. If I get five years I think I'll be doing very well. All I can do is help people get the message the sun is lethal. It doesn't matter you're not tanned; if you're healthy at 45, that's a good outcome."