"I shouldn't have waited so long."
Those are the words of Tauranga woman Pamela Jones who hopes others don't have to experience the past eight years she has.
A mole on her back in December 2012 was the first sign she needed to be checked but with the rush of the holiday season, Jones decided she would see to it at an easier time.
"I should have also looked at my back because it was quite bad and quite deep. It had infiltrated my lymphatic so it was in my bloodstream."
It being melanoma which is more than "just a skin cancer", Jones said, who now has tumours in her brain.
The past eight years have been a rollercoaster of treatments for Jones, who has been fighting cancer with a positive outlook since day one.
New Zealand has the highest incidence of melanoma in the world with more than 4000 cases diagnosed each year.
More than 300 Kiwis die from melanoma each year, which is more than the annual road toll.
Jones had surgery to have the cancer removed in 2013 but a few months later she noticed blue dots around her groin area.
The cancer had spread but she was able to get a new drug Dabrafenib, specifically for melanoma, on compassionate grounds, meaning she did not have to find the $21,000 a month it would usually cost.
It worked for her for two years until bumping her head led to an MRI and she found out brain tumours were now part of her diagnosis.
"All it has done for me is make me live every day and enjoy my life. We've all got a journey and none of us knows when it's gonna end."
Countless surgeries and medications, a new diagnosis of rheumatoid arthritis, believed to be a side effect of medication, plus a hip replacement, and radiation in her brain have all been part of her journey.
In January she will undergo her "last hope"; another five day round of radiation on the brain.
"This is what can happen. People don't realise how dangerous melanoma can be.
"This could be you if you don't get checked."
The Bay of Plenty District Health Board did not respond to a request for comment, instead provided a link to the cancer registry website.
However, the Lakes DHB said the approximate cost to treat each melanoma patient over the past four years was $9000.
Lakes DHB was also able to provide a breakdown of those who had an episode at Lakes DHB with a principal diagnosis of melanoma from 2017 to 2020.
The Cancer Registry provided "the most up-to-date" data for the Bay of Plenty area, up to 2016.
Ninety-eight people were diagnosed with melanoma in Tauranga in 2016 and 40 in the Western Bay.
Seventeen people in Whakatāne and one person in Kawerau and Ōpotiki respectively were also diagnosed. Across all areas, the number of men with melanoma was overwhelmingly higher than women.
There were 29 deaths in the Bay of Plenty DHB area in 2016 caused by malignant melanoma. The number was the fourth-highest out of all health boards.
Dr Rosalie Stephens, medical oncologist and Melanoma New Zealand board trustee, said New Zealanders' complacency was part of the problem.
"There is a range of factors that contribute to our high melanoma rates. Our UV radiation intensities in New Zealand are high because of our environment.
"We have less ozone than elsewhere, we have clean air and the sun orbits closest to the Earth during our southern hemisphere summer.
"That, combined with New Zealanders' love of an outdoor lifestyle and our complacency when it comes to protecting our skin from the sun, contribute to our very high melanoma rates."
Typically, melanoma is caused by sun exposure in people with a fair skin type, however, everyone is at risk.
Those who have a personal or family history of melanoma are more at risk, Stephens said and so are those who use sunbeds.
However, thinking you are safe because of your olive skin will not work. Stephens said those with olive or darker complexions can still get melanoma.
"Melanoma is a problem for Māori, who have a disproportionately high death rate from melanoma, compared to the rate of diagnosis."
The aggressive melanomas usually present as a new spot on the skin, so Stephens advised getting a GP or specialist to check a skin lesion that hasn't been noticed before.
If there is a change in an existing freckle or mole, such as a change in colour, change in shape or size, bleeding, or itching, that also needs immediate attention as not doing so could be fatal.
"The melanoma cells have the ability to survive and spread to lymph nodes and other parts of the body through the blood stream.
"Melanoma can spread from the skin to the brain, lungs, and liver and once that has happened it is difficult to cure it."
Te Aho o Te Kahu Cancer Control Agency chief executive Professor Diana Sarfati said being sun smart should be a priority.
"In regions like the Bay of Plenty, which has high sunshine hours, it is vital people take being sun smart seriously.
"Skin cancer is New Zealand's most common form of cancer, estimated to make up approximately 80 per cent of all new cancer diagnoses each year."
New Zealand performs poorly against other comparable countries when it comes to skin cancer. It is second only to Australia in skin cancer diagnosis, according to the World Health Organisation.
Dr Rosalie Stephens' sun smart tips
Melanoma is largely preventable if we practise sun smart behaviour and avoid getting sunburnt, especially in childhood and young adulthood. Sunscreen is very effective at doing this if applied liberally and frequently.
• Sunscreen should be at least SPF30, broad spectrum which means it protects you against both UVA and UVB rays, and water-resistant
• Check the packaging for the expiry date and that it meets the Australian New Zealand Standard
• Sunscreen should be applied 20 minutes before going outside and reapplied every two hours, or more frequently after swimming, towel drying or sweating
• Nine teaspoons of sunscreen for should be used for an average adult on each application
It also helps to avoid sun exposure in the middle part of the day and/or from September to April, especially between 10am and 4pm.
Beach poll - Are you wearing sunscreen?
We visited Pāpāmoa beach on Sunday to ask people whether they were wearing sunscreen if so, or if not, why? Here's what we found.
Daniel Arnott, 24, Auckland
"Yes, SPF50. I don't want to get cancer but you've got to enjoy the sun."
Charlie Wall, 23, Auckland
"Yes. I've been notoriously burned before so I try to avoid that."
Ross Attwood, 32, Te Puke
"Yes. Today is my first day wearing sunblock in two months. I find it really hard putting it on ... but I'm trying to take that step."
Flynn Mansvelt, 19, Taranaki
"No, because I just got up and have come out (for a look at the beach). I will probably put some on later."
Tyron Titter, 19, Taranaki
"No, but I will put some on later when it's hotter."
Deqers McQueen, 18, Taranaki
"I've got some on. I put it on every day, when it's sunny. I just don't like that feeling of getting burned, especially when you're trying to sleep."
Jan Coleman, 77, Pāpāmoa
"I've never worn it and I lived in the tropics for one to two years when I was younger. I don't know why I don't, but I just never have."
Warren Garrick, 67, Mount Maunganui
"No, I should be. Normally I do, and normally I wear a cap."