Transcript: Summer's Coming: Spot The Problem - Consume This podcast

Dr Shona Dalzell: So just looking at your history, you've got something that's bothering you, is that right?

Christina Baldarelli: Yeah, well I have a few, yeah, I have a few sort of, I mean I have a lot of moles anyway. I have had one removed in the past, they didn't even track it, they just said that one's got to go. But then, yeah, I've got a couple spots on my face that bother me and I don't know if they're things that are going to turn into moles. I have quite a lot of those little red spots that turn into moles.

Dr Shona Dalzell: Now tell me, you've had something taken out that you've indicated to your chest, is that right?

Christina Baldarelli: Yeah, on, on like, my right breast I had a mole taken out once. Like a little sort of American football shaped chunk that was taken out. And it was just, they didn't like the shape, they didn't like the outline.

Sophie Stewart: This is Christina Baldarelli. She's originally from California, but has spent the last 11 years living in Aotearoa. She's currently based in Wellington with her partner and two young children. Her family have a history of melanoma, and as you've just heard, she's also had her own issues in the past.

Christina Baldarelli: I've had to have two moles cut out before. They just didn't like the shape of it, didn't like it was uneven in colour, and then I've had another similar one on my back before.

Sophie Stewart: We're joining her in Dr Shona Dalzell's office in the Skin Institute. She is preparing to undergo her first skin check in over five years. Which for someone with her history, does feel like a long time.

Christina Baldarelli: It's been weighing on me that I haven't prioritised getting my own kind of preventative healthcare. Enough time has passed that it's just, I feel the pressure I need to kind of put it on the top of the stack.

Sophie Stewart: But today's visit is also spurred in part by two new moles that she's noticed recently. One on her chin and one on her nose.

Christina Baldarelli: I think, you always mentally prepare yourself, that like, hey, alright, you know, you're probably going to find a little something.

Sophie Stewart: Hopefully, once Dr Shona has had a proper look, she'll tell us they're nothing to worry about. But it's worth remembering that here in Aotearoa, we do have the highest melanoma rate in the world.

Dr Shona Dalzell: Alright, so we're just going to go through the other room and we'll do your examination.

(🎶 Intro music 🎶)

Sophie Stewart: You're listening to Consume This with me, Sophie Stewart.

As we approach the official start of summer - that's the 22nd of December if you're curious - it's time for our annual reminder that despite being essential for all life on earth, the giant nuclear fusion reactor in the sky is also slowly, subtly trying to kill us.

Yes, I'm talking about the sun, and as we know, it's trying just that little bit harder to burn us here than almost anywhere else in the world. That's why, as I've already mentioned, we have the highest rate of skin cancers. Over 80,000 of us are diagnosed with one every year. It accounts for 8 out of 10 new cancers and costs the health service almost $200 million annually.

In fact, my dad just had one removed the other week.

We get lots of sunburn and a higher dose of UV than most of the world. To explain why, I've called in an expert.

Olaf Morgenstern: Right, my name is Olaf Morgenstern, I'm a principal scientist, climate and atmosphere here at NIWA. I've been in atmospheric science since I started my PhD in 1994, so it's a long time ago.

Sophie Stewart: So it turns out that there are four main factors.

Olaf Morgenstern: So ozone is one of those.

Sophie Stewart: Ozone is a molecule made up of three oxygen atoms bound together.

Those atoms vibrate at a frequency that absorbs harmful UV rays in the atmosphere before they reach the ground. And our skin. Essentially it acts as a big blanket of sunscreen for the planet.

Olaf Morgenstern: Ozone absorbs UV, so the ultraviolet light that comes from the sun. If that wasn't the case we would have much larger levels of UV at the surface, and it would essentially prevent terrestrial life from occurring. Or at least not in the forms that we know today.

So we express total amounts of ozone in terms of Dobson units, where a Dobson unit is a millimetre of ozone at high pressure essentially. So we might have about 300 Dobson units or so here in summer. In the Northern Hemisphere it's exceeding 400.

Sophie Stewart: So that's part of it. We naturally have a lower concentration of ozone than they do in the Northern Hemisphere. Plus, very occasionally, bits of the ozone hole that usually lives over Antarctica can break off, drifting casually over the top of us, which is obviously not great. The second reason, somewhat unbelievably, boils down to dust. Anybody know dust? Apparently, we have less dust here. Yes, really. Everyone needs to stop vacuuming.

Olaf Morgenstern: So if you go out, if you've been to the Northern Hemisphere, you notice that the visibility in this country, is often a lot better than in comparable places in the north.

That's because of the particulate matter in the air that is just lower here in this part of the world. But these particles would also be reflecting UV back into space, and so they contribute to the protection that we would otherwise... Well, they don't contribute because of their absence in this country so much.

The third factor is that the earth is not on a circular path around the sun, you know, in its annual development, but rather on an elliptical path. And so in our summer, the distance between the sun and the earth is actually relatively small. So the distance minimizes in our summer and maximizes in our winter, whereas in the northern hemisphere, it's the other way around.

Yeah, I mean, there's an astronomical factor that is quite basic.

Sophie Stewart: So yeah, quite basic. Essentially, we're victims of our own geography. The Icarus of the Earth, flying too close to the sun.

Olaf Morgenstern: But they don't explain all of the difference in UV that we observe in this country relative to the Northern Hemisphere.

So there's a significant fourth factor that we have to associate with clouds, where the clouds here are different from the North and effectively allow more UV through.

Sophie Stewart: If you think that sounds very vague, well, you're not alone. We know the clouds are up to something, those sneaky bastards, but it's not really clear what.

Olaf Morgenstern: Yeah, well, that's a research problem.

Sophie Stewart: Research is currently being undertaken in collaboration with the University of Hanover in Germany, so watch this space. I want to get back to Christina and her skin check very soon. We can't leave her hanging for too long. But first, how does all of this UV translate into actual sunburn?

To answer that question, we're going to need another expert.

Dr Bronwn McNoe: So, there's two main types of UV that actually reach the skin surface, UVA and UVB, and they just differ by their wavelengths, essentially.

Sophie Stewart: This is Bronwyn McNoe. She works for the University of Otago, on the Cancer Society Research Collaboration.

Dr Bronwn McNoe: So UVA penetrates much more deeply into your skin and it results in skin ageing and tanning. So that doesn't actually stand for ageing, but that's how I remember it. And UVB, which reaches the epidermis, which is the more outer layers of skin, and that causes your skin to burn. So both UVA and UVB do cause skin cancer. And so when you're thinking about sunscreen, broad spectrum just means it blocks UVA and UVB, whereas the SPF factor of sunscreen just is talking about the UVB component.

UV rays generally will, damage the DNA within the skin by causing alterations of the DNA structure. So the DNA damage is what will result in your increase in risk for skin cancers in terms of the actual sunburn. How that happens. is that when you're exposing your skin to too much UV, you're damaging the skin cells and what they do is they release a chemical, which then triggers an inflammatory response. And you can see that physically with redness and swelling and heat and pain in your skin. Your body responds to that by causing inflammation, dilation of blood cells near the skin surface where you've got that damage, and causing your skin to feel sore and red.

Yeah, essentially that's the process.

Sophie Stewart: So sunburn is an immune response which is triggered by UV rays causing damage to our DNA. It's also something that Christina has had more than her fair share of.

Christina Baldarelli: Yeah, oh, I could get real deep on that, eh? Cause like so much of it just comes down to your social circles and your, you know, your self image and that kind of thing.

Like when I was growing up you were just gonna be tan and you were gonna be in the sun and, I mean, our favourite activity was laying out, literally. We'd go, do you want to go lay out? You know, and we would go to the pool, we'd go to the beach, and we'd just go lay there and chat. That was the social activity that we did.

Um, so it would be really hard not to do. Now, um, I mean, I'm a lot more my own person, right? Like, I'm not exactly succumbing to the peer pressure of going around to Days Bay Beach and, you know, want to see and be seen or anything.

Sophie Stewart: When we left her at the start of the episode, she was just heading in for her skin check. She's changed into a gown, removed her makeup, well, most of it...

Dr Shona Dalzell: Okay, so I see you've got lovely nails. Now you can actually get melanoma underneath the nail.

Christina Baldarelli: Okay. Okay, alright.

Dr Shona Dalzell: Um, so if you notice a dark streak in the nail.

Christina Baldarelli: Yeah.

Dr Shona Dalzell: Now, next time your nail polishes off, just have a look.

Christina Baldarelli: Yeah, good.

Dr Shona Dalzell: You can get melanoma anywhere. You can get melanoma where the sun doesn't shine.

Christina Baldarelli: Yeah, really? Oh, wow.

Dr Shona Dalzell: And Bob Marley actually died of a melanoma of his toe.

Christina Baldarelli: Really?

Sophie Stewart: Christina is now sitting in the middle of a well lit room. Kind of like a dentist, but with a friendlier vibe. Dr Shona pulls out a dermatoscope. It's a special kind of polarised magnifying glass that lets her examine the subsurface skin structures in Christina's epidermis.

Dr Shona Dalzell: Okay, so, like any sort of good examination, it starts with a history. So you find out about risk factors, and then you find out what the patient is concerned about as well.

And then it's sort of doing a stepwise examination, starting a top to toe examination, looking for anything that might be concerning and that can be sort of both what we call pigmented or cutted lesions or it could be things which are scaly, raised, bleeding, non healing, those sort of things.

Sophie Stewart: She starts off by examining the spots Christina is most concerned about.

Dr Shona Dalzell: So these little red dots that you're talking about, they're little capillary hemangiomas, they're a little gift of time, those ones.

Christina Baldarelli: Yeah, yeah, they're adding up with time, yes.

Dr Shona Dalzell: So, they're harmless.

Sophie Stewart: Okay. So that's great news, but there's still the rest of the body to check, and that's where Shona finds something that she's not so sure about.

Dr Shona Dalzell: This little mole, which is pretty tiny on the back of your right shoulder here, probably one that you would never think about

Christina Baldarelli: Not at all.

Dr Shona Dalzell: It's only about 3mm if that, okay? But when we look here, we can see that it's got... the pattern when we divide it into quarters, all looks a little bit different, right? It's not nice and even through. We've got what we call some globules here, over this side here, okay? A little bit of grey under here.

Christina Baldarelli: Yeah, it's so crazy because when you just look at it, it looks just like a regular mole.

Dr Shona Dalzell: It does, doesn't it?

Christina Baldarelli: Yeah. Yeah.

Dr Shona Dalzell: Yep. So, I mean, that's the importance of getting your skin checked. Sometimes it's just not what bothers you, that bothers us, right?

Christina Baldarelli: Mm-Hmm.

Dr Shona Dalzell: Um, and having the right tools to be able to look at the, the skin properly.

Christina Baldarelli: Yeah.

Dr Shona Dalzell: So you can make a proper assessment.

Christina Baldarelli: Yeah. That's amazing. Like I would not guess that closeup photo is this little spot compared to the spot next to it, which looks exactly the same.

Dr Shona Dalzell: Yeah.

Sophie Stewart: So Dr. Shona has found something that she's concerned about. It might be cancerous or it might not be.

The only way to know for sure is to have it taken out. After Shona has finished her inspection, Christina gets dressed and makes an appointment to have it removed in a couple of weeks time.

Dr Shona Dalzell: So we'll get Christina in and we'll put a little bit of local anesthetic in, a numbing agent in, and we'll take out that lesion with a small margin, put a couple of stitches in that and then we'll send it away to the laboratory to be processed.

They'll look under the microscope and they'll just see whether the cells are behaving themselves or not.

If it is a skin cancer, then we'll need to take some more out. And then it really depends on if it is a skin cancer, when they look under the microscope, they look at the length, the depth of the cell and sort of the surrounding tissue around that, and then that will decide whether further investigation is needed or just take it out with a wider margin.

Sophie Stewart: Dr Shona doesn't seem particularly phased by this discovery. So just how common is it for her to find something she wants to remove?

Dr Shona Dalzell: Look, it can be quite variable and it can depend on your patient list of the day.

Of course, skin cancer increases with age and it also can increase in location as well. So often places like Nelson, where people get a lot of sun, there's quite a high rate and you probably find something every second consultation. And an older population as well.

Not necessarily melanoma, but a lot of squamous cell and basal cell and a lot of sun damage. So, it is a little bit variable, but, you know, usually you would find a skin cancer most days, whether or not it's a melanoma. Melanoma is less common. Much more common are the non melanoma skin cancers.

Sophie Stewart: That is remarkably common, but there are some simple steps we can take to drastically reduce the chance that one of those people is us. The first is, before we go out, we should get into the habit of checking the UV index. It's not hard. You'll be able to find it on your phone's weather app. NIWA also publishes it on their website.

Dr Bronwn McNoe: It's about the amount of UV reaching the Earth's surface. So at the UV index of 3, sun protection is recommended. At a UV level of 6, the levels are considered high, so you would take even more precaution. At a UVI of 8, it's very high. And then a UVI of 11 is extreme, and you would consider staying inside at those levels.

Sophie Stewart: And that some protection should involve the old slip, slop slap & wrap. Staying covered up and wearing sunglasses.

Dr Bronwn McNoe: So, just basically, essentially, if you're covering up with clothing, the UV can't reach your skin. If you do use shade, and it's good shade, it can reduce UV by 75%, so very effective sun protection strategy.

Sophie Stewart: And of course, one of our favourites here at Consumer NZ - wearing SPF 50 plus sunscreen. Which is now actually 50 plus. Thank you, Consumer NZ.

Dr Bronwn McNoe: So it's important when you are using sunscreen that you make sure that you apply enough. You have to apply it reasonably thickly. So for an average size adult, if you're not wearing very much, it's 45 grams, which is about a teaspoon per body part.

You need to make sure that it's broad spectrum. It's better if it's SPF 50 plus. You need to apply it 20 minutes before you go outside, and then two hourly after that.

Sophie Stewart: And like Christina, if there's something you are concerned about, go and get it checked out. You don't necessarily have to go to a specialist clinic, you might just be able to go to your GP.

Surveying by Bronwen and the Cancer Society indicates that almost 90 percent of us know all of this. But it doesn't seem to be having much of an impact. Our skin cancer rate is flatlining, whilst across the ditch in Aussie they're seeing it trending down.

Dr Bronwn McNoe: So Australia has basically left us behind in every single dimension. Except for now, we actually have sunscreens regulated, which is great.

They're investing a considerable amount in their national campaign. Even the SunSmart program. They've got a complete ban on sunbeds. We do not have that. We only have restriction on those aged 18 years old and over.

They have removed GST off sunscreen. We have not done that.

They have funding, not all the states, but some of the states have shade grants available for schools to apply for to put shade into their playgrounds. In a New Zealand school, if you want shade installed, you're going to have to fundraise for it. The Ministry of Education does not fund it, unless it's a new school. So, that's quite a big ask for a school to do that.

And as a result in Australia, their melanoma rates are now coming down. Ours are not coming down. That just shows the investment that they've made over decades, really.

So, skin cancer is like 20 years, so that's a long time. Outside most politicians career. So, I think that's an issue for us. And I'm not quite sure how that can be addressed really.

Sophie Stewart: So ultimately, while we are always going to be exposed to more UV than our friends in the Northern Hemisphere, there are things we can do to reduce our skin cancer risk.

We know what to do. We just have to do it.

As with many things that involve behaviour change, it's not going to happen overnight. It needs sustained, generational change. Talking to Christina gives me hope.

Hope that the message is trickling down.

Hope that there's an end in sight for our frankly ridiculously high skin cancer rate.

Christina Baldarelli: I didn't have great practices when I was a kid and you know, my older generations didn't have the education to educate us about what to prioritize.

So I can definitely try to do that for the kids, especially when it comes to actually, like, it's not just sunscreen, it's hats... it's, you know, when, when we go out, that kind of thing. So that's definitely given me better practices, because I know that I'm responsible for keeping my kids healthy. So, while I might not prioritise it for myself, or I might not have internalised that oh, that's something that I need to be concerned about, just from all the historical, you know, experience, like, for my kids, I'm hyper aware of kind of doing the right thing. So, hopefully there's been some positive benefit to my own health from, you know, just not taking them out at the wrong time.

(🎶 Outro Music 🎶)

Sophie Stewart: Since we recorded this podcast, Christina has had her mole taken out, and we're happy to report that everything looks great. You've been listening to Consume This with me, Sophie Stewart. Consume This is brought to you by Consumer NZ. And this episode was made possible in part by support from the Ministry of Health. It was produced by Tom Riste-Smith. Our thanks go out to the Skin Institute, the Cancer Society, University of Otago and NIWA for their help with this episode.

Ka kite!