Bizzy, Melanoma incidence increases with age because older people have had more opportunities to be exposed to UV radiation and their capacity to repair the damage is diminished. How can older people know if their skin is has cancers? And what can be done about the damage already done?

Older people need to have a regular, at least annual, thorough head to toe check to identify any skin cancer at an early treatable stage. Skin Cancer is the most common form of cancer in NZ There are 3 types of skin cancer; Melanoma, Basal and Squamous Cell carcinoma that have different appearances. Melanoma can appear anywhere on the skin and Basal and Squamous Cell Carcinoma usually appear on sun exposed areas. Melanoma, if unnoticed, can rapidly spread and become life threatening- so early detection is the key. Watch out for any of the following- A new fast growing bump, growing in height- an aggressive Nodular melanoma presents like this. A mole or freckle lesion that stands out as different known as the "Ugly duckling" Any A, B, C, D, E , F, G H changes (Asymmetrical , Border irregular, Colour variable, Diameter changes, Evolution, Firm, Growing, Height increase) A new lesion An unhealing sore. A persistently itchy lesion A tender lesion A lesion that bleeds readily A scaly lesion that grows in height. All these signs need checking sooner rather than later. Getting familiar with your skin by regular self- monitoring helps identify changing moles, freckles and lesions earlier. Seeing pictures of what to watch out for and self- monitoring is encouraged. It is valuable to get a head to toe MoleMap to thoroughly check all the skin, including the back which is harder to self- monitor. It is especially helpful for people living alone and when cannot see as well. Try to justify the cost of good health checks as often things caught early are generally readily and more simply treated. It is never too late to be careful with best practises with sun protection to get the benefit. September to April use sun protection( shade, clothing, hats, sunscreen and sunglasses) especially between 10am and 4pm A 30- minute daily walk or some form of exercise for 30 minutes in the early morning or late afternoon without sun protection is recommended for Vitamin D absorption Those who have had past skin cancer need advice from their doctors as to whether wear sun protection all year and whether vitamin D supplements are important. Using a good moisturizer that suits your skin can help prevent scaly lesions developing.

Question Two Bizzy, A study of New Zealand melanoma cases between 2000 and 2004 found that the median age for females was 57 years and for males was 62 years (Liang et al., 2010). Do you find when an older person is diagnosed with having a melanoma it spurs their friends to get their skin checked too?

If a family member or friend has a skin cancer diagnosed, especially a melanoma it definitely has a powerful positive effect of prompting others to get a careful check of their skin. Although some people are still fearful and may postpone. My advice is to brave a MoleMap check as it will be very empowering with knowledge and give great peace of mind and as staff are always friendly they hopefully will enjoy the experience.

Question Three. Bizzy, as melanoma survival decreases with increasing melanoma thickness and older people are more likely to have thicker melanoma's. Should all older people in New Zealand invest in professional Skin Cancer Surveillance? Or do older people effectively consult their doctors about suspicious lesions?

New Zealand guidelines for melanoma say that the best way to detect skin cancer early is by using Total Body Photography (Complete Medical record of your skin), Dermoscopy (Magnified inspection of skin lesions) And Sequential Dermoscopy (Monitoring moles over time). MoleMap uses these gold standards during a full body MoleMap along with a Specialist Dermatologist diagnosis. In an ideal world everyone with risk factors would have an annual MoleMap. No GP referral is required. Half of melanoma present as a change in an existing mole or freckle and half appear as a new lesion on a clear patch of skin. A full body MoleMap record helps identify new or changing moles and suspicious lesions at subsequent appointments that helps catch melanoma and other skin cancers early. GP's vary with their knowledge of Skin Cancer and it can be challenging to achieve a thorough check in a short appointment especially if the appointment is combined with other medical needs. MoleMap research into validation, a good measure of accuracy shows how many lesions are excised to find a melanoma. Ideally the less moles that need to be unnecessarily cut out the better. MoleMap by Dermatologists 4 : 1 GP 20 : 1 After a MoleMap the individual who attended and their GP are sent a MoleMap report including pictures, location and recommended treatment for any lesions the MoleMap Dermatologist has identified as requiring action. This then allows the GP to carry out treatment recommendations. I believe this achieves an ideal outcome. Here is the list of Clinics that the voucher can be redeemed, http://molemap.co.nz/clinics/ Draw closes 24th December 2014

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Liam Butler
Bizzy Candler Grad Dip Phys, MCSP, NZRP is a melanographer who works at MoleMap in Sunny Nelson and this interview is based on information found in The New Zealand Skin Cancer Steering Committee New Zealand Skin Cancer Control Strategic Framework 2011 to 2014