New Zealand has the second-highest rate of melanoma in the world, just behind Australia.
But now a new medical breakthrough may see the sun finally beginning to set on the worst outcomes of skin cancer.
An experimental mRNA cancer vaccine has allowed people with high-risk melanoma to live longer, cancer-free, according to drug companies Moderna and Merck.
Medical oncologist and Melanoma New Zealand spokesperson Dr Gareth Rivalland called it a "big step forward".
"The idea that the immune system has a role in cancer protection or cancer treatment has been around since the late 1890s," he told RNZ's Saturday Morning, but it was not proved until the 1990s and 2000s.
"It's taken a long time to establish this idea of immunosurveillance, that your immune system goes around looking at our cells and takes out those rogue cells before they become cancer."
That led to the development of therapies like Keytruda and Opdivo, which "unmask the cancer and allow someone's immune system to attack".
Keytruda, the first to be rolled out, will be used to treat six cancers. (Source: 1News)
"This has really changed melanoma. When I started training in oncology treatment in the mid 2000s, we really had no good treatments. Once a melanoma had spread and if we couldn't cut it out, chemotherapies and these things really were pretty dire.
"But with the advent of these immunotherapies, that changed the game for us completely."
But they don't work for everyone, he said.
"For those people for whom it doesn't work, there's this desire for us to keep pushing and keep getting better.
"And this vaccine that we've been working on with a global team around the world, what it does is we take someone's tumor and then we take their normal DNA and we send it to Moderna in the States. And what they're doing there is they're mapping 34 different areas in the tumor DNA and comparing it to someone's normal DNA - and those areas are where the tumor might make weird-looking proteins on the outside of these cancer cells, and your immune system would come along and say, 'Hey, that's not one of our proteins, we need to attack the cell'.
"And this vaccine, what it's doing is saying, 'OK, for your melanoma at positions A, B, J, Z, the tumor looks different to normal you. Okay, we're going to set up an individualised, personalized mRNA - let's call it a vaccine'. And we're going to tell your immune system, 'Hey, go and look for these proteins'.
"So what we're doing here is we're using our traditional immunotherapies that unmask cancers and then combining it with this thing that's trying to help your immune system target the cancer cells even better."
Rivalland says if it works well, it could even wipe the cancer out completely - and perhaps with fewer unwanted side effects than previous treatments.
There are fears it could lead to a rise in skin cancer if the message. (Source: 1News)
"There are side effects. They're not our traditional chemotherapy side effects, but for many people, they can get through treatment relatively unscathed, keep living their lives, going to work, doing things. So these types of treatments do offer us something quite unique in the world of cancer treatment."
The technique was first trialled a few years ago in about 150 people in Australia and the US. Success there led to a wider trial in just over 1100 people around the world.
"We've had a number of other medications over the years that have looked promising, and then you use them in a large number of people and they fail. And so everyone's very wary about things that look really good early on or in the lab. We've had a lot of things fall over.
"But this one lived up to the hype. And so over the past few years here in New Zealand, we've been part of these trials."
The new approach has been tried on various cancers, including melanoma and lung cancer.
"Based on the early information, this has really expanded into many, many different cancers. The fact now that this big trial has proven its success and its effectiveness, I think there's going to be a push into lots of other types of cancers as well."
Around 40 New Zealanders took part in the global trial - our high rates of melanoma proving attractive for researchers.
Rivalland doesn't foresee too many regulatory hurdles, provided it works and can be rolled out.
"Then it becomes the two major things: how quickly can a company make this mRNA vaccine at scale, and then what does it cost? And the cost is always the unknown, but I mean, that becomes a commercial decision. And we know that new breakthroughs are always expensive in the medical world.
"And so quite when it would be available for us here in New Zealand is a tricky one, because Pharmac has to then juggle the budget and decide whether that's good value for money.
"So for us in New Zealand, it always takes a few years before we're able to get these types of medicines into sort of broad availability. But at the moment in the melanoma world in New Zealand, we actually do pretty well in terms of what's available to us."
In the meantime, prevention remained the best course of action. Rivalland said we could no longer entirely blame the hole in the ozone layer.
"We do have slightly higher UV exposure in New Zealand relative to our latitude compared to, say, the northern hemisphere.
"But the other thing is that for many of us whose ancestry is in the northern hemisphere, our skin type was not designed for the New Zealand sun. And so what we tend to find around the world is your skin type is the thing that predisposes you to skin cancer development.
"And there's been some interesting research in the last few years looking at rates of DNA damage in European skin versus say people from East Asia where melanoma is very rare, actually, and we see more DNA damage from UV in people with European background, European skin.
Despite years of research into the impacts of sun exposure, New Zealand and Australia still see the highest mortality rates of melanoma in the world. (Source: 1News)
"And so I think probably all those people with ancestry from Scotland and Ireland and the Celtic red hair, that type of thing, are more prone to damage to their skin cells when we're exposed to UV."
Many Māori and Pasifika would also have European DNA, he said, but even if they did not could still develop melanoma in lighter areas such as their palms, soles and nails.
"Then I think the other thing is our lifestyle. New Zealanders are outdoors all the time, and I think it's an exposure thing… So I think the message is, even from very young, protecting ourselves from the burning sun and being smart about when we're out in the sun in the middle of summer, that really does have value in your later life…
"I'm obviously excited about these new breakthroughs in treating people with very advanced melanoma. But the truth remains, if you can catch it early and get rid of it, then you never need to come and see me. And that's probably a better thing to do."
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