Areas of focus

An individual’s risk of skin cancer from UV exposure is determined by both personal behaviours and characteristics such as skin type, hair and eye colour, number of freckles and moles, family history of skin cancer, and genetic constitution. We are beginning to generate increasing knowledge and understanding of the risks and benefits of solar radiation for people depending on a range of factors including skin type. Prevention activities for people with greater risk factors for skin cancer will continue to be a focus area for work.

We also have a better understanding of how genomes contribute to the development of skin cancers. This may enable better identification of individuals at high risk of skin cancer for targeted population-level screening.²⁹

Cancer control data related to Aboriginal people in NSW demonstrates that melanoma is the fourth-most common diagnosed cancer for Aboriginal women and the fifth-most common diagnosed cancer for Aboriginal men.³⁰ Approximately one-third of melanomas are diagnosed among Aboriginal people who are under the age of 50 years, and the median age of diagnosis is 60 for Aboriginal people (and 67 for non-Aboriginal people). This data supports evidence from the literature,³¹ noting that the combined burden of melanoma and non-melanoma skin cancer in Aboriginal communities is significant, with lower incidence but higher mortality than the general population. There is also some evidence to suggest there are disparities in relation to access to diagnosis and treatment of skin cancer in Aboriginal communities,³² with the authors of this study suggesting that improving skin cancer awareness to allow earlier detection and management is important.

Notwithstanding the data and information presented here, we need to collaborate with Aboriginal people and organisations, to understand more about the risks and impacts of skin cancer in Aboriginal communities, and co-design initiatives to address the issues that are identified.

Across NSW there is considerable regional variation in melanoma rates. Higher incidence rates occur along the coast, and these rates are generally higher in the northern parts of the State. In 2022, melanoma incidence was significantly higher among Local Health District residents of Northern NSW, Mid North Coast, Hunter New England, Central Coast and Western NSW.³³  This data may inform work in rural and remote NSW communities in relation to primary prevention, and secondary prevention including early detection of skin cancers.

At the commencement of this Strategy, we're committing to exploring the role of secondary prevention of skin cancer. The NSW Government and non-government organisations reflected on potential secondary prevention initiatives in the evaluation of the previous Skin Cancer Prevention Strategy and in consultation for this Strategy. Stakeholders consider it the right time, at the commencement of this new, future-focused Strategy, to consider efforts beyond primary prevention of skin cancer, and include a focus on early detection. Secondary prevention initiatives are likely to include exploring early detection of skin cancer to reorienting health services to achieve better health outcomes for people with a skin cancer diagnosis. Activities could include ‘know the skin you’re in’ messaging to encourage people to check their own skin for changes and seek a medical skin check if needed, especially among people who are at higher risk of skin cancer. The first action will be that the Cancer Institute NSW commission an evidence review into early detection to build on existing evidence about current approaches and new opportunities.³⁴

Some areas for consideration include: effectiveness of current methods of early detection of skin cancer, considering the range of service providers and acceptability among priority populations economic costs and benefits and the mix of public and private providers of skin checks the current and potential roles of a range of health practitioners in detecting skin cancer potential for digital innovation and the role of technology in similar health issues investigation of data sources for greater monitoring of keratinocyte (non-melanoma) skin cancers in primary care.

In line with our commitment to evidence-based action, further steps will be based on the review of evidence. Activity in this area will be reported through this Strategy’s governance, and we aim to contribute to the generation and dissemination of evidence in this area of focus.