As his patient sat on the examining table, dermatologist Jeremy Brauer explained the pathology report, letting him know that the lesion on his chest was skin cancer and that minor surgery would be required to remove it.
“I’d like to try to get this done before the weather gets nice,” the patient, himself a physician, told Brauer, “so I can get back out into the sun.”
Brauer, a clinical associate professor of dermatology at NYU Langone Health, says he was stunned.
“I said to him, ‘You are exemplifying a very big part of the problem for men when it comes to skin cancer.’ There’s just a massive disconnect in men’s perception of the sun and sun damage and skin cancer,” says Brauer, who has a dermatology practice in Purchase, N.Y.
In 2023, according to the Skin Cancer Foundation, 97,610 cases of invasive melanoma will be diagnosed in the United States; of those, 58,120 will be in men, 39,490 in women. Of the 7,990 people who will die of melanoma, 5,420 will be men.
A quick-growing cancer, melanoma can spread into blood vessels and lymph nodes and attack other organs, according to the Skin Cancer Foundation.
What makes men so vulnerable to melanoma, the deadliest form of skin cancer?
Some studies suggest that men’s skin may not retain antioxidants the way women’s skin does, which could heighten skin cancer risk. Others suggest that women’s higher estrogen levels may offer skin protection. But men like Brauer’s patient show the effects of behavior.
Surveys show that men tend to know less about skin cancer risks than women and consequently are less likely to use sunscreen.
Dawn M. Holman, a behavioral scientist with the Centers for Disease Control and Prevention, has studied sunscreen use in the United States. “About half of women say they regularly use sunscreen when they’re spending time outdoors on a sunny day whereas only about a quarter of men say they do,” she says. “And more than 40 percent of men say they never use sunscreen when they’re out in the sun.”
“Some men may actually see sunscreen use as more of a feminine behavior,” Holman adds.
Men tend to work and play outdoors more than women, says Ida Orengo, professor and chair of dermatology at Baylor College of Medicine in Waco, Tex. “So, they tend to get more cumulative sun exposure over their lifetime.”
Men also seem to know less about the risks of the sun. Fewer men than women gave correct answers in an American Academy of Dermatology survey on sun exposure and the risk of cancer.
Men more often believed that you can have a healthy tan (all tans signal sun damage to the skin, Orengo says), a “base tan” can protect you from the sun (it cannot), and you cannot get skin cancer in out-of-the-way spots such as the skin between your toes (you can).
One of the best ways to avoid skin cancer is to avoid the sun, experts agree. But if you’re going to spend time outdoors, protect yourself. Lotion, cream, stick or spray sunscreen can be applied many ways. Find one you like and use it, Orengo says.
Cover all exposed skin, Holman says, including your ears and the back of your neck. Reapply every two hours or when you come out of the water or are sweating. And if you’re a hairy man, be sure to carefully rub in the sunscreen, says Stacy P. Salob, clinical assistant professor at Weill Cornell Medical College. Don’t count on hair to protect your skin.
Holman adds that sunscreen is not enough: Stay in the shade when you can, and wear a hat and sunglasses. You should also avoid the sun’s harshest rays: If your phone’s weather app has a UV index, consult it, Holman says. Avoid outdoor activities in the middle of the day when the index is above five. If it is 11 or higher, stay indoors.
Lastly, consider UV protective clothing. “I’m such a fan of the sun-protective clothing,” Salob says. “It offers the equivalent of a 50 SPF and you don’t have to wear sunscreen for that whole large part of your body. And then you don’t need somebody else to put it on your back.”
Another challenge for men is that they often get melanoma on their backs and the tops of their head, places they can’t see. As a result, men often miss the changing moles that are the hallmark of melanoma. That may explain why some studies show that men with partners have earlier detection of melanoma — and healthier outcomes — than single men.
Brauer says many male patients come in with “things circled in pen all over their bodies. Their wife or partner is very much paying attention to them, which is great.”
Dermatologists would rather reassure you that you’re fine than discover a melanoma too late. “We’re great at treating melanoma when we catch it in the early stages when it’s just on the skin,” Salob says. “And we’re terrible at beating it when it has spread inside the body. So early detection is key.”
One of the biggest risk factors for melanoma is previous sunburn.
“If you’ve had even just one of your sunburns blister, it automatically puts you into a higher risk category,” Salob notes, as does having blonde or red hair, blue eyes, fair skin and more than 50 moles on your body. It may be hard to believe, but a sunburn you got in your teens could be responsible for the skin cancer you develop in your 50s. Each time you burn, you elevate your risk. And according to Holman’s study, more than one-third of Americans say they had a sunburn in the past year.
In addition, while White men are more likely to be diagnosed with melanoma, Black men are more likely to die of it once diagnosed — perhaps because their diagnoses tend to be at a later stage.
“When you get sunburned, the ultraviolet light goes into your skin and damages the DNA in the skin cells,” Orengo says. “Then your immune system goes in there and says, ‘Oh my gosh, we have to fix this damage before cancer starts,’ The immune system fixes the damage. That may happen again and again — until you get into your 40s, 50s and 60s when your immune system naturally starts to be less effective. When the DNA breaks down again, your immune system can’t fix it, and the cancer grows.”
To ensure early detection, see a dermatologist for a yearly skin cancer check.
In between, Brauer says, check yourself out. He recommends standing nude in front of a full-length mirror once a month. Scan your body, and grab a hand mirror to check out your back. Look for anything “new, changing or unusual,” Brauer says, and if you find it, consult your physician.
An ABCDE guide has been developed by dermatologists to help patients identify melanoma on their bodies:
Asymmetry: A melanoma lesion often is oddly shaped
Border: It has an irregular border
Color: It has varying color
Diameter: It is usually 6 millimeters wide, about the size of a pencil eraser
Evolving: It changes quickly on the skin.Sign up for the Well+Being newsletter, your source of expert advice and simple tips to help you live well every day