Men Are More Likely to Die From Melanoma—But Why?

Fact checked by Nick Blackmer

• Melanoma is the most dangerous form of skin cancer. Left untreated, it has the ability to spread throughout the body and become deadly.

• Men are at an increased risk of invasive melanoma, and they're also more likely to die from the disease.

• Genetics, cultural differences and norms, and public health messaging all come into play, creating a gap in both awareness and preventive measures between men and women.

Melanoma is the most dangerous form of skin cancer—left untreated, it has the ability to spread deeper into the skin or to organs within the body, and become deadly. It’s also on the rise: According to the Skin Cancer Foundation, the number of deaths from melanoma are expected to increase by 4.4% in 2023, with an expected 186,680 cases diagnosed in the United States.

Men in particular are at an increased risk for serious melanoma. Out of an expected 97,610 cases of invasive melanoma in the U.S. this year, more than half—58,120 cases—will be in men. Of the 7,990 estimated deaths from melanoma in 2023, men also make up the majority, at 5,420 deaths.

It’s a serious problem, with many factors. Genetics, cultural differences and norms, and public health messaging all come into play, creating a gap in both awareness of risks and adoption of preventive measures between men and women.

“We know that women develop more melanomas than men before the age of 50, and after the age of 50 men have higher rates of melanoma. Men are also more likely to die from melanoma than women,” Jesse Miller Lewin MD, FACMS, program director for the Micrographic Surgery and Dermatologic Oncology fellowship program at Mount Sinai Health System, told Health.

As the weather gets warmer and sunnier, and more people spend time outdoors, sun exposure will increase along with risk of skin cancers, including melanoma. Experts say this is an important time to raise awareness of melanoma risks and communicate to everyone—especially men who either might not be as aware or downplay concerns around skin cancer—that it's important to catch and treat melanoma as early as possible.

Men Are Typically ‘Less Attuned to Their Skin’

When it comes to this issue of why more men tend to deprioritize concerns over skin cancers like melanoma, experts tend to return to one general explanation: “Men generally tend to be less attuned to their skin,” than their female peers, Teo Soleymani, MD, founding director of California Dermatology and Mohs Surgery Specialists and former assistant clinical professor at the David Geffen School of Medicine at UCLA, told Health.

Dr. Soleymani, a board-certified dermatologist and fellowship-trained Mohs Micrographic and Reconstructive Surgeon, said many factors account for why men not only experience more melanomas in general, but also are “almost twice as likely to die from it” than women.

Skincare and awareness is culturally less ingrained in American male consciousness. Dr. Soleymani said men tend to be out in the sun more, historically in careers that require them to be out and exposed to the sun more frequently.

“They tend to be less aware of things growing on their skin, on average, and will have a melanoma diagnosis usually at a worse stage than women, and they tend to show up to the doctor much later,” he explained. “Women tend to be more aware of things growing on their skin and check their skin more frequently.”

Dr. Soleymani said this could be partially due to cultural dynamics of “cosmetics and aesthetics that are more attuned for women than men.”

Susana Ortiz-Urda, MD, PhD, MBA, a dermatologist and melanoma specialist who serves as co-director of the UCSF Melanoma Center, said men are also less likely to use sunscreen. Most either aren’t used to applying it as part of their regular routine when they leave the home and go outside, or don’t find it easy to apply if they have more body hair and are sitting out at the beach, for example.

Both Drs. Soleymani and Ortiz-Urda said delayed melanoma detection fits into a larger problem that men in general seek health care services less frequently than female peers. This is true for not just primary care services, but certainly for regular dermatological screenings.

“Men, for some reason, are less likely to notice changes in their skin, they don’t seek medical attention as frequently as us females,” Dr. Ortiz-Urda told Health. “Basically, delayed diagnosis in treatment causes melanoma that is found later that is more fatal.”

Dr. Lewin echoed these thoughts, adding that many women use makeup that contains SPF sunscreen, and they generally apply more sunscreen, more frequently throughout the day than men.

“It has also been hypothesized that other behavioral factors may impact men’s increased susceptibility to melanoma such as wearing fewer wide-brimmed hats than women, and spending more time outdoors for work or recreation,” Dr. Lewin added. “For men and women, we know that the risk factor that can be mitigated to prevent melanoma is sun exposure and protection. Avoiding sun during peak hours—10 a.m. to 2 p.m.—sitting in the shade, wearing wide-brimmed hats, sunglasses, and SPF 30 or above sunscreen all help protect us from the harmful effects of the sun.”

He stressed that early stage melanomas have a 99% survival rate. This underscores just how important early detection with skin examinations is to find this form of skin cancer at its earliest stages.

Related: 8 Questions About Sun Protection

Some Genetic Factors May Be at Play

There are some genetic and physical factors at play here beyond behavior and a culture where men just don’t focus on their skin and overall health.

Dr. Ortiz-Urda said men generally have “thicker skin with less fat beneath” that also contains more collagen than women’s skin. She said some research shows these differences make this kind of skin more susceptible to sun damage from ultraviolet (UV) rays from the sun.

“There is also science that supports the possibility that the makeup of the skin in men differs in ways that makes men more susceptible to damage of ultraviolet radiation,” Dr. Lewin added.

Underlying genetic factors behind melanoma and its presence in men compared to women is still being researched, but Dr. Ortiz-Urda said some research out there suggests men are more likely to inherit genes that increase the chance of developing melanoma. She said mutations in the CDKN2A gene—which research has shown to exist in a 20% to 40% of families afflicted by melanoma—may be more common in men.

A 2019 study suggests that estrogen in a woman’s body might also offer more protection from melanoma, something that could be a factor in this melanoma gender gap.

When asked about genetic underpinnings behind the presence of more melanoma in men than women, Dr. Soleymani said it’s hard to know right now and more research is looking into this.

He said melanocytes, the cells that produce our skin pigments, produce moles and are progesterone-sensitive. This is why moles can tend to get darker during pregnancy, or why a woman might develop a dark line in the middle of her abdomen during pregnancy.

Theoretically, it’s under the female hormone influence when moles darken and change, and testosterone and its “signaling pathway” tends “to make things grow faster.”

“Cancer of all lineages—lung, breast, prostate, et. cetera—hormones, testosterone, tend to make cancers grow faster, but it hasn’t really been elucidated the role this plays in melanoma [differences between men and women],” Dr. Soleymani said.

Related: Sunscreen vs. Sunblock: What's the Difference, and Which One Is Better?

Most People Can Benefit From an Annual Skin Check

It’s crucial we all pay attention to changes in our skin. Dr. Soleymani said many melanomas emerge in areas of the skin that aren’t even exposed to the sun. They often are on the backs of men and the legs of women.

“Myself included, I don’t look at my back that regularly and it’s the most common source of melanoma for men that’s killing them,” Dr. Soleymani said. “There was a study that showed patients who were diagnosed with melanoma had a better survival if they had a significant other.”

“At first people couldn’t understand why that was,” Dr. Soleymani continued, “but when we looked into the study, patients who had a significant other came into clinic at an earlier stage because their significant other was looking at other areas they couldn’t see, like the back.”

Dr. Ortiz-Urda said it’s important that you have a partner, a loved one you live with, or a caretaker who looks after you if you’re elderly, check your back for signs of new or strange moles.

It’s also helpful to make an annual appointment to see your dermatologist, she said. In the way that people make routine dental cleanings, go in for routine colonoscopies, and schedule annual physicals with a primary care provider, it’s crucial that you go in for a yearly all-body skin check with a dermatologist.

Dr. Ortiz-Urda said, despite best efforts by the medical community at large, messaging around dermatological appointments as a regular aspect of preventive medicine hasn’t really translated broadly to the public at large.

Recent research has pointed to how this is especially necessary for groups that often face entrenched health disparities.

A 2016 paper in the Journal of the American Academy of Dermatology revealed that white people had the longest survival time after melanoma diagnosis, with Black melanoma patients having the lowest level of survival.

The authors concluded that while white people showed the higher incidence of melanoma, “overall survival for cutaneous melanoma in non-whites was significantly lower,” suggesting that “more emphasis is needed for melanoma screening and awareness in non-white populations to improve survival outcomes.”

Dr. Soleymani said to check your skin once a month, even if it’s something as simple as getting a mirror and holding it up to hard-to-see places. Testing for skin cancer is easy—it doesn’t require an MRI or a chest X-ray, for instance.

“You can make different lumps and bumps—that is all normal as our skin tends to be very dynamic and active—but if it doesn’t go away in four to six weeks, then you should get it checked out,” Dr, Soleymani added.

“Generally, we shouldn’t be making new moles after 35 to 40 years old, although there are exceptions to every rule,” Dr. Soleymani said. “The general consensus is that our bodies are still very young and melanocytes are making new moles in our younger years, but after 35 to 40, they shouldn’t be making new moles. If you see something that looks like a new mole and you’re over 35, get it checked.”

He said that’s true for men as well as women. Additionally, make sure you know your family history to the best of your ability. If you know you have a family history of melanoma, be extra sure to schedule an annual skin exam.

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Read the original article on Health.