Ten years ago, Steve Wilson’s wife spotted an unfamiliar black mark on the back of his calf. A fit and healthy 41-year-old, Wilson brushed it off as nothing, but his wife insisted that he got the blemish checked out by his GP. Six months later, he was diagnosed with melanoma, the most serious form of skin cancer. He had an operation to remove the cancer and it appeared to be successful: over the next six years, during which he had regular check-ups, there was no sign that the cancer had spread.
Then, in 2017, Wilson felt a lump in his groin; the cancer was in his lymph nodes. He underwent another operation to remove fifteen lymphs in his left groin and pelvis – a procedure that left him with a disfigured leg. A further operation followed four weeks later to reconstruct his wound, which had become infected; he also contracted pneumonia and bilateral pulmonary embolisms between the two operations.
Today, a decade on from his initial diagnosis, Wilson is still living with stage 3c melanoma, with a 67 per cent chance of it spreading further.
The diagnosis has taken a significant toll on his emotional wellbeing. “As it was on the back of my calf, I had no reason to notice it,” he says. “If I had, I probably wouldn’t have done anything about it, since I wasn’t feeling unwell. I was going about my life having a great time, and suddenly they told me I had cancer. My first thought was death; it knocks you for six.”
Wilson’s story is not unique. Research shows that men are already twice as likely to die of skin cancer than women, largely due to a reluctance to seek medical help. Even more shocking is the fact that this figure is forecast to rise by 90 per cent in 40 years’ time. According to Cancer Research UK, melanoma incidence rates in men have increased by 47 per cent over the last decade.
After lockdown, experts are worried that these figures could rise due to increased sun exposure, particularly from more people exercising outdoors during a period of uncommonly good weather. According to the British Association of Dermatologists, since lockdown started, the UV index, which measures the sunburning strength of UV radiation in a particular time and place, has repeatedly reached levels at which sun protection is advised for lighter skin types.
It’s bittersweet news: as men use the pandemic as an opportunity to improve their physical health, their risk of getting skin cancer increases.
This week is men’s Health Awareness Week, which aims to increase awareness of male health issues on a global level. We’ve broken down why men may be more likely to get skin cancer, and what they can do to stay safe.
Why are men more likely to die from skin cancer?
Many experts believe the gender disparity in skin cancer mortality rates is due to men’s reluctance to see a GP if they spot an unusual mark on their skin. While the five-year survival rate for melanoma is almost 100 per cent, this decreases over time; the later you find the tumour, the more chance it has of spreading to other parts of the body, such as the lymph nodes.
“It’s a problem we’ve had for generations – men are notoriously bad at seeking help and medical attention,” says Gillian Nuttall, founder of Melanoma UK. “When women spot a blemish, nine out of ten will go to get it checked out straight away. Men won’t get round to it, and before we know it we have a problem when it’s melanoma and it can’t be treated as successfully. Around 2 per cent of cases will go on to become advanced, and then it can spread internally.”
Damage from ultraviolet (UV) rays is one of the leading causes of skin cancer. According to research by LifeJacket Skin Protection, 70 per cent of men avoid using sun protection, while women are over twice as likely as men to think about UV protection every day.
Location of the tumour also plays a part. Dr Bav Shergill, of the British Association of Dermatologists, says that the most common places for men to develop skin cancer is on their back and torso, making the tumours harder to spot day to day. In women, legs are a common place for skin cancer to develop.
“It’s socially more acceptable for a teenage boy to go around with his top off – and we know that sun exposure under the age of twenty is correlated strongly with skin cancer and melanoma later on in life,” he says.
Some experts believe that the composition of men’s skin could increase their predisposition to skin cancer, although the data is conflicting. One study that was conducted in the Netherlands found that men’s skin reacted more intensely to UV rays than did women’s skin.
Dr Paul Banwell, a consultant plastic surgeon and founder of Melanoma And Skin Cancer Unit in East Grinstead, says that skin cancer may be more common in males due to the “physiology of men’s skin.”
“We know that men’s skin differs from women’s skin biochemically and structurally. For instance, structurally men have thicker skin and less fat with more collagen and elastin – the fibres that give the skin firmness,” he says. “Biochemically a man’s skin is less acidic than a woman’s and there is evidence that the difference in these intrinsic enzymatic processes may also contribute to the predisposition to skin cancer.”
Who is most at risk?
According to cancer UK, incidence rates for melanoma in the UK are highest in people aged 85 to 89, while each year 28 per cent of all new melanoma skin cancer cases in the UK are diagnosed in people aged 75 and over. However, this doesn’t mean that young people shouldn’t be vigilant; according to Dr Shergill, 80 per cent of our skin’s sun damage is done before the age of 20.
Indeed, Wilson believes this was the case for him. With pale skin and ginger hair, he spent most of his early life desperate for a tan, and regularly sunned himself on holidays abroad and during a backpacking trip to Australia.
“Although they were different times, it’s so frustrating to look back on that now,” he says. “The one thing about melanoma is it’s so easily preventable if you just avoided the sun when it’s strongest, and put SPF on. My relationship with sun has completely changed now; if it’s a sunny day, I will always sit in the shade.”
Men who spend a lot of time outside, and those who are bald, will be more at risk of developing skin cancer due to their increased exposure to UV rays.
“People who are at risk include those working in male dominated industries, such as construction, where there’s a lot of chronic sun exposure for that particular group,” says Dr Shergill. “We also see it a lot in sportsmen and golfers, people from the army and those who are keen sailors.”
Will skin cancer rates increase among men during lockdown?
The short answer is yes, quite possible. Gyms have been closed since March 21, meaning people have taken advantage of the warm weather to start exercising outdoors. As pubs and restaurants have also been off limits, a daily run, or sitting in the local park, has become one of the main activities for people during the lockdown – not to mention the snaking supermarket queues. Due to increased sun exposure, this all amounts to bad news for skin health.
“We’ve had a lot of calls from people who are really anxious about a blemish and can’t get in to see a specialist,” says Nuttall. “We are predicting there’s going to be an upsurge; not specifically in melanoma but other skin cancers such as basal cell carcinoma, because people are too afraid to go and get them checked during the pandemic.”
According to Dr Shergill, the average melanoma takes 12 – 14 months before the patient notices it enough to seek treatment. Some faster growing types take 4-6 weeks and are easy to pick up with regular monitoring of the skin.
How can men protect themselves when they’re exercising?
The key here is prevention. If you are going to go out on a run when it’s sunny during lockdown, Nuttall recommends covering up and avoiding the midday sun between 11 and three.
“If you can’t avoid those times, make sure you’re wearing factor 50 SPF, a hat and a top with long sleeve,” she says. “UV clothing is available now so there’s no excuse for people not to be protected.”
However, it’s important to note that applying sun cream only partially protects your skin, and can lull people into a false sense of security. The best protection is shade and clothing. For example, LifeJacket makes UPF 50+ clothing which is designed to be worn outside by men.
What are the symptoms to look out for?
The ABCD rule remains one of the most useful ways of identifying a melanoma. According to the British Association of Dermatologists, this is:
- Asymmetry – the two halves of the area may differ in shape
- Border – the edges of the area may be irregular or blurred, and sometimes show notches
- Colour – this may be uneven. Different shades of black, brown and pink may be seen
- Diameter – most melanomas are at least 6mm in diameter. Report any change in size, shape or diameter to your doctor
- Expert – if in doubt, check it out! If your GP is concerned about your skin, make sure you see a Consultant Dermatologist, the most expert person to diagnose a skin cancer. Your GP can refer you via the NHS
“When people reach 30 they rarely get new blemishes. Anything that people present with after should be looked at seriously and treated,” says Nuttall. “It might not look like a big brown glaring mole; it might be a bit of a pimple prick that you would never expect to be melanoma.”
If you are worried about melanoma, visit the Melanoma UK website or call them on 0808 171 2455