Why Do Men Get Sunburned? The Problem Lies Between Their Ears Posted Tuesday, June 22, 2004 by arjuna
June 21, 2004


By DONNA WILKINSON

M EN over 50 are twice as likely as women to develop skin cancer and, even more sobering, to die from it, according to the American Cancer Society.

Experts say the reason lies not in men's skin -- but in their brains. Hatless, sunscreenless, heedless, men have made fewer changes in the decades of warnings about overexposure to the sun than women have.

"Women get the health message early on," said Dr. Darrell S. Rigel, clinical professor of dermatology at New York University Medical Center. "Under the age of 40, more women than men get skin cancer, but by 80, the ratio is 2 to 1, men to women. Women's skin is more sensitive to sun damage in terms of appearance, so they tend to change their behaviors earlier."

Men are at higher risk because they often have more sun exposure. For instance, they do more outdoor recreation and more outdoor work, as construction workers, longshoremen, fishermen or farmers.

But men are less apt to take precautions. Though susceptible to skin cancer on the face, nose, neck, scalp, ears, chest, back and shoulders, they are not inclined to wear protective clothing like long-sleeved shirts or wide-brimmed hats in the sun. Men like baseball caps, but they do not provide full coverage. "Baseball caps protect only the forehead and face to the tip of the nose," said Dr. Jeffrey Dover, associate clinical professor of dermatology at Yale University School of Medicine. "They provide no protection to the side of the face or neck."

Hats are especially important for men who are bald or losing their hair. "We see a tremendous amount of precancers and squamous cell carcinoma on the scalps of balding men, and a hat is by far the best sunscreen because men are not likely to put sunscreen on their heads," Dr. Dover said.

Not only are men unlikely to put sunscreen on their heads, but they are unlikely to put it on at all. "It's a major ordeal for many of us to shower, shave and brush our teeth," said Dr. David Swanson, assistant professor of dermatology at the Mayo Clinic in Scottsdale, Ariz. "The application of sunscreen adds another layer of self-maintenance and complexity."

Then there's the "goop" factor. "If you ask most men if they like to put cream on their faces, the answer is no, because they don't like the feel," Dr. Dover said.

Men are also less vigilant about checking their skin. A 2001 study by the American Academy of Dermatology found that middle-aged and older men were the least likely to perform self-examinations or visit a dermatologist. Doctors say women are frequently the ones who spot problems. "Often a man will come in and say, `My wife made me come in -- I don't think it's anything,' " Dr. Rigel said, "and it will turn out to be advanced skin cancer."

Though skin cancer is preventable, it is on the rise. The American Cancer Society estimates that more than a million nonmelanoma cancers and 55,100 melanoma cancers will be diagnosed in this country this year. And, the society says, 7,910 Americans will die of melanoma, 5,050 of whom will be men.

The most common types of skin cancer are basal cell carcinoma, which accounts for about 75 percent of all cases; squamous cell carcinoma, accounting for about 20 percent; and melanoma, which is less common but far more deadly, causing 79 percent of skin cancer deaths. There are also precancerous lesions called actinic keratoses, which can become cancerous.

Skin cancer is curable, if detected early. But putting off treatment incurs a high price. "Once a melanoma has spread, basically nothing works," Dr. Rigel said. "A melanoma the size of a dime on your skin has a 50 percent chance of having already spread -- that's why it is so critical to catch it and treat it early."

Prevention is critical because sun damage is cumulative. "With basal cell and squamous cell, it's the chronic sun exposure that does you in," Dr. Rigel said. "But with melanoma, it's the sunburns." Having two or more blistering sunburns in your life can double or triple your chance of melanoma.

How do you know what to look for? Warning signs include new moles or changes in existing moles (irregular pigmentation and borders; assymetrical shape); or sores that do not heal. Also watch for crusting, bleeding, scaling or discoloration.

Ted and Jim Vitas know the importance of prevention. Growing up in a New England beach town, the brothers never thought much about sunscreens when they were lifeguards every summer. "We'd sit all day with our backs to the sun -- we didn't realize it was causing damage," said Ted Vitas, 50. "The only skin care that people talked about then was keeping your skin moist, so we'd put oil on."

During a routine test a few years ago, a nurse noticed an odd-shaped mole on Mr. Vitas's back and urged him to see a doctor. It turned out to be melanoma. And recently, his brother, Jim, 55, was treated for a precancerous lesion found on his back.
Luckily, Mr. Vitas's melanoma was diagnosed as noninvasive. The brothers, who are Dr. Dover's patients, are a lot more sun-cautious. Ted uses a 30 S.P.F. and Jim said he wears "nothing less than a 45." They also go regularly for skin checkups. But Ted still enjoys the outdoors. "You don't have to become a hermit," he said, "but you have to take the appropriate precautions."