It’s no exaggeration to say that doctors around the world have recently become increasingly concerned about men's health. This time, the issue that has come to the forefront is skin cancer. The prevalence of skin cancer has increased worldwide. In Estonia, over the past 20 years, the incidence of skin cancer has doubled among women and tripled among men. Notably, in 2007, for which the Estonian Cancer Registry has provided the latest data, the incidence rate among women was twice as high as that of men.
Population prevalence study in Germany
"Between 2003 and 2007, a skin cancer screening study was conducted in Schleswig-Holstein, Germany, covering 1.6 million people aged 50 and older," says Ave Vahlberg, a dermatologist at the Tõnismäe Polyclinic of the East Tallinn Central Hospital. "Such a large-scale screening has not yet been done in any other part of the world."
The doctor clicks through increasingly revealing graphs on her computer screen. If the incidence of skin cancer among young women is rising globally, something unusual happens to men around the age of 50. While the rate of skin cancer in women continues to rise steadily, there is a sudden spike in the rate for men.
"That’s why the focus in Germany was on men over 50. The result of the screening was that the diagnosis of early-stage melanoma, or pigmented tumors, improved from 26% to 43%. This is an early non-invasive cancer that is confined to the first layer of the skin, does not metastasize, and from which the person can recover. Early detection of invasive melanoma improved from 29% to 83%."
The reason why more large-scale screenings aren’t conducted is no mystery, according to Ave Vahlberg. "Everything is measured in money – unfortunately, only the immediate cost is considered, without realizing that early cancer detection actually saves the healthcare system enormous amounts of money. Of course, each life saved is priceless, but treating advanced cancer is very costly for the state. I believe you can’t measure human life in money at all," says Ave Vahlberg.
Men don’t go to the doctor
The general trend, both globally and in Estonia, according to Dr. Vahlberg, is that while young women are more likely to develop skin cancer, they are also more diligent about going to the doctor for checkups. As a result, cancer is detected in the early stages, and they recover.
Men, on the other hand, don’t go to the doctor. One of the reasons is that skin cancer is harder to detect in men, as it typically starts on the back or the head. But how many men check their backs using two mirrors?
Ave Vahlberg believes that, given men’s almost non-existent skills or willingness for self-examination, help could come from a family doctor's "accidental discovery."
However, if a person notices something new on their skin that is growing rapidly, they should see a doctor immediately. A new formation on the skin doesn’t necessarily mean cancer, but diagnosing it could save a life. If you wait for all the classic signs of skin cancer to appear, it may already be too late.
You should also watch for changes in the size, color, or surface of moles (nevi). If a mole’s size increases quickly, disappears, or new shades of color appear, if there is growth on the surface or a nodule forms – these are also cases where you should consult a doctor.
What are dermatologists looking for on the skin? Melanoma and other skin cancers: basal cell carcinoma or squamous cell carcinoma, which can be either pigmented or not.
"Squamous cell cancer is directly related to cumulative sun exposure and typically develops in people who spend a lot of time outdoors, either sunbathing or working. That's why doctors refer to sun-exposed areas of people’s skin as fields of cancerization. Cancer cells can easily develop against the background of changes in the skin’s surface."
Dr. Vahlberg emphasizes that the best piece of clothing a person can wear is a hat, as it provides shade from the sun. Young parents are already skilled at protecting their children from the sun, but the same can’t be said for middle-aged men. Globally, skin cancer is most commonly seen among professions such as road workers, especially asphalt workers, and gardeners.
Unfortunately, fashion has shifted towards reducing the amount of skin covered by clothing.
Tanning beds are the skin’s worst enemy
"Since 2009, the World Health Organization has classified tanning beds among the devices that emit the most carcinogenic radiation," says Ave Vahlberg. "In Latvia and Lithuania, the use of tanning beds is regulated by the state, but in Estonia, there are no legal restrictions. A tanning salon can obtain a license from the local government and start operating.
In Latvia and Lithuania, minors are banned from using tanning beds. Skin burns acquired during childhood are the most dangerous in terms of long-term effects. In Germany, health education programs in kindergartens already include information about ultraviolet radiation. Warnings about the health risks of tanning beds should be posted on the walls of tanning salons, just like warnings on cigarette packs."
The doctor notes that, fortunately, women’s magazines have successfully conveyed the message to young women about the importance of skin checks. But where are the men’s magazines that warn men about skin cancer?
Sunscreens with UV protection have been produced since the 1950s. Yet, there has been no noticeable decrease in the incidence of skin cancer over the years. "SPF creams prevent sunburn, but if a person doesn’t see or feel the burn, they tend to stay out in the sun longer, which can lead to overexposure. This doesn’t mean that SPF products shouldn’t be used," warns the doctor. "You should use both protective creams and wear more clothing that covers the body."
Despite this, it is acknowledged that many people in our climate zone have a deficiency of vitamin D. Dr. Vahlberg has her own stance on this as well: "If you have a vitamin D deficiency, you should buy supplements from the pharmacy.
It’s clear that our fair-skinned northern type, whose skin constantly burns, who has over a hundred moles on their body, and whose family has a history of melanoma, should avoid sun exposure."
Dr. Vahlberg recommends that people at risk for melanoma should stay indoors when the UV index reaches 6. "If you were born white, stay white" should be the guiding principle. But, unfortunately, white people seem determined to tan themselves to death, while those with darker skin want to bleach themselves white. Even migrations can cause problems. If you want to be really strict about it, you could say: ‘Live in the right place and stay in your skin color.’
Myths and risk factors
One of the biggest myths circulating among people is the belief that surgery triggers the disease.
"Regardless of the prognosis, even if the tumor is advanced and has metastasized, the primary tumor should always be removed. Otherwise, the area will simply decay. A person might get the impression that removing the tumor caused the metastases, but surgery does not worsen the course of any disease."
Another misconception is that sticking plasters over moles when going out in the sun provides protection from UV radiation. UV rays affect the entire body.
There is also a false belief that visiting a tanning bed before a trip to a sunny destination provides some protection against UV radiation. Unfortunately, this is not true either.
According to Dr. Vahlberg, having more than 100 moles on the body, atypical moles, a family history of melanoma, or very large congenital moles (over 7 cm) are all risk factors for skin cancer. It’s important to note that melanoma can also recur.
Anyone with more than 30 moles on their body should undergo digital dermoscopy 1–2 times a year.
The most beautiful and warmest time of the year is just around the corner – let’s enjoy the sun while being health-conscious.
The article is also available on the W3 portal.