Skin cancer is a threat to everyone, but researchers are increasingly tracking how men — especially those age 50 and older — are at particular risk.

Men are more likely than women to die from melanoma, the deadliest form of skin cancer, and the risk grows as men age. By 65, men are twice as likely as women to develop melanoma. Researchers believe a combination of factors, including greater lifetime sun exposure and lower rates of skin self-exams and sun-protective behaviors, may contribute to that risk.

Dr. Logan Rhea, a hematologist and oncologist at Novant Health Cancer Institute, says those habits are beginning to change as more people become aware of the risks. But many older men spent decades in the sun before sunscreen use became routine. Men may also be more likely to miss warning signs, particularly when they live alone and don’t check hard-to-see areas like their backs and shoulders for unusual skin markings or lesions.

“They say, ‘Well, you know, back in the day, sunscreen wasn’t a thing, and we were out in the sun all day, and nobody put anything on us at all,’” Rhea said. “I think now, because we’ve gotten so much better about earlier detection ... and knowing how little preventive things can help lower that risk for anybody, that we will see that shift over time.”

Rhea explained why skin cancer is such a threat to men’s health, why men in particular are more likely to miss warning signs, and what everyone can do to protect themselves from the sun’s harmful ultraviolet rays.

Are men more susceptible to skin cancer?

Yes. In fact, the National Comprehensive Cancer Network, which releases guidelines on how to manage cancer, lists being male as an independent risk factor for melanoma and other aggressive skin cancers.

That’s partly due to behavioral factors. Statistically, men are less likely to use sunscreen or engage in sun-protective behaviors. There are, of course, some potential anatomic reasons — men have male pattern baldness, so the tops of their heads, on average, are much more susceptible to developing skin cancer. But ultimately, men have historically greater outdoor UV radiation exposure, which is the cause of skin cancers and melanomas.

Does the risk of skin cancer increase with age?

Age certainly does contribute. The average age of melanoma diagnosis is about 63, and the National Comprehensive Cancer Network considers being older than 50 an independent risk factor for developing melanoma. That increased risk is a little bit more pronounced in men.

Much of that increased risk is thought to be related to cumulative lifetime exposure to UV radiation.

What skin cancer warning signs should people look for?

New and changing moles are always a big thing to keep an eye out for. Especially when it comes to melanoma, anything that looks a little different from what you’re used to, anything that is changing in its size or characteristics, is certainly something to bring to the attention of either your primary care doctor or your dermatologist. About 50% of melanoma patients present to a doctor and say, “I have this mole, and it’s changing.”

The big, concerning things are bleeding, ulceration of the skin, or crusting of these types of skin lesions, or ones that just look very, very different from all the other moles that you have on your body. Sometimes, people report itching or a kind of altered sensation over the area of the mole. Some people note these pearly or pink papules or nodules on the skin, or even crusty, scaly types of areas. Those can be indicative of other types of skin cancer, like basal cell carcinomas and squamous cell carcinomas.

Some skin cancer prevention methods are obvious — limit exposure to the sun, wear sunscreen, etc. But what’s most effective for skin cancer protection if you have to be in the sun?

Limiting UV exposure, especially between the hours of 10 a.m. and 2 p.m., can be extremely helpful to lower risk for skin cancer. Applying SPF 30+ sunscreen every two hours can lower the risk of melanoma. And we are getting better about alternative means of protecting you from UV radiation beyond sunscreen. You may have seen shirts that say UPF 50+ or 30+, and those are essentially clothes that have been rated to screen or filter out the most harmful UV rays. In sunscreen, SPF stands for sun protection factor, and in clothing, UPF stands for ultraviolet (UV) protection factor. We’re getting better and more affordable options for UPF clothing. The extra protection comes either from special solutions that are put onto the clothing or the way that the fibers are woven together.

Think about wide-brimmed hats that cover the tops of the ears and top of the head. I tell people all the time: “Your favorite trucker hat is maybe not the one to wear out in the sun all day because of all those holes.” You’ll see people who have almost the sunrise shape on the back of their bald heads because of where the snap part of the cap is, or little dots from where the little perforations in the trucker hats are.

Where are signs of melanoma likely to show up on the body?

The common sun-exposed areas, of course, are our head and our neck, where some people may not realize how much sun exposure they’re getting. As we age, we certainly see higher incidences of skin cancers on places like the backs of the hands, the ears — places that have just been out in the sun your whole life with relatively limited protection.

Another interesting caveat is that there was a study that showed that in men, about one-fourth of melanomas were actually detected by a spouse or loved one — someone who said, "Hey, you should get this checked out," whereas in women it was almost 0%. Women were finding them on their own.

Oh, really? So as a doctor, what does that tell you about male patients?

This is just me kind of making an assumption, but with men, a lot of times, there’s maybe a little bit of machismo, where you can do no wrong, and your body will never fail you. A lot of men are not as aware of their skin in the context of cosmetic types of changes. They may say, "Oh, what do I care what my back or ears look like? I’m not going to win any beauty pageants or anything like that.”

In short, if you check yourself in the mirror and see something suspicious, should you resist the urge to act like a tough guy and have it checked out by your primary care doctor or a dermatologist?

Yes. Have someone take a look at it, because there also could be other physical exam findings that may steer your doctor one way or another, or help them to facilitate a referral to someone who would perform a biopsy (a small sample of the skin) to confirm an abnormality.

What’s the bottom line when it comes to men and skin cancer?

You know your skin better than anyone else. You’re the one looking in the mirror everyday. So the biggest thing I would emphasize is paying attention to any areas that are changing or becoming unusual over time. About 30% of melanomas develop from existing moles, meaning a mole that was once benign and ordinary can gradually develop atypical — and ultimately cancerous — features.

And that clue really comes from changes in size, shape, color or appearance, or in symptoms such as itchiness, bleeding or ulceration. But melanoma can also arise from a brand-new spot that wasn’t there before.