The Skin Cancer Foundation Journal

MAY 2014

The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.

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55 Why is Melanoma Deadlier for Young Men than Young Women? W e've known for decades that mela- noma is deadlier for men than for women. 1 In 2014, an estimated 9,710 people will die from melanoma in the US, with men accounting for nearly two-thirds of the deaths. 2 This gender difference is usual- ly explained by differences in skincare and sun safety: men are less diligent about using sun protection, performing skin self-exams, or see- ing physicians for total-body exams. Thus, they would logically develop more skin cancers and discover them later, when they are more lethal. But recent research suggests a more complex picture. Biological differences between men and women — and how their bodies respond to tumors — may also play an important role. The Before-40 Conundrum After age 40, more men than women develop skin cancer and die from it. Overall, about 60 percent of melanoma deaths occur in white men age 50 and older. But before age 40, the equation is more enigmatic. In the frst four decades, more young women than young men develop skin cancer. Despite this, more young men than young women die from the disease. Since many experts attribute young women's higher incidence to greater use of sunbeds, it could be argued that they are the ones practic- ing riskier behavior; nonetheless, more young men are dying. In fact, the difference is stun- ning: young men account for only 40 percent of melanoma cases in their age group, but more than 60 percent of melanoma deaths. 3,4 Our team recently conducted a study in young men and women (ages 15-39) diag- nosed with melanoma in the US from 1989- 2009, fnding that regardless of body site, tumor size, extent of disease in lymph nodes and distant sites, or other factors affecting prognosis, men were 55 percent more likely to die from melanoma than women. 4 Such a disparity in death rate for the same severity of tumor suggests a basic biological vulner- ability in young men over young women. Men's Gender Disadvantages Other recent studies support the idea that biol- ogy, not just behavior, is a key factor in the dif- ference between male and female melanoma outcomes. In a German cancer registry study, women had nearly a 40 percent survival advan- tage compared to men and were signifcantly less likely to have the disease spread to the lymph nodes or internal organs. 5 Similarly, an analysis of four multicenter melanoma trials in Europe showed a 30 percent survival advan- tage in women, even when men and women were matched for age, tumor characteristics, anatomic location, and trial-associated treat- ment and follow-up. 6 These fndings suggest that men's and women's bodies respond differently to tumors. We don't yet know the reasons, but one compelling theory, espe- cially in young men and women, is that male hormones may aid the spread of cancer cells and suppress the immune system's ability to destroy them, while hormonal factors in young women may offer a protective effect. Another physical disadvantage men face is that while women most often develop melanomas on their legs, where they can be readily spotted early, men develop nearly one third of their melanomas on their backs, where they often go undetected until they have grown dangerously thick or presented more advanced symptoms such as bleeding. Thus, men have several strikes against them: poorer sun protection practices, less skin examination, more hidden tumors, and especially for young men, a deadlier response to melanoma than their female counterparts. Survival Strategies for Men To date, most public health messages on the dangers of tanning beds and sun exposure as well as the urgency of early detection have fo- cused on women. But if, as our study showed, young men are inherently at greater risk of death from melanoma, they must educate themselves. They need to practice daily sun protection and be on the alert for skin changes. Since patients initially detect lesions more often than doctors do, men need to examine their skin head to toe regularly (The Skin Cancer Foundation recommends monthly), and since lesions often develop on men's backs, wives and other loved ones could play a lifesaving role by aiding in these self-exams and encouraging prompt medical attention for any suspicious lesions. Annual total-body skin exams by physicians are just as important, because lesions found during routine health exams are generally thinner and more curable than those found by patients; if a man fnds a melanoma only when it is large or bleeding, his survival chances markedly diminish. More young females than young males develop melanoma; but more young men die from it. What explains it? Susan M. Swetter, MD, Christina A. Clarke, PhD, MPH, Theresa H. M. Keegan, PhD Biological differences may explain why young men are more likely to die from melanoma. References available on p.96

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