This is the one article on this site where the stakes are not cosmetic. Melanoma is the skin cancer that kills, and UK data has consistently shown worse outcomes in men. The reasons are largely behavioural, which means they are among the few things in this field that can genuinely be changed by knowing about them.
1. The three that matter
Basal cell carcinoma. The most common skin cancer. Slow growing, locally destructive, almost never spreads. Typically a pearly or translucent papule, sometimes with visible vessels, that may bleed, crust and fail to heal. Common on the head, neck and ears, which in men are frequently the most exposed sites.
Squamous cell carcinoma. Arises from keratinocytes, usually on chronically sun exposed sites. Can be a scaly, tender, rapidly growing lump. Has the capacity to spread, particularly at certain sites and in immunosuppressed people, so it is treated more urgently than basal cell carcinoma. Actinic keratoses, rough scaly patches on sun damaged skin, are the precursor lesions.
Melanoma. Arises from melanocytes. Far less common than the other two and responsible for the majority of skin cancer deaths. It can arise in an existing mole or as a new lesion, and outcome depends heavily on the depth at which it is removed, which is why early presentation matters more here than almost anywhere else in dermatology.
2. Where the male disadvantage comes from
- Later presentation. Men are consistently reported as presenting with thicker melanomas, and thickness at diagnosis is the strongest determinant of outcome.
- Site. The back and trunk are more common male sites and are the hardest areas for a person to examine.
- Less skin checking. Men are less likely to examine their own skin and less likely to have a partner who does it for them.
- Less sun protection. Sunscreen use is consistently lower among men, as discussed in sunscreen and men.
- Occupational exposure. Outdoor trades are heavily male, and cumulative occupational ultraviolet exposure is a recognised risk factor.
- Scalp exposure. Male pattern hair loss exposes a site that is otherwise protected, and the scalp is easy to neglect and hard to see.
3. What to look for
The widely taught ABCDE prompts remain useful for pigmented lesions: Asymmetry, Border irregularity, Colour variation, Diameter that is increasing, and Evolution, meaning any change over time.
Two additional principles matter more in practice. The ugly duckling sign: a lesion that looks different from the person's other moles is more significant than one that meets a checklist. And change of any kind: a mole that has started to itch, bleed, crust, change shape or change colour is a reason to be seen, regardless of whether it satisfies any acronym.
Non-pigmented lesions need a different prompt. Any sore, lump or scaly patch that has not healed within a month, particularly on the head, neck, ears, scalp, forearms or hands, warrants assessment.
4. The UK pathway
NICE guideline NG12 sets out the referral thresholds for suspected cancer, including the two week wait pathway for suspected melanoma and for suspected squamous cell carcinoma. A GP is the entry point. In practice, taking a photograph with a ruler or a coin for scale, and being able to say how long the change has been happening, makes the consultation considerably more useful.
The NHS does not offer population wide skin screening, because the evidence has not supported it. Private mole mapping services exist; they can be useful for people with very large numbers of moles or a strong family history, and they are not a substitute for getting a changing lesion looked at promptly.
5. Sunbeds
Artificial ultraviolet tanning is classified as carcinogenic to humans, and use before the age of 35 is associated with a substantially increased melanoma risk. In England and Wales it is illegal for under eighteens to use commercial sunbeds. There is no protective or preparatory benefit that survives scrutiny: the idea of building a base tan is a misunderstanding of what a tan is, which is evidence of ultraviolet induced DNA damage.
6. Who is at higher risk
- Fair skin that burns easily, red or fair hair, freckling, light eyes.
- A large number of moles, or atypical moles.
- A personal or family history of melanoma or other skin cancer.
- Significant cumulative exposure, particularly with episodes of severe sunburn.
- Immunosuppression, including after organ transplantation, where squamous cell carcinoma risk is markedly increased and surveillance is routine.
- Outdoor occupations, where exposure is chronic rather than episodic.
Richly pigmented skin carries lower risk but not zero risk, and melanoma at acral sites, the soles, palms and nail units, is proportionally more significant. Late diagnosis is a recognised problem in these groups, as noted in male skin of colour.
7. What to actually do
Three things, in order of impact. Reduce ultraviolet exposure, using shade and clothing first and sunscreen as the third line rather than the only line. Check your skin every few months, including the back with a mirror or a partner's help, and the scalp if hair is thinning. And go early when something changes, because the entire outcome distribution in melanoma is a function of how thick the lesion is when it is removed.
8. How to actually check, in five minutes
A skin check is only useful if it is repeatable, and most men either never do one or do it once haphazardly. A workable routine takes about five minutes and should be done every couple of months, in good light, after a shower.
Work top to bottom. Scalp, using a comb to part the hair or a second person, and paying attention to any area of thinning. Ears, including the upper rim and behind them. Face, neck and the front of the chest. Arms, including the backs of the hands, the nail beds and between the fingers. Trunk, front and back, using a mirror or a partner, since the back is the commonest male melanoma site and the least visible. Legs, feet, the soles and between the toes.
Photograph anything you are unsure about, with a coin or a ruler for scale, and compare in six weeks. A lesion that has changed in that period is a reason to make an appointment, not to take another photograph. The referral thresholds are set out in NICE guideline NG12.