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Skin Cancer Risk Often Comes From Everyday Sun Exposure, Not Just Severe Burns

By Aubriana McEvoy, MD, MS, FAAD, Siteman Cancer Center |
A couple in their car on a sunny day
In the U.S., we commonly see more sun damage and skin cancers on the left hand and forearm from years of incidental exposure. In the U.S., we commonly see more sun damage and skin cancers on the left hand and forearm from years of incidental exposure.

Routine outdoor work, driving, hobbies and missed spots like the scalp and ears can add up over time — so make sun protection a daily habit, not just during vacation.

One of the most common themes I hear from patients with skin cancer is not a single dramatic sun exposure — it’s years of routine, unremarkable exposure that never felt risky at the time.

Occupational exposure plays a big role. People who work outdoors — construction workers, landscapers, electricians, delivery drivers, mail carriers, farmers — accumulate significant ultraviolet (UV) exposure over time. Even pilots and cabin crew have roughly double the risk of melanoma due to chronic UV exposure at altitude.

Hobbies matter too. Activities like golf and fishing often involve hours in direct sun with little shade, and patients rarely think of them as “high-risk.”

Other Contributors to Cancer Risk

Another important contributor to skin cancer is immunosuppression. Patients with conditions like rheumatoid arthritis or inflammatory bowel disease often are prescribed medications that dampen the immune system. Organ transplant recipients are at especially high risk — approximately 100 times more likely to develop squamous cell carcinoma. That risk often catches people completely off guard.

I hear versions of this story all the time: “I had one bad sunburn there only once … .” And that’s exactly where we end up treating a skin cancer.

Another pattern I frequently see is skin cancer along the hair part in younger women. The scalp — especially the part line — is one area of the body that is exposed most directly to the sun, but it’s often missed when applying sunscreen.

Another area to keep in mind is the left side of the body in drivers. In the U.S., we commonly see more sun damage and skin cancers on the left hand and forearm from years of incidental exposure through the car window. It’s not something people ever think about in the moment, but it adds up significantly over time.

Keeping Kids Safe in the Sun

Parents and guardians also have an important role to play here. Children’s skin is especially vulnerable to UV damage, and the habits they learn early can help lower their skin cancer risk later in life. Modeling sun-safe behavior — applying sunscreen before school, sports and outdoor play; choosing hats, sunglasses and protective clothing; and seeking shade when possible — helps make protection feel normal, not optional. Just as important, teaching kids to reapply sunscreen and to think of sun safety as part of everyday life, not just beach or lake days, can help those habits last into adulthood.

Make It a Daily Habit

For ourselves and people of any age, it’s very important to make sun protection part of one’s routine. That means:

  • Applying sunscreen on ordinary days — not just vacations
  • Covering high-risk areas people forget (the scalp part, ears, hands, even eyelids)
  • Wearing sunglasses — not just for comfort, but to protect the delicate skin around the eyes, where skin cancer surgeries can be especially challenging

Just as important is getting familiar with your own skin — and remember that you have skin from the top of your head to the bottom of your feet. Many skin cancers are first noticed by patients or their partners. Look for the “ugly duckling” — a spot that stands out — or anything that’s changing, bleeding or not healing.

Another point I always emphasize is this: There’s no such thing as a “healthy tan.” A tan is a visible sign of DNA damage in the skin.

Finally, when it comes to sunscreen, the best one is the one you’ll actually use. I encourage people to try a few (with a Sun Protection Factor, or SPF, of 30 or higher) and find something that fits easily into their daily routine — because consistency is what really makes the difference over time.

Make an Appointment

To schedule an appointment with Dr. McEvoy or another WashU Medicine dermatologist at Siteman Cancer Center, call 800-600-3606 or fill out this form, and our Patient Care Coordination Center will contact you.

Other Resources

Aubriana McEvoy, MD, MS, FAAD, is a WashU Medicine dermatologic surgeon at Siteman Cancer Center, based at Barnes-Jewish Hospital and WashU Medicine and Siteman Kids at St. Louis Children’s Hospital. She treats adults and children and specializes in Mohs surgery, clinical trials and intralesional therapies for a variety of rare and more common skin cancers, including Merkel cell carcinoma, squamous cell carcinoma, melanoma and basal cell carcinoma. She is board-certified in both dermatology and micrographic surgery and dermatologic oncology.