Is skin cancer linked to war service in a specific location?

Is Skin Cancer Linked to War Service?

Yes, military service—particularly in tropical or high-UV environments—is definitively linked to increased skin cancer risk, with World War II veterans stationed in the Pacific theater showing statistically significantly higher rates of both melanoma and nonmelanoma skin cancers compared to those stationed in Europe or non-military populations. 1, 2, 3

Evidence for the Link

Pacific Theater Service and Skin Cancer Risk

• A consecutive survey of 370 World War II servicemen with skin cancer found a statistically significantly greater number of Pacific veterans developed basal cell or squamous cell carcinomas compared to Europe veterans, demonstrating that even a few months to a few years of prolonged sun exposure in high-sun-intensity areas can result in skin cancer development many years after exposure 1

• Among melanoma patients of World War II draft age, 34% had served in tropical theaters compared to only 6% of age-matched controls without melanoma (p = 0.0002), representing a nearly 6-fold increased risk 3

• Melanomas arising in veterans who served in tropical theaters were overrepresented among those originating from nevocytic nevi, suggesting a two-step process: solar induction of nevi followed by malignant transformation 3

Branch-Specific and General Military Risk

• Systematic review evidence reveals increased melanoma risk is branch-dependent, with the highest rates among United States Air Force personnel 2

• The overall increased risk for skin cancer in active duty military and veteran populations is attributed to increased UV radiation exposure, minimal sun-protective strategies, and inadequate education regarding UV exposure risks 4, 2

• Occupational sun exposure combined with inadequate access to sun protection and work in geographic regions with increased sun exposure creates a perfect storm for skin cancer development in military personnel 5

Underlying Mechanisms

UV Radiation as the Primary Culprit

• Squamous cell carcinoma occurrence is usually related to chronic ultraviolet light exposure and is especially common in sun-damaged skin of fair-skinned individuals 6

• Epidemiologic evidence convincingly links UV radiation exposure during youth and early adulthood to moderately increased risk for skin cancer later in life 6

• The British Association of Dermatologists confirms good evidence linking squamous cell carcinomas with chronic actinic damage 6

Long Latency Period

• The development of skin cancer many years after initial military sun exposure demonstrates the long-term carcinogenic effects of intense UV exposure during early life 1

• This latency period explains why veterans may develop skin cancers decades after their service ended 3

Clinical Implications for Veterans

High-Risk Veteran Populations

• Veterans who served in tropical environments (Pacific theater, Southeast Asia, Middle East) warrant heightened surveillance 1, 2, 3

• Fair-skinned veterans with red or blond hair and light eye color who served in high-UV environments face compounded risk 7

• Former prisoners of war also show increased melanoma risk 2

Screening Recommendations

• While the U.S. Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of routine whole-body skin examination screening in the general population 6, clinicians should remain alert for suspicious lesions in high-risk veterans during examinations performed for other purposes 6

• Asymmetry, border irregularity, color variability, diameter greater than 6 mm (ABCD criteria), or rapidly changing lesions warrant biopsy 6

• Veterans with atypical moles or more than 50 moles constitute groups at substantially increased risk requiring closer monitoring 6

Common Pitfalls to Avoid

• Do not dismiss skin concerns in veterans based solely on time elapsed since service—the latency period can span decades 1, 3

• Do not perform superficial tangential shave biopsies for suspected skin cancers in veterans, as this can miss aggressive subtypes; ensure biopsy depth includes the deep reticular dermis 8

• Do not assume all military-related skin cancers are melanoma—nonmelanoma skin cancers (basal cell and squamous cell carcinomas) are actually more common and also show increased incidence in military populations 1, 2

• Document military service history including theater of operation, duration, and occupational sun exposure when evaluating any veteran with skin lesions, as this information guides risk stratification and treatment selection 8