Melanoma on the Mountain: Addressing the UV Crisis in Snow Sport Communities

For elite skiers, snowboarders, and other winter athletes, risk is often framed in terms of speed, terrain, and weather. Few consider UV radiation to be among the most dangerous hazards on the mountain. Yet for Travis Ganong—US Olympian, World Cup downhill racer, and lifelong skier—sun exposure ultimately proved to be consequential. His melanoma diagnosis at age 36 exposed gaps in prevention, screening, and education in winter sports communities, highlighting opportunities for clinicians to intervene during National Cancer Prevention Month.

The High-Altitude UV Hazard

Dermatology clinicians practicing in alpine regions routinely observe increased rates of keratinocyte carcinoma and melanoma among participants in snow sports. Whitney Hovenic, MD, who practices in Reno, Nevada, treats skin cancers on snow sport enthusiasts on a near-daily basis. “Our community already lives at altitude, and these pursuits take people to even higher elevations,” she told Dermatology Times.

For every 1000 ft of elevation gained, UV intensity rises by approximately 3% to 4%. Snow can reflect up to 90% of UV radiation, dramatically amplifying cumulative exposure.¹ Skiers and snowboarders may spend 6 to 8 hours outdoors per day, often over consecutive days and seasons, resulting in chronic intermittent UV exposure. Importantly, these frequently occur under conditions that patients perceive as low risk, including cloudy, snowy, or cold days, when sunscreen use tends to decline.

Barriers to Effective Protection

Despite this risk profile, sunscreen adherence among winter athletes remains inconsistent. Many patients apply sunscreen once before activity and do not reapply throughout the day, with full adherence rates as low as 4.4%.² Cold temperatures reduce the tactile reminders associated with sun exposure, and protective gear can create the impression that the face is fully shielded.

“Even when most of the face is covered by helmets, goggles, and neck gaiters, these small, exposed areas, such as the nose, remain vulnerable and are among the most common sites where I diagnose skin cancers,” Hovenic said. Additional lapses often occur during lunch breaks or après-ski, when protective gear is removed, and sunscreen seems unnecessary in cold environments.

An Olympian’s Diagnosis

Ganong recently spoke to Dermatology Times about his upbringing in Lake Tahoe, California, where life revolves around the outdoors. He joined the US Olympic ski team at age 15, went on to compete at the Olympic and World Cup level for over a decade, and spent 9 to 10 months each year training and racing at high elevations across the globe. Although aware of the importance of sun protection, he describes inconsistent use, particularly during winter conditions.

“As a kid growing up, we would think it was super cool to get the biggest goggle tan possible. That’s probably one of the reasons why I had melanoma,” Ganong said.

When a friend noticed a small spot beneath his right eye, Ganong was urged to have it examined. The biopsy came back as melanoma in situ and was successfully treated by Hovenic with Mohs micrographic surgery (Figure).

“That call was quite a shock,” Ganong said. “I think most people think about melanoma as something that happens later in life, but looking back at my history of competing at the highest level, this high-elevation mountain lifestyle of skiing all over the world, it’s kind of no surprise that my exposure was super high.”

Professional Sports Medicine

Ganong’s case reflects familiar challenges: delayed presentation, low perceived risk in younger patients, and no routine dermatologic screening despite extraordinary cumulative UV exposure.³ Ganong noted that during his career, he underwent extensive medical monitoring for orthopedic and general health concerns, yet never received a routine skin examination.

“I was on the US Olympic ski team for 18 years, and we would do all sorts of blood tests and wellness checks, but we never saw a dermatologist. That was never part of the standard medical care,” he said.

Competitive skiing is heavily regulated for safety, including frostbite prevention at extreme windchill thresholds. However, when asked about regulations regarding sun protection on the slopes, Ganong shared that there is little to no mandated support from the International Ski and Snowboard Federation, the International Olympic Committee, or other governing bodies. He and Hovenic hope to raise awareness through skin checks on the mountains, portable sunscreen marketed specifically for winter athletes, and other advocacy initiatives to make UV protection accessible.

“Just changing the rhetoric around skin care and skiing...we all want to be outside more and doing things we love, but we need to do it with protection so that we can do it until we’re old,” Ganong said.

Skin Health Beyond the Slopes

The lack of routine dermatologic screening for professional athletes, outdoor resort employees, instructors, and youth competitors represents a missed opportunity for early detection of all skin cancers, including precancerous conditions such as actinic keratosis.⁴ For clinicians, this population warrants proactive identification, counseling, and surveillance. A recurring theme among long-term patients is a sense of regret. “I always encourage my patients to continue enjoying the activities they love, including skiing the highest peaks, while emphasizing the importance of consistent sun protection. But a sentiment I hear repeatedly is, ‘I wish I had taken better care of my skin.’” Hovenic said.

As melanoma incidence continues to rise, particularly among younger adults, winter athletes should be recognized as a distinct high-risk group.⁵ For clinicians practicing in mountain regions, integrating targeted education, screening, and prevention strategies into routine care may reduce the morbidity—and, in some cases, mortality—associated with melanoma.

References

1. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Radiation. International Agency for Research on Cancer; 2012. https://www.ncbi.nlm.nih.gov/books/NBK304366/
2. Buller DB, Andersen PA, Walkosz BJ, et al. Compliance with sunscreen advice in a survey of adults engaged in outdoor winter recreation at high-elevation ski areas. J Am Acad Dermatol. 2012;66(1):63-70. doi:10.1016/j.jaad.2010.11.044
3. Varedi A, Secrest AM, Harding G, et al. Comprehensive outreach, prevention education, and skin cancer screening for Utah ski resorts. Dermatol Online J. 2018;24(2):13030/qt8d82g9vk.
4. Gilaberte Y, Casanova JM, García-Malinis AJ, et al. Skin cancer prevalence in outdoor workers of ski resorts. J Skin Cancer. 2020;2020:8128717. doi:10.1155/2020/8128717
5. Serrano MA, Cañada J, Moreno JC; Members of the Valencia Solar Radiation Research Group. Erythemal ultraviolet solar radiation doses received by young skiers. Photochem Photobiol Sci. 2013;12(11):1976-1983. doi:10.1039/c3pp50154j