Sunscreen’s New Blind Spot: Fashion Trends, Tanning Myths, and the Rise of Gluteal Melanomas

Kelly English was in her mid-40s, working as an outdoor adventure guide, when a new exercise routine inadvertently may have saved her life. Having just started CrossFit in the summer of 2024, she noticed an irritated mole on her lower back and, while examining it, spotted something else: a lesion positioned in a part of the body most people never inspect.

“Just from looking at it, my dermatologist immediately said this was for sure melanoma,” English said in a conversation with Dermatology Times. A biopsy confirmed stage I superficial spreading melanoma. The location: the center of her buttocks.

For board-certified dermatologist Whitney Hovenic, MD, the case was not surprising—it was illustrative. English, a close childhood friend of Hovenic’s, had endured not only the diagnosis but a surgical recovery complicated by wound reopening, daily wound packing, and weeks of debilitating pain in one of the body’s highest-movement anatomic zones. The experience prompted Hovenic to think about the thousands of people who come to her attention at the beach, where she observes something clinicians increasingly need to consider: significant sunburns in places rarely discussed in sun protection counseling.

“Every single time I go to the beach, I realize how important it is to share this message that these delicate areas are vulnerable,” said Hovenic, who practices at the Skin Cancer & Dermatology Institute in Reno, Nevada.

As we recognize UV Safety Awareness Month, the concern is timely. With cheeky-cut bikini bottoms now among the most popular swimwear styles, a growing body of epidemiologic data on intermittent UV exposure in typically covered skin, and a Generation Z cohort demonstrating dangerously permissive attitudes toward tanning, the community faces a real-world gap between where sun protection messaging focuses and where skin cancer risk may be quietly accumulating.

The Changing Biology of Trunk Melanoma

Historically, the buttocks have been among the lowest-incidence anatomic sites for cutaneous melanoma, precisely because they receive virtually no UV exposure under conventional clothing and swimwear. A landmark Swiss epidemiologic analysis identified the buttocks as a site of minimal melanoma risk for both sexes, consistent with their typically sun-protected status.¹ The same study noted that melanoma risk at various body sites closely tracked sex-specific differences in clothing patterns and recreation habits. Trunk melanomas were more common in men, and leg melanomas in women, reflecting where each sex received the most intermittent UV exposure.

That association between intermittent exposure and tumor biology is critical. Melanomas arising on intermittently exposed sites are more likely to carry BRAF mutations and occur in the context of higher nevus density, suggesting a distinct oncogenic pathway triggered by episodic, intense UV insults rather than cumulative daily exposure.² The American Cancer Society notes that trunk and leg melanomas have been specifically linked to recurrent sunburns, particularly those occurring in childhood and early adulthood.³

This distinction matters for patient counseling and for understanding the risk posed by new exposure patterns. When a body region that has been UV-naive for decades is suddenly, repeatedly exposed to high-intensity summer sun without sunscreen, it may behave more like intermittently exposed skin with all the associated oncogenic implications.

How Minimalist Swimwear Is Redefining Sun Exposure

The relationship between swimwear coverage and melanoma risk is not a new observation. A 1986 case-control study remains one of the most striking data points in the field: Women who wore bikinis or bathed nude at ages 15 to 24 years had a rate ratio of 13.0 for trunk melanoma compared with those who wore conservative 1-piece suits, after adjusting for constitutional risk factors.⁴ Decades later, minimalist swimwear is not merely an option—it is the dominant trend. Cheeky-cut bottoms, high-cut legs, and string configurations that leave the gluteal region almost entirely exposed have become standard across retailers, with their mainstream appeal extending well into the Gen Z consumer base.

What fashion brands are not discussing—and what clinicians increasingly should—is that the skin being shown may have no history of sun exposure and correspondingly no tolerance for it. The lower buttocks, posterior thighs, and the perianal area represent regions that may receive intense intermittent UV exposure during beach and pool activities. For patients with high nevus burden, fair complexions, or a personal or family history of melanoma, this represents a clinically meaningful risk shift.

Tanning Myths and Social Media Misinformation Among Gen Z

This swimwear trend is amplified by a broader generational pattern of sunscreen avoidance and tanning aspiration that dermatologists have been tracking with increasing alarm. A 2024 survey by the American Academy of Dermatology found that 37% of Gen Z adults were unaware of 1 or more sunburn risks, and 57% endorsed common tanning myths, including the belief that a base tan provides protection from further UV damage. Approximately 34% reported that achieving a tan was more important to them than preventing skin cancer. Half reported being sunburned at least once in 2024, whereas 10% reported blistering burns.⁵

Social media has become a significant driver of misinformation. A 2024 Orlando Health Cancer Institute survey found that 14% of adults younger than 35 years believed that daily sunscreen use was more harmful to skin than direct sun exposure, whereas 23% believed staying hydrated and drinking more water could prevent sunburn.⁶ English’s arc reflects the pattern. As a self-described outdoor adventurer of Irish ancestry, a demographic with among the highest UV sensitivity, she spent years leading bike and hiking expeditions and working on the production of a major television series that filmed extensively in tropical locations, all without consistent sun protection. “In my 20s and 30s, I felt invincible,” she said. “But the older you get, the more you see the damage to your skin.”

Managing Complex Excisions in High-Mobility Zones

Beyond detection, English’s case illustrates a complication pattern that surgeons and dermatologists should discuss proactively with patients undergoing excision in high-mobility anatomic sites. Following wide local excision of her stage I melanoma, her surgical wound failed to heal. Her wound became infected, required reopening, and necessitated weeks of wound packing before reclosure. “It was a huge pain in the butt—literally and figuratively,” English said.

For gluteal melanomas specifically, the physics are unforgiving. Standard margins for stage I melanoma require excision to subcutaneous tissue, and for deeper lesions, to fascia, producing wounds that may be several centimeters wide in tissue that moves with every step. Wound dehiscence, infection, and need for repacking are not rare outcomes in this location, and patients benefit from explicit counseling before surgery rather than discovering these possibilities in recovery.⁷

Overcoming Patient Blind Spots and Referral Hurdles

The buttocks represent a diagnostic blind spot for patients. Unlike the face, arms, and legs, the posterior trunk and gluteal region require active effort or assistance to examine. Total-body skin examinations by a dermatologist remain the most reliable means of detecting lesions in these locations, yet English had never had a full-body skin check before her diagnosis, a pattern clinicians recognize as common.

Compounding the challenge is the referral pathway. English navigated the diagnosis through a primary care physician who sent photographic images to a dermatologist; an approach that correctly triggered urgent specialist evaluation but relied on the patient’s initiative to flag the lesion. Embedding that message in primary care—particularly around newly exposed anatomic sites—could extend its reach to patients who will never present to a dermatologist until a lesion is found.

“With my insurance, you have to go through a primary care doctor to get to a dermatologist,” English said. “And I feel like informing the primary care doctors on how important it is to get their patients to wear sunscreen is important.”

Evolving the Conversation

For clinicians, the convergence of these trends—minimalist swimwear, tanning culture, low sunscreen adherence, and anatomically novel UV exposure—creates a specific counseling opportunity during routine visits and full-body skin examinations. Hovenic frames the swimwear conversation as one that extends beyond individual patients, whether that results in industry partnerships, label warnings, or simply more consistent clinician-to-patient conversations.

“I think there’s an important opportunity to raise awareness, especially among young women and even swimwear brands, about how changing fashion trends may be shifting sun exposure patterns,” she said. “The reality is, these styles aren’t going away anytime soon, so we need to evolve the conversation around protection.”

References

1. Bulliard JL, De Weck D, Fisch T, Bordoni A, Levi F. Detailed site distribution of melanoma and sunlight exposure: aetiological patterns from a Swiss series. Ann Oncol. 2007;18(4):789-794. doi:10.1093/annonc/mdl490

2. Whiteman DC, Stickley M, Watt P, Hughes MC, Davis MB, Green AC. Anatomic site, sun exposure, and risk of cutaneous melanoma. J Clin Oncol. 2006;24(19):3172-3177. doi:10.1200/JCO.2006.06.1325

3. Risk factors for melanoma skin cancer. American Cancer Society. Updated October 27, 2023. Accessed June 15, 2026. https://www.cancer.org/cancer/types/melanoma-skin-cancer/causes-risks-prevention/risk-factors.html

4. Holman CD, Armstrong BK, Heenan PJ. Relationship of cutaneous malignant melanoma to individual sunlight-exposure habits. J Natl Cancer Inst. 1986;76(3):403-414.

5. AAD survey: half of Gen Z got sunburned in 2024—and many still don’t know the risks. News release. American Academy of Dermatology. May 20, 2025. Accessed June 15, 2026. https://www.aad.org/news/survey-gen-z-sunburned

6. Survey finds young adults more likely to believe myths about sun protection and skin cancer prevention. News release. Orlando Health Cancer Institute. May 1, 2024. Accessed June 15, 2026. https://www.orlandohealth.com/content-hub/survey-finds-young-adults-more-likely-to-believe-myths-about-sun-protection-and-skin-cancer-prevention

7. Schlager JG, Hartmann D, Wallmichrath J, et al. Patient-dependent risk factors for wound infection after skin surgery: a systematic review and meta-analysis. Int Wound J. 2022;19(7):1748-1757. doi:10.1111/iwj.13780