Dr. Joan Ramon Garcés,

The known risk factors are determined by the basic constitution of the patient and by types of external aggression that are harmful to health. People who:

• have little melanin (pigment protecting against the sun)
• have a fair complexion or red hair
• burn easily when exposed to the sun

are 20 to 30 times more likely to develop skin cancer in their lifetime than those with dark complexions who tan easily.

• People with atypical nevi (irregular-shaped moles of a larger than usual size) or a large number of such moles (more than 20) should check with their dermatologist for possible skin cancer symptoms. This type of patient may also have a personal or family background in skin cancer, factors which in themselves represent a greater risk.
• Patients with a deficient immune system (natural defenses), whether due to illness or medicine taken to prevent organ transplant rejection, for example, have "weaker" resistance to the appearance of a cutaneous tumor.
• The most studied type of agression is solar radiation. The influence of sunburn (especially in childhood) on the possible future development of skin cancer is well known: the more sunburn the greater the likelihood (consult the relevant section in the book "Cuando calienta el sol" – "When the Sun Shines")

This depends largely on the type of tumor, its location, size, depth, and the condition of the patient, etc.

A biopsy (sample analysis) is compulsory. Treatment subsequent to a biopsy is sometimes not necessary, since all the lesion is extirpated when the sample is taken. Most treatment can be carried out under local anesthetic at a local clinic or surgery.

The techniques employed may be of two types: destruction or extirpation of thetumor

• Destructive techniques have the advantage of being more straightforward and some require no local anesthetic. The main drawback is that we cannot "obtain" a tumor for subsequent analysis (because it has been destroyed), and therefore we are unable to calculate the surgical safety margins exactly. Thus we do not know for sure if the cancer has been definitively removed. These techniques are therefore employed in superficial cases, where a recurrent tumor (a tumor that develops again) presents no problems, or in patients with conditions that make surgical extirpation difficult. Such techniques always require regular check-ups. The most commonly employed destructive methods are: cryosurgery (freezing), laser treatment, curretage, radiation therapy, topical imiquimod (immunotherapy) and photodynamic therapy.
• Surgical extirpation of a tumor is the technique recommended wherever possible, since it is curative and enables us to analyze the margins of resection to determine if all the tumor has been removed. In tumors with a tendency to spread (melanoma), the extent of the safety margins is determined according to the depth of the tumor, and sometimes also neighboring glands must be analyzed to check for any possible spread. In solid tumors with local invasion (basal cell carcinoma), the surgical safety margins may be the minimum required; the smaller the margin the smaller the defect, and the smaller the defect the better the aesthetic and functional result. Mohs micrographic surgery is a special technique involving a phased extirpation of the tumor, with microscopic analysis of surrounding tissue performed during the operation itself. Thus the entire tumor is extirpated while conserving healthy skin tissue in the region as far as possible. Results obtained as regards cure are better than in other tumor treatment techniques. The complexity of this treatment means that it is employed only in specific cases.

Although different types of skin cancer have different appearances, any lesions (spots, scabs, scars, wounds, lumps, freckles, etc) liable to appear, change in appearance, bleed or grow without apparent motive, do not go heal by themselves or otherwise get worse must receive attention from your dermatologist. Pain is not a significant sign, since skin cancer is rarely painful.

Basal Cell Carcinoma. The most typical sign is a small, hard or lumpish scar resembling a drop of wax, though somewhat more translucent, with small blood vessels on the surface. It is not painful and may bleed spontaneously, only to scab over before bleeding again. Its growth is slow and may be noticed over a period of months. It is almost always located on the face, especially around the nose, although it may appear on any part of the body. It may become very destructive if allowed to develop. On the trunk it may resemble a well-defined rough area of skin with a "dirty" appearance, slow growth and slight soreness.

Spinocellular carcinoma (squamous cell carcinoma). Often appears as a nodular lesion of the "wart", "lozenge" or "horn" type. These lesions are hard, reddish in color, opaque, surrounded by slight inflammation and have faster growth. They are commonly found on sun-exposed areas of the body, such as the back of the hands, the lower lip, the lower neckline, the ears, the forehead, and the scalp in bald patients.
The cancerous cells are sometimes confined for a while to the epidermis (the outermost layer of the skin). They have a slower growth rate without invasion. These spinocellular carcinomas in situ go by the name of Bowen's disease or erythroplasia of Queyrat (when they appear on the glans penis).
Other flat lesions, reddish in color, with scaling and spicules, and found on the same areas of the body of people with fair skin, may be the forerunners of this type of cancer. Regarded by some authors as true superficial spinocellular carcinomas, they are known as actinic or solar keratoses (AK). They have a very high incidence rate and are likely to reappear. Although they are benign, their importance as lesions signalling the appearance of spinocellular carcinomas makes them the target of tests for multiple treatments aimed at tackling skin cancer at its inception: before it appears.

Melanoma. An irregularly pigmented freckle or mole (brown, black, red, white, gray, blue), asymmetric, flat or raised, with irregular borders, usually larger than 0.6 cm in diameter, which may bleed, change shape or grow… Also the appearance of a new lesion on any part of the body that "looks like a freckle", grows bigger, changes shape or texture. The best-known rule for recognizing a melanoma is ABCD:

A= Asymmetry
B= Border (irregular)
C= Color (variable)
D= Diameter generally greater than 6 mm

A for asymmetry
Melanomas acquire an asymmetric shape.

B for border
Melanomas have borders that are notched and irregular in outline.

C for color
Melanomas usually have a varied range of colors:
brown, beige, blackish, bluish, etc.

D for diameter
Melanoma normally measure more than 6 mm in diameter.

Important. Most skin changes and lesions are not associated with cancer. If you believe you have a skin lesion that may be associated with skin cancer, do not hesitate to see your doctor or dermatologist, since accurate diagnosis is painless and easy to perform. Remember that in most cases total cure can be achieved by early diagnosis.

Exposure to solar radiation

The incidence rate of skin cancer can be reduced providing we take a rational approach to exposure to solar radiation (common sense sunbathing) and by carrying out regular self-examination.

Self-examination of the skin

The best time for self-examination of the skin is when taking a bath or a shower. For this you will need a large mirror and a hand mirror. It is necessary to take into account skin lesions already present and to note any change or the appearance of a new lesion.

The steps to follow are:

1. Examine your face and then, with your arms raised, your body, both front and back as well as the sides.
2. Examine arms, forearms, hands and nails.
3. Behind the legs. In a seated position, examine your feet, particularly the soles and between your toes.
4. Examine your neck and back with a hand mirror, not forgetting the scalp with the aid of a comb, parting the hair to get a good view.
5. Examine your lower back, buttocks and genitals with a hand mirror.