¿What is skin cancer like?
Skin cancer is currently a very common condition and one of the most frequent reasons for consultation in dermatology. Its incidence has increased in recent years, mainly due to cumulative sun exposure over time and the progressive aging of the population.
It is especially common in older individuals who, during their childhood and youth, did not have sufficient information about sun protection. As a result, they were exposed for years to ultraviolet radiation without adequate protection. This accumulated damage leads to a process of photodamage in the skin which, over time, can result in the development of different types of skin cancer.
Types of Skin Cancer
There are mainly two broad types of skin cancer:
- Melanoma, which originates from pigmented lesions, that is, moles.
- Carcinoma, the most common type, which includes basal cell carcinoma and squamous cell carcinoma.
- Basal cell carcinoma is the most frequent and is primarily locally malignant. When an appropriate excision is performed with tumor-free margins, the probability of cure is virtually 100%.
- On the other hand, squamous cell carcinoma has a somewhat more aggressive behavior. In certain situations—such as when it is located in high-risk areas or in immunocompromised patients—it can grow, invade deeper tissues, and even produce metastases, similar to melanoma.
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Melanomas
Melanoma is a tumor that originates in melanocytes, the cells responsible for producing the pigment of the skin. Early detection is essential, and for this it is key to recognize the warning signs summarized in the ABCDE rule:
- A (Asymmetry): a mole that loses its symmetry in shape or color.
- B (Borders): irregular, poorly defined borders or borders that change over time.
- C (Color): the appearance of different shades (brown, red, gray, white)
- D (Diameter): rapid, irregular, or noticeable growth.
- E (Evolution): any change in the mole, whether in size, shape, color, or symptoms such as itching, pain, or bleeding.
It is important to understand that some changes in moles can be part of their normal evolution. However, when these changes are rapid, irregular, or striking, they should be considered warning signs. In case of any doubt, it is essential to consult a dermatologist.
Carcinoma
Carcinoma is the most common type of skin cancer. Within this group, basal cell carcinoma stands out due to its high prevalence, especially in older individuals with accumulated sun damage.
One of its most typical manifestations is the appearance of a crusted lesion that does not heal. It often seems to improve and then reappears, which should raise suspicion. Clinically, it usually presents as a lesion with shiny, translucent, or pearly borders.
Although its malignancy is mainly local and it rarely produces metastases, it can cause significant problems when located in high-risk areas such as:
- nose
- periocular areas
- lips
- ears
- facial structures
In these locations, tumor growth may require more extensive surgery, which can result in important aesthetic and functional defects if not treated in time.
In poorly defined carcinomas, where tumor margins cannot be clearly identified, or in recurrent carcinomas, more advanced surgical techniques with intraoperative margin control are required to ensure complete tumor removal.
Types of Skin Cancer by Location
Skin cancer can appear on any part of the body. However, its location is often related to its cause:
- Carcinomas most frequently appear in sun-exposed areas such as the face, scalp, or ears, due to accumulated sun radiation.
- Melanoma can develop anywhere on the body, even in less visible areas, often arising from a mole that undergoes transformation.
Useful Information
Immunosuppression
Immunosuppression is a key factor to consider. Some patients undergo pharmacological treatments that reduce the body’s defenses, such as in inflammatory diseases or following organ transplants.
These immunocompromised patients have a higher risk of developing skin cancer, as they combine two important factors:
- reduced skin defense capacity
- accumulated sun exposure
For this reason, they require closer dermatological monitoring.
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Review my choiceWhat the First Visit Involves
During the first dermatology consultation, a complete skin examination is performed. It is essential to examine the entire body, as there are areas patients often do not check themselves, such as the back.
Based on this evaluation, an initial diagnosis is established, and a plan of action is defined, which may include monitoring, diagnostic tests, or treatment.
Non-Surgical Treatment Options
Prevention
Prevention is the fundamental pillar, especially for melanoma. The skin is a visible organ that allows changes to be detected early through proper self-examination. It is important to check the entire skin surface, including less visible areas such as mucous membranes or the soles of the feet. During a consultation, the dermatologist uses dermoscopy, a tool that magnifies the skin and allows the analysis of structures not visible to the naked eye. This facilitates the detection of suspicious lesions at very early stages. It is particularly useful for pigmented lesions, as it allows direct visualization of melanin without the interference of the stratum corneum. Additionally, images can be recorded to monitor the evolution of moles over time.
Biopsy
For a suspicious lesion, the initial treatment involves its removal and subsequent histological analysis. This allows confirmation of whether the lesion is benign or malignant. In some cases, when the lesion is not clearly suspicious, periodic monitoring may be chosen to assess its evolution.
Creams
There are topical treatments for precancerous lesions or superficial carcinoma, such as imiquimod, which induce a local inflammatory response. When applied over several weeks, they can achieve complete healing of these lesions.
Photodynamic Therapy
Photodynamic therapy combines the application of a photosensitizing cream with exposure to a specific light. This process selectively destroys the most active tumor cells, providing an effective targeted treatment for superficial precancerous and cancerous lesions.
Surgical Treatment Options
When lesions show greater depth or invasion, surgery is the treatment of choice, as it allows complete removal of the tumor and confirmation of eradication through histological analysis.
Simple Excision
This involves removing the tumor with safety margins. It is the most commonly used technique and offers high cure rates, especially for well-defined carcinomas.
Mohs Surgery
Indicated for tumors with poorly defined margins, high-risk features, or recurrent lesions. During the procedure, the margins are analyzed in real time through intraoperative biopsies, ensuring complete tumor removal in a single procedure. It is a more complex technique requiring the collaboration of multiple specialists, but it offers high precision and safety.
F.A.Q.
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How can I tell if a spot or mole is dangerous?
Any change in a mole—such as asymmetry, irregular borders, color variations, growth, or symptoms—should prompt a medical consultation.
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What is the most effective treatment for skin cancer?
Surgery is the most effective treatment, as it allows confirmation through histological analysis that the tumor has been completely removed.
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Will I have a very visible scar after surgery?
The visibility of the scar depends on the size and location of the tumor. There are currently multiple techniques—such as laser treatment, silicone patches, and topical treatments—that help improve the aesthetic outcome.
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Is the procedure or recovery painful?
The procedure is performed under local anesthesia and is painless. Postoperative recovery is usually well tolerated, though it may vary depending on the treated area.
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What are the chances of skin cancer recurring?
The risk of recurrence is low, though not nonexistent. In more complex cases, advanced surgical techniques are used to minimize this possibility.
Expert opinion
Dra. Marta Alegre
In the treatment of skin cancer, early detection is the most important factor. A full clinical and dermoscopic examination of the skin is essential to identify suspicious lesions at an early stage. Digital monitoring of pigmented lesions allows for the assessment of very subtle changes during patient follow-up and helps detect malignant lesions, for which surgery remains the gold standard treatment.
Regarding non-melanoma skin cancer, or carcinoma, we have multiple therapeutic options available: from non-surgical treatments for more superficial lesions to advanced surgical procedures with intraoperative margin control, ensuring complete removal and cure of the lesions.