Skin cancer is a major health problem in Spain and its incidence has risen in recent decades. “In four years it has grown by approximately 40%, a progressive and expected increase,” dermatologist Eduardo Nagore, one of the leading specialists in melanoma in our country, a member of the Spanish Association of Dermatology and Venereology and clinical chief, told La Vanguardia. of the dermatology service of the Valencian Institute of Oncology (IVO).
The doctor, who treats thousands of cases of skin cancer each year, warns about the minimization of the risk of death that a large part of the population makes regarding melanoma, and attributes this to its small size and the mistaken perception of superficiality and innocuousness. In an eminently practical conversation, Nagore corrects some errors in the use of sunscreens and gives very useful advice to prevent this disease.
Why was the increase in skin cancer to be expected?
Due to factors that we carry, such as the habit of sunbathing or the way we dress. Before, the Spaniards went covered on the field, but in the last 100 years that has changed a lot. In addition, many people now work in the service sector, with a very characteristic pattern of intermittent sun exposure, which increases the risk of melanoma: they do not see the sun in winter, while in summer they are exposed all day.
Has the trend of being tan caused many deaths?
Being white was a sign of distinction, of upper class. But Coco Chanel came along and being tanned became synonymous with having money to go on vacation. That created a copycat effect.
Is there now more awareness about the dangers of the sun?
Knowledge about the dangers of ultraviolet radiation dates back to the 80s and 90s, when people began to know that roasting on the beach is not good, campaigns began to tell the population that they had to protect themselves from melanoma. A few years ago, when summer began, you would go to the beach and the first day you would surely burn, peel, and there was the idea that your skin would tan and in the end you would get tanned. That changed and in the 90s fathers and mothers already put more protection for their children. When the generation that has grown up in the 2000s is 60 years old, the decrease in the incidence of melanoma will be seen in the numbers.
Other than ultraviolet radiation, what are the risk factors for skin cancer?
Cancer is inherent to the human being, when a cell multiplies it sometimes produces errors. They are almost always corrected, but some of those errors can lead to cancer. In skin cancer, in the first place, the risk factors are environmental, ultraviolet radiation. Secondly, there are the characteristics of the individual that do not protect him from that radiation, such as having white skin.
How does each type of skin work, in terms of sun protection?
It has to do with the type of melanin or type of pigmentation. Skin phototypes are determined based on the reaction to ultraviolet radiation. The more white, the more risk of skin cancer. The ease of burning or tanning determines the phototype. Redheads have lousy melanin (pheomelanin), which increases free radicals from radiation hitting the skin. Asians, Latin Americans, or blacks have a much lower risk of skin cancer. The person with many moles or nevus has an ease for their melanocytes (cells that become cancerous) to multiply, with less radiation they have an easier time for the appearance of melanoma.
Is there a genetic risk factor in skin cancer?
Yes, genetic characteristics can be a risk factor. Familial colon cancer has mutations that favor it, the same thing happens in melanoma, there are families that have two cases, because there are predisposing genes that favor it.
Are there tests and studies to verify our genetic predisposition?
There are genetic analyzes and studies that include about 80 genes on which there is scientific evidence that condition cancer. These people are put into early detection programs, since these genes predispose not only to melanoma, but sometimes to pancreatic, or breast, in some cases.
What types of skin cancer are there?
Melanoma is the most aggressive, but it is not the most frequent. The most common is basal cell carcinoma, which represents one in three cancers, it is the most frequent in the world, although it is not famous because it does not kill, it is eliminated and it does not metastasize.
What is the main way to prevent skin cancer?
To try to avoid cancer, you must make proper use of ultraviolet radiation: never use tanning booths and do sun exposure correctly, depending on the type of skin. If you have white skin and many moles, be extremely careful. In the central hours of the day, from 11 in the morning to 5 in the afternoon, exposure must be avoided. If you go to the beach, apply the necessary means of protection: creams, clothes, hats, umbrellas… The more things, the better.
On the market there are sun creams for 8 euros and 50. Do they all protect effectively if they have the same protection factor?
Yes, if the cream puts factor 50, they have had to test it, they cannot fool you on this. The difference between supermarket and pharmacy creams is cosmetic, aspects such as texture. The cheapest one may be stickier, but not everyone can afford to use 50 tubes in one summer. With one from the supermarket I am equally protected, you just have to look at the protection factor, and that they carry the EU seal. Also, what protects is not the cream, but what is inside it, the cream is a vehicle. Some commercial brands may have found creams that last longer.
What does the protection factor mean?
The factor 50 means that you need 50 times more radiation for the skin to burn. To put it simply, that cream lets through one ray out of 50.
What do we do wrong, with sunscreen?
The cream takes about 15 to 30 minutes for the product to enter the skin and be located where it touches, therefore, it must be applied well in advance of sun exposure. In addition, it is tested with two grams of product per square centimeter, and if you want to use that amount, you would have to add a third of the bottle per application. That is to say, a pasture in cream! That’s why nobody does it.
So what good is that factor? Should we always use very high factors?
Exact. You have to go up in the protection factor, because if you decrease the amount of cream that you apply, that protection decreases. If you use factor 50 and you wear less than you should, maybe you are actually wearing factor 20 or 30. The recommendation? Factor 50, put it on with time, and don’t forget to apply cream again. There are products that are more resistant to sweat or bathing and last longer, although after two hours their effect declines because the product degrades.
Is it better to protect yourself with tissue, than with cream, when we can?
The clothes are fantastic against the sun, because you save a lot of money on cream. In addition, there are now solar shirts, which are tested with spectrophotometers and have EU labels; with a factor 30 in a shirt is enough. You avoid having to reapply creams, you don’t have to do anything else all day! Now they are designed to be outdoors, for sports and movement, they are thin and allow them to breathe, they are not a nuisance.
What else can we do to prevent skin cancer? Early detection is key…
The universal message is that you have to get used to knowing your skin and checking it from top to bottom once a month at home, emphasizing the most difficult areas of the body, such as the scalp. Have someone look at the parts of your body that you don’t see every day in the mirror: behind your ears, head, genital area, buttocks, soles of your feet… Those who have risk factors should go to the dermatologist once a year, who will make an assessment and determine if inclusion in a specific program is required.
What are the alarm signs before a mole?
The most important, that the mole is rare. If you see that you have a different mole, that changes or itches, consult! I only see melanoma patients and many people come to the office saying that they have not had time to go for a check-up. I tell them that if they brush their teeth, this is more important: two minutes a month are necessary to avoid dying. For an ugly mole, if you don’t watch it, you can die. Patients with melanoma one centimeter in diameter, the size of a fingernail, have a 30% chance of dying in five years. People think I’m kidding them when I explain it.
Is melanoma a much more aggressive cancer than we think?
Melanoma is said to be aggressive because if you were to compare it to the size of other cancers, it is much more likely to cause death. People may downplay it because of its size and because it’s on the skin; It seems that they remove it and that’s it, but melanoma metastases can go to the lymph nodes, lungs, liver, brain… and kill you. People with a severe melanoma -more than 4 millimeters thick- have a 40% chance of dying in five years, although with new drugs this is changing.
