The arrival of summer and high temperatures makes it even more necessary to protect ourselves from the sun’s rays, something that should be done throughout the year, but especially in these months when the radiation is more harmful.
From the Dermatology Service of the Healthcare Complex, Dr. Javier Cañueto assures that in Salamanca, more than 1,500 cases of skin cancer are diagnosed each year, however, “Melanoma represents only 5% of skin cancer cases, just over 100 cases per year in our health area.”
The sun is the most important environmental factor for the development of skin cancer. “Intense intermittent exposure to ultraviolet radiation, especially in childhood and adolescence, increases the risk of melanoma, and chronic sun exposure over the years increases the risk of actinic keratosis and cutaneous squamous cell carcinoma,” he explains to Tribuna de Salamanca in an interview.
If we are going to be exposed to the sun, regardless of age, “we must regularly apply a photoprotector, with a high sun protection factor and that also protects in the UVA spectrum; and we must re-apply it every two or three hours. The application should ideally be done 30 minutes before exposure.”.
Of course we have to avoid exposing ourselves during the middle hours of the day. “We must not forget that the skin has memory and the sun we take will accumulate over the years. In some way, our skin will remember in the future how we have treated it throughout our lives.”
-How many cases of skin cancer are detected each year in Salamanca?
-“More than 1,500 cases of skin cancer are diagnosed each year in the CAUSA Dermatology Service. Perhaps when we talk about skin cancer, most people think of melanoma, which actually continues to increase and is the which probably represents a greater loss of quality-adjusted life years within tumors that affect the skin. However, Melanoma represents only 5% of skin cancer cases, just over 100 cases per year in our health area. Other types of skin cancer, which are globally known as non-melanoma skin cancer, and of which the most important representatives are basal cell carcinoma and cutaneous squamous cell carcinoma, have a greater impact in terms of incidence. More than 1,000 cases of the former are diagnosed and about 400 cases of the latter in our centre. There are also other types of skin cancer that are much less frequent and have a much more modest impact in terms of incidence. The incidence of non-melanoma skin cancer is so significant that, despite its relatively good prognosis, it can account for a number of deaths comparable to melanoma in certain regions and age groups.”
“The risk of skin cancer doubles after five years of working in the sun”
-Is the sun the main reason?
-“The sun is the most important environmental factor for the development of skin cancer. Intermittent intense exposure to ultraviolet radiation, especially in childhood and adolescence, especially increases the risk of melanoma, and chronic sun exposure maintained over the years, to actinic keratosis and cutaneous squamous cell carcinoma. Precisely for this reason, our population, very aged and having been exposed to solar radiation for years due to work in the fields, is a group at special risk. In fact, The risk of skin cancer doubles after five years of working in the sun.
The skin’s ability to tan modulates this risk and thus, light phototypes are associated with a higher risk of skin cancer. The risk of developing most types of skin cancer increases with age and is more common in men. However, in recent decades we have been witnessing a “increase in young patients, especially women, which seems to be related to sun exposure habits and a fondness for tanning and recreational sun exposure.”
-What is the most common skin cancer among people from Salamanca?
“As I said before, Basal cell carcinoma is by far the most common type of skin cancer in our population and in general in white people., regardless of the region of the world. Every year we see more than 1,000 cases of this type of skin cancer in our center. Cutaneous squamous cell carcinoma is the second most common type of skin cancer in our population, with about 400 cases per year. Both are often referred to globally as non-melanoma skin cancer. Regarding melanoma, about 100 cases occur each year in our health area.”
“We must regularly apply sunscreen with a high sun protection factor that also protects against the UVA spectrum.”
-What advice would you give to prevent it?
-“Ultraviolet radiation is the most important environmental agent in the development of skin cancer. Therefore, if we are going to be exposed to the sun, regardless of age, we should regularly apply sunscreen with a high sun protection factor that also protects in the UVA spectrum; and we should reapply it every two or three hours. The application should ideally be done 30 minutes before exposureOf course we have to avoid exposing ourselves during the central hours of the day. We must not forget that the skin has memory and the sun we take will accumulate over the years. “Somehow, our skin will remember in the future how we have treated it throughout our lives.”
-Is it good to have an annual appointment with the dermatologist to check spots,
moles, etc.?
-“Could be recommended, especially in patients with a higher risk of skin cancer. The Primary Care doctor it’s a good filter in order to assess the need for a patient to be evaluated by a dermatologist. Taking into account that the population of our health area is more than 300,000 people, it would be a little difficult to be able to review everyone in our Service each year (we are 12 dermatologists), so we focus on patients at highest risk“who are those who are more likely to develop skin cancer, to have another one – in patients who have already been previously diagnosed with skin cancer – or to have a poor prognosis event in the follow-up of skin cancer with a high risk of relapse.”
-You have to examine your skin and if you have any questions…
-“What we must pay attention to is, on the one hand, the appearance of new skin lesions and, on the other, the changes that occur in pre-existing lesions. In general, when something appears on the skin that was not present before, if it persists, you should consult. Obviously, with age, spots appear on the skin and other types of processes that are not important and that we can consider part of natural aging. Nevertheless, It is advisable to ensure that this is the case. A wound that does not heal, a spot that is darker than the others or a reddish lesion with a rough and hard surface are aspects to take into account.
Changes in pre-existing lesions are what often put us on the path to skin cancer. Thus, an injury that has remained stable for a while but begins to bleed spontaneously and whose wound does not resolve should make us go to the dermatologist. A reddish spot with a rough surface that begins to grow and bulge should prompt us to consult. A mole that begins to grow and change its edges and color forces us to rule out melanoma. For the latter, it is useful to take into account the ABCDE rule, which should be applied to moles to identify those that may be at higher risk of not being benign. A refers to asymmetry, B to irregular edges, C to variegated coloring – with darker and lighter areas -, D to a diameter of more than 6 mm and E (from English evolving), to the fact that the lesion has changed. In general, if any injury raises doubts, we recommend consultation.”
-With the new hospital, how have operations in Dermatology changed? Can they be done faster? What techniques are available?
-“The CAUSA Dermatology Service is a leading center in the treatment of skin cancerOn the one hand, it is a Service with a great surgical tradition and many Dermatology residents from other Hospitals in Spain They come to our center to have short stays and learn from us, which is a huge source of pride. Besides, We receive patients from other areas of the community for more specific techniques, such as Mohs micrographic surgery (which is based on the analysis of the tumor as it is removed, until it is confirmed that all malignant cells have been eliminated) and for selective sentinel lymph node biopsy. On the other hand, we have clinical trials which benefit many patients in our health area and others in the community and in the very near future we will have others available that can help many patients.
In order to continue to remain at the top level, it is necessary to acquire the infrastructure that we have requested in the provision plan for the new hospital. With it, We will be able to make a more reliable early diagnosis and a much more precise follow-up. In addition, we will be able to optimize the indications and treatment of Mohs surgery, and we will be able to generate new knowledge in dermatological diagnosis and imaging. We consider all our requests essential to be able to offer our patients the best, and we are sure that the Regional Health Management of Castilla y León is aware of this and will help us. I hope that if you repeat this question to me when you open a new outpatient clinic building, I can tell you everything new that we have.”
“We have strengthened the non-face-to-face consultation, which allows us to filter about 30 patients a day”
-Why is it usually one of the services with the highest demand for care?
-“In recent years, society tends to consult about their health problems. This is especially observed in specialties such as dermatology, in which, in addition, any injury is visible. This means that despite trying to respond to the demand of the population as best we can, Sometimes we don’t arrive as quickly as we would like. We have strengthened the non-face-to-face consultation, which allows us to filter about 30 patients a day. We have been going to health centers weekly for a few months now, thanks also to the good availability of primary care physicians, with which we try to provide training to these doctors and, on the other hand, see patients in a more efficient way, in addition to maintaining the consultations that have always been done. With all this, We can serve more than 1,500 new patients each month, which is about 18,000 new patients each year, but even so we cannot assume all the care demand that is generated (which is even more difficult in Béjar and Ciudad Rodrigo, where we will begin a shock plan in the month of July with the idea of giving a better response to the population of those areas). To these numbers we should add the patients that we continue under review, and those that we see in super-specialized consultations. It is possible that the workforce is not adequately sized for the increase in healthcare demand that has occurred in recent years. This means that sometimes more is asked of us with similar resources. The Management tries to retain residents, not only in Dermatology, but also in other specialties, being aware that more human resources are actually required, but sometimes it is not easy to retain them because there are many offers in public and private activity. I believe that sizing the workforce according to the increase in demand, on the one hand, reinforcing primary care – as is being attempted – and relying on the tools that technology offers can help. From another point of view, The population must know that purely aesthetic reasons should not be consulted so as not to saturate a system that is already somewhat stressed.“.