In the 60s, thousands of families, friends and almost all Spaniards were looking for any excuse to take a few days and go to the beach. Tanning was beginning to be fashionable, and no one wanted to return from vacation without skin several shades darker. “I remember applying oil and being able to spend hours lying in the sun without thinking about the overexposure I was having,” she says. Loneliness Macias to RTVE.es.
This woman from Cáceres was diagnosed in 2008 with a melanoma in a stain that had grown. “They cut me open from my forehead to my chin. Luckily they caught it in time and it hadn’t spread,” he adds. He melanoma It is one of the types of skin cancer more aggressivewhich can spread and generate metastases.
Thanks to early detection, Soledad did not have to undergo any treatment.
When it began to bother her, Soledad went to a specialist who burned it with nitrogen, although a dermatologist later confirmed the worst prognosis. “I remember when I received the results, I started crying. You hear cancer and you sink,” she says. Years later, she was diagnosed with carcinoma in time and after removing it she managed to overcome it again.
According to the ‘Study of the Skin in Spain’ prepared by IMR, during the last four years, the Skin cancer diagnoses have increased by 40%, reaching 78,000 new patients annually. Although the statistics speak of an increase in the case of older populations, in the case of young people they have stabilized.
A silent cancer
When the skin is exposed to the sun for a long time, melanocytes produce more melanin as a defense against the action of ultraviolet rays. When they outnumber normal skin cells, new moles and freckles (nevus) appear. It is in the epidermis where lesions occur that can evolve into skin cancer, melanoma and nonmelanoma. The main difference is that non-melanoma is generated from skin cells other than melanocytes, such as basal and squamous cells.
While non-melanoma carcinomas are the most common in our country, melanomas are the most serious. However, it is the most preventable and has a good prognosis when treated and detected in time.
Sustainable Universe: Skin cancer
While skin cancer can affect anyone, exposure to UV radiation, genetics, skin type or immunosuppression are risk factors. Dr. of the International Dermatological Clinic Pedro Rodriguez explains to RTVE.es that new reasons are added to explain the increase in cases, such as greater exposure to the sun due to lifestyle and leisure habits, the aging of the population or the abuse of tanning booths.
Against this backdrop, early detection has become essential for survival of patients, which can reach 80% in the case of melanoma. Little by little, technological advances are striving to achieve greater precision to save resources, time and improve the patient experience.
A standardized diagnostic procedure
Juan Rubio, 71, was diagnosed with melanoma a few weeks ago on his back. It is the second time that he has gone through the process, although he is now much more aware than in 2001, when he went for a consultation for a “bad looking” wound that turned out to be skin cancer. Both Soledad and he emphasize the idea that the skin has memory.
“The Burns what we do in our childhood They can affect future skin cancers. These cells can be damaged for years,” explains RTVE.es, the person responsible for prevention at the Association Against Cancer, Karen Ramirez. In part, this is what could have happened to Juan, who remembers burning himself many times when he was young without giving it much importance.
Currently, Juan is a member of the Local Board of the Spanish Association Against Cancer in Calatayud.
The diagnostic procedure usually begins with a complete skin examination by a dermatologist, who may apply the ABCDE rule To evaluate the characteristics of moles: asymmetry, edges, color, diameter and evolution. Subsequently, the dermoscopy, or epiluminescence microscopy, will allow you to refine it with other dermoscopic criteria. This tool, already proposed in the 17th century by a French doctor, botanist and alchemist, Pierre Borrel, is currently standardized in consultations.
In case of doubt, the next step is to perform what is known as the “gold standard”, the biopsy, in order to obtain a sample of the tissue that is analyzed under a microscope in a pathological anatomy laboratory. “The waiting time for results varies by communities, centers and volume of tests,” explains Ramírez. This type of analysis allows you to confirm the diagnosis and determine the type and stage of skin cancer. A few days later, Juan received the results and quickly underwent surgery.
At the beginning of 2000 came the revolution of digital dermoscopy with which, through photographs, doctors could have a record of the evolution of moles, and the teledermatology, to assist patients from a distance.
3D skin reconstruction at a microscopic level
Over the years and advances in medicine, the technologies used to diagnose skin cancer have evolved significantly. Dermatoscopy was followed by other tools less invasive and more precise to make the work of professionals easier, as is the case of reflectance confocal microscope. Although his use is still not the majorityas explained by dermatologist Pedro Rodríguez.
The dependence on operator skill and the difficulty in differentiating certain types of lesions in early stages remain the main challenges.
One of the places where they are being used is in the Hospital Clinic of Barcelona, which already has three different ones. “Applying a microscope to the skin with a low power laser light cellular resolution can be achieved, reducing biopsies by 50%,” the head of the Dermatology Service explains to RTVE.es, Susana Puig. This is especially useful when there are injuries to a lip or the tip of the nose.
Spain is at the bottom in the use of this technology in the EU, despite having been a pioneer in its development. DIAGNOSTIC CENTER IN DERMATOLOGY
In those patients who have many moles, it is sometimes very difficult to know if a lesion already existed, has changed or is new. For this reason, they have developed new imaging techniques that not only allow us cellular resolution, but also a 3D reconstruction of the skin at a microscopic level. “It’s like a kind of 3D virtual biopsyeven in very few hospitals in the world, and that is where the future is going,” explains Puig.
For some years now and with a high level of evidence, a type of procedure known as total body maps It has also been gaining more and more followers. In some cases, they can make a 3D recreation of the entire body.
Example of the equipment used at the Hospital Clínic of Barcelona to make 3D body maps. VECTRA
“It is done with teams of more than 90 cameras that are fired at the same time so that AI algorithms rebuild the person’s skin and all their moles,” adds the dermatologist. Although they are not yet perfect systems, Puig highlights that they help us make decisions and notice small changes that can be overlooked.
Robotic technologies with AI for more effective detection
Artificial intelligence tools already allow dermatological images to be analyzed to identify suspicious lesions with high precision, assisting dermatologists in diagnosis. In Spain, there are several innovative initiatives focused on early detection, especially of melanoma.
Since 2019, the Catalan startup Dermavision Solutions has been working on a robot capable of autonomously taking images of moles, assisting the dermatologist in the detection process through algorithms. Their first trial was carried out last year at the Hospital Clínic of Barcelona and is now in the development and research phase to be able to certify that the AI algorithms they have been creating are safe.
“We have been feeding them through images of patients who have previously been dermatologist reviewedso the latter are the ones that feed their knowledge,” Narcís Ricart, CEO of the project, tells RTVE.es.
The project has obtained positive results during its first trial, in 2023. DERMAVISION
However, he emphasizes that the new regulations regarding medical devices are partly stopping this type of initiatives that, on many occasions, are encountering bureaucratic obstacles. “Once you have the project, it can take up to two years to get approval. There are few companies that can certify and many medical devices that are coming out,” adds Ricart. Added to this are the “fast queues” that are generated when companies decide to pay more in order to validate themselves sooner.
The last step will be to obtain that certification which, according to Narcís, would not reach until the 2026 or 2027. “What we want to do is simplify the work of the dermatologistsince now he has almost no time, so we give him a tool that helps him make a diagnosis with more information and care,” he concludes.
The rise of apps as complementary tools
From home and without help, just with the mobile camera, these apps allow you to locate, record and, in some cases, detect suspicious injuries thanks to algorithms. They seek to improve the detection and increase awareness about skin monitoring, although experts recommend caution when using them.
Puig warns against excessive use, which can lead to a overdiagnosis of harmless injuries. “We see more people coming in with anxiety after using them,” she adds.
The computer expert and member of the Official Association of Computer Scientists of Madrid, Javier Rubio, points out the lack of standards. “The legislation does not require an engineer’s signature on these projects, something we have been asking for as a requirement for some time,” he says. He believes that the new AI law will not change the situation much without an audit body.
Although there are positive examples, most of them paid, experts believe that it is too early to evaluate their effectiveness, since many are taking their first steps, and they continue to emphasize the importance of going to a professional.
Prevention and self-exploration, the best weapons
Although these advances seem like the most immediate future in the fight against skin cancer and improving the user experience, prevention and Self-exploration continue to be the most effective weapons. According to the patients consulted by RTVE.es, there are a series of myths and social beliefs that may continue to influence the perception of this disease. However, they believe that young people are becoming more aware, with the data reflecting a lower incidence.
Talk about this same thing Marta Caneiroa 26-year-old Galician who was diagnosed with melanoma in 2020, and who claims that there is increasing fear of suffering from this type of cancer. His habits have totally changed. “Now I apply protection all year round and in summer every two hours. I usually wear hats and cover myself if I see that I am going to be working in the sun,” she explains.
According to dermatologist Karen Ramírez, contrary to popular belief, the majority of melanomas occur in dark-skinned people. “It is also important to know that it can appear on the mucous membranes, in the nail matrix (base of the nail), in the iris of the eye and on the soles of the feet, so it is important to check them,” she clarifies.
Although it is sometimes difficult to do a thorough self-examination, experts recommend at least knowing the moles we have on our skin and observing them every two or three months.