Skin cancer: warning signs not to ignore and new treatments that are changing the prognosis

A mole that changes shape. A spot that suddenly appears. A lesion that seems harmless but never truly heals. The skin is constantly communicating, often in a quiet voice. Learning to listen to it could make a significant difference.

The key word linking prevention and increasingly effective new treatments is awareness.

«In oncologic dermatology, and in dermatology in general, there is a simple acronym: A-B-C-D-E, like the letters of the alphabet. It works in both Italian and English and refers to a series of features that ordinary people can observe if they notice something changing», explains Andrea Pietro Sponghini, an oncologist specialising in skin cancers at the University Hospital of Novara.

The specialist distinguishes between moles that appear over time and those present from birth or early childhood. The former, he explains, “appear on parts of the body where they were not previously present,” while the latter “are moles we are born with, or that develop during the first years of life.”

The ABCDE Rule

To help people recognise potentially suspicious signs early, dermatologists have long used a simple rule known as the ABCDE rule.

Asymmetry, Borders, Color, Diameter, and Evolution are the main features that may indicate the need for a specialist evaluation.

«A stands for Asymmetry, meaning the shape of the mole changes and is no longer the same on both sides. B stands for Borders, which may become irregular or jagged instead of remaining smooth. C stands for Colour, such as changes in pigmentation, darker areas, or lighter spots. D is for Diameter, if it changes or grows. Finally, E stands for Evolution, meaning something is changing over time, perhaps rapidly, and that should raise suspicion».

According to Sponghini, what matters is not only how a mole looks at a particular moment, but especially how it changes over time.

How skin cancers can develop

When people think of skin cancer, they almost always associate it with sun exposure. In reality, the picture is more complex.

«Some skin cancers can arise from injuries other than sunburn. For example, severe burns caused by boiling water spilled during childhood can leave damaged skin that may later develop into cancer, even at a relatively young age».

The oncologist also points out that some skin cancers can develop without any obvious history of burns.

«Skin cancers such as melanoma, but also non-melanoma skin cancers, can develop on skin that has never experienced a previous burn or in people who have not had significant unprotected sun exposure».

Some individuals are naturally more susceptible. People with fair skin types, he notes, “with very pale skin tending toward red or light pink tones,” should pay particular attention to both sunburns and the appearance of new moles.

Areas we check less often (but should watch more carefully)

Self-examination of the skin is an important first step in prevention, but it is not always enough. As Sponghini notes, the first person to notice a change is often someone else. «It’s often not the patient themselves, but someone else who points out that something has changed».

The reason is simple: many moles develop in areas that are difficult to see. «Areas with skin folds that are less visible, perhaps covered by hair. A mole does not necessarily appear on a leg or thigh, where it is easy to notice».

For this reason, regular dermatological examinations remain essential, especially for people at higher risk.

Three strategies to protect your skin

When discussing skin cancer, one of the most common questions is whether it can be prevented.

According to Sponghini, prevention occurs at three different levels. «Primary prevention is the intuitive one: avoid getting sunburned and avoid inappropriate sun exposure. This applies even to people with darker skin types».

He emphasizes that risk is not limited to beach vacations.

«People often think about the seaside, but not about the fact that UV radiation is much stronger at 2,000 meters (about 6,500 feet) above sea level».

Sunscreen remains a fundamental protective tool and helps dispel a common myth.

«Let’s debunk the myth that wearing sunscreen prevents tanning. That is not true. In fact, it helps preserve the skin and is much better for healthy aging».

This focuses on early diagnosis.

«We are talking about mole checks, which may be yearly or every six months depending on the individual’s risk».

An experienced dermatologist can use imaging and monitoring tools to detect suspicious changes early.

This applies to people who have already been diagnosed with skin cancer.

«It is no longer really prevention but follow-up. It means receiving the best possible treatment at specialized centers and then adhering to long-term monitoring schedules to reduce the risk of recurrence».

Melanoma, basal cell carcinoma, and squamous cell carcinoma

The term “skin cancer” encompasses very different diseases in terms of frequency, aggressiveness, and prognosis. Among them, melanoma remains the most feared.

«Melanoma is the most extensively studied because of its aggressiveness and its ability to metastasise, that is, spread beyond the original mole and affect other organs».

Fortunately, early diagnosis has dramatically changed the course of the disease.

«Many suspicious moles can be surgically removed at an early stage. This often protects patients from future disease progression».

Far more common, however, are basal cell carcinomas and squamous cell carcinomas.

Basal cell carcinomas generally remain localised, while squamous cell carcinomas tend to be biologically more aggressive.

«They have a higher degree of aggressiveness compared with basal cell carcinomas».

Although their metastatic potential is lower than that of melanoma, squamous cell carcinomas can still spread.

«Like melanoma, though to a much lesser extent, they can give rise to distant metastases».

Smart therapies that are changing the history of skin cancer

In recent years, scientific research has profoundly transformed the treatment of skin cancers.

While surgery was the primary weapon for decades, clinicians now have access to increasingly personalised and targeted therapies.

Among these, immunotherapy has marked an unprecedented breakthrough in the treatment of advanced melanoma.

According to Sponghini, these therapies have achieved results that would have been unthinkable only a few years ago. In many cases, they can control the disease over the long term and, for some patients, even lead to a cure.

Alongside immunotherapy, targeted therapies are becoming increasingly important. These drugs are designed to attack specific molecular abnormalities within tumours, making treatment more precise and individualised.

This progress does not replace prevention, it complements it.

Because, as everyday clinical experience continues to show, early diagnosis remains the most effective tool for improving the prognosis of many skin cancers.