Your skin is talking to you. Are you listening?

Every day, our skin speaks to us. It sends us more obvious signals, such as wrinkles or loss of elasticity, but also subtler ones, such as a mole changing shape, a spot appearing suddenly or a lesion that fails to heal.

Behind an apparent imperfection, in fact, there may be something more significant.

From sun damage to the risk of melanoma, learning to listen to your skin means taking care of your health.

Skin is a mirror of our longevity

Skin is much more than a calling card: it is a valuable indicator of our state of health.

In recent years, terms such as anti-aging and longevity have entered everyday language, often associated with the promise of treatments capable of stopping the aging process. The reality, however, is very different.

As Professor Alessandro De Luca, reconstructive and aesthetic surgeon and breast specialist, lecturer at the Faculty of Medicine and Dentistry at Sapienza University of Rome, and Medical Director of the Breast Surgery Unit at Policlinico Umberto I in Rome, explains: «It is more appropriate to talk about Age Management Medicine, that is, medicine whose goal is to achieve slow aging, or a slower aging process. We all age and we will all continue to age. The goal of evidence-based medicine and scientific protocols is to achieve slower aging and therefore to age while retaining youthful characteristics».

We cannot stop time, but we can slow the effects of aging by taking care of our skin health.

Skin tells our story

Every exposure to the sun, every sunburn and every daily choice leaves a mark. The best treatment is still prevention. This principle is particularly evident when it comes to skin health. Monitoring changes in a mole, protecting yourself from UV rays and undergoing regular check-ups are simple actions that can make the difference between an early diagnosis and a disease discovered too late.

Behind a mole that changes appearance is a process that began long before it became visible. This is where melanoma begins.

Gianluca Pistore, science communicator and writer, and president of the Melanoma Day association, explains: «Melanocytes are skin cells that can become abnormal and give rise to tumors known as melanomas. It is important to point out that these melanocytes are not found only in the skin, but also in other areas where we might not expect them. For example, at the back of the eye, in the genitals or in the lining of internal organs of the digestive system. Fortunately, these melanomas are rarer than cutaneous melanoma. Melanoma is very aggressive, but there is also a positive aspect: it is relatively easy to prevent, so prevention can truly make a difference».

It’s not just melanoma

When we talk about skin cancer, attention often focuses on melanoma. There are, however, several types of non-melanoma skin cancer. Among the most common are basal cell carcinoma and squamous cell carcinoma. Other, less frequent types include basosquamous carcinoma, Merkel cell carcinoma and extramammary Paget’s disease.

Dr Silvio Abatangelo, a specialist in plastic surgery with extensive professional experience in oncological dermatologic surgery and Medical Director of the Reconstructive Plastic Surgery Unit at ASST Nord Milanese, Ospedale Città di Sesto San Giovanni, points out: «In Italy, there are approximately 19,000 new cases of squamous cell carcinoma every year. One in three Italians will develop basal cell carcinoma during their lifetime».

Among the risk factors highlighted by Dr Abatangelo are immunosuppression, both following transplants and in the presence of conditions such as leukemia and lymphoma, which can impair the effectiveness of immune surveillance. He adds: «Chronic inflammation, such as the presence of ulcers or longstanding scars, particularly post-burn scars, predisposes people to the development of squamous cell carcinoma».

Simple actions can make a difference

While melanoma is one of the most aggressive forms of skin cancer, it is equally true that when it is detected in its early stages, the chances of successful treatment increase significantly. The ABCDE rule remains a useful tool for identifying potentially suspicious changes.

Dr Andrea Pietro Sponghini, an oncologist specializing in skin cancers at Ospedale Maggiore Universitario di Novara, explains the meaning of the ABCDE rule: «A stands for Asymmetry, meaning that the shape of the mole changes and it is no longer the same on one side as the other. B stands for Border: the borders change shape, perhaps becoming more irregular on one side when they were previously even. C stands for Color: for example, a change in pigmentation, perhaps with a darker area inside or lighter patches. D stands for Diameter, or size. If it changes or starts growing. Finally, E stands for Evolution, meaning that something is changing over time, perhaps even rapidly, and this should raise suspicion».

Prevention begins above all with our everyday habits. Australia provides a good example, as the country has one of the highest rates of melanoma in the world. As Dr Andrea Boutros, a medical oncologist working in the melanoma unit at Ospedale Policlinico di Genova, recalls: «Australia has played a pioneering role in primary prevention. Today, even at school, young children seen walking to and from school are all dressed in sun-safe clothing, designed to protect them from sun exposure. They all wear hats, use sunscreen and seek out shade. There is also a strong culture around this in Australian beaches. Melanoma is one of the major killers in Australia, so it certainly has a different epidemiological significance there compared with Italy».

Prevention starts at an early age

Dr Franco Castelli, director of the Dermatology and Venereology Unit at Ospedale Koelliker in Turin, stresses the importance of having the first checks from the age of 12, because although melanoma is rare in children and adolescents, that does not mean it cannot occur.

«The important thing to do – says Dr Castelli – is to avoid sunburn, because sunburn during adolescence is definitely a risk factor. We therefore advise parents to protect their children at least until the age of 20–25. Protection is also important afterwards, but to prevent the immune system from making us pay a high price in adulthood, we need to protect children».

A challenge requiring a multidisciplinary approach

In recent years, the management of melanoma has changed profoundly. Today, diagnosis and treatment involve multidisciplinary teams. Professor Emilia Migliano, head of the Plastic Surgery Department at Ospedale San Gallicano in Rome, highlights this very point: «We discuss the most serious cases within multidisciplinary teams involving oncologists, radiologists, dermatologists and other specialists».

Collaboration between specialists, together with advances in research and the introduction of new targeted therapies, is significantly improving treatment options and patients’ quality of life.

Migliano concludes: «We try to personalise treatment as much as possible, ensuring aesthetic and functional reconstruction even in the most complex areas».