#BIOSPAIN2023Interview | "The main risk factor for skin cancer is exposure to ultraviolet radiation"

The European Day for the Prevention of Skin Cancer is celebrated every June 13. A date established with the aim of raising public awareness of the importance of adopting good habits regarding sun exposure. According to the data contained in the report drawn up by the Spanish Society of Medical Oncology (SEOM), "Cancer figures in Spain 2023", over 8,000 cases of cutaneous malignant melanoma will be diagnosed in our country this year.

Early detection plays an essential role in terms of skin cancer survival and rates have improved significantly in recent decades, with figures above 90% in patients diagnosed in the early stages of the disease. Skin cancer is one of the most common cancers globally: one third of cancer diagnoses are skin cancers. 

The most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma and melanoma. Although risk factors vary among the different types of cancer, exposure to ultraviolet light emerges as one of the main risk factors.

With this photography as a backdrop and on a day as important as today, we talk about skin cancer with Almirall, a leading global pharmaceutical company focused on skin health and Platinum Sponsor of BIOSPAIN 2023, a reference event that will focus on the search for new therapeutic approaches, among other topics. Jordi Valls, Medical Director Iberia of the company, talks to us about the main risk factors and the importance of prevention.

AseBio. What is skin cancer and what are the main risk factors?

Jordi Valls. Skin cancer is caused by the abnormal growth of skin cells that have lost control over their own life cycle. It is the most common type of cancer: one third of cancer diagnoses worldwide are skin cancers.

In the vast majority of cases, skin cancer is due to ultraviolet radiation-induced changes in skin cells that accumulate as a result of either excessive or unprotected exposure to ultraviolet radiation. Other risk factors for developing skin cancer are skin type and hair color - people with fair skin and red hair being the most at risk - genetic predisposition, the presence of atypical moles, and the fact of having received an organ transplant.

AseBio. What are the main types of skin cancer and which involves a higher risk?

Jordi Valls. There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma and melanoma. 

Basal cell carcinoma and squamous cell carcinoma consist of the abnormal and uncontrolled growth of skin cells - basal in the case of basal cell carcinoma and squamous in the case of squamous cell carcinoma - in the epidermis, the most superficial layer of the skin. Melanoma, on the other hand, is a cancer that develops in the melanocytes, the cells that produce melanin-the color-of the skin.

Although both basal cell carcinoma and squamous cell carcinoma usually develop on the parts of the body most exposed to the sun (face, head, ears, neck and hands), melanoma can occur anywhere on the body. 

Melanoma is the most aggressive type of cancer, since in more than half of the cases it penetrates the second layer of the skin - the dermis - while basal cell carcinoma and squamous cell carcinoma have higher prevalence rates and present risks of metastasization, especially in the case of squamous cell carcinoma.

Squamous cell carcinoma is derived, in a large percentage of cases - between 60% and 80% - from a precancerous condition called actinic keratosis. Actinic keratosis (AK) is the most common precancerous skin condition and consists of the appearance of small, dry, scaly or crusted patches of skin as a result of prolonged exposure to the sun, and the risk of its appearance increases with age. Early treatment of AK with the help of a dermatologist is essential to prevent the development of squamous cell carcinoma.

AseBio. In skin cancer, as in all types of cancer, early diagnosis is fundamental, but the population is often not aware of this. How can skin cancer be identified in the early stages of the disease?

Jordi Valls. It is important that a specialist physician or dermatologist performs regular examinations, since it has not been proven that skin self-examinations are determinant against this type of cancer. Even so, it is important to know the spots or nevi we have on our skin in order to detect any changes and thus go to a dermatologist without delay.

The ABCDE rule can help us to distinguish a normal mole from a non-normal one:

• A for Asymmetry: half of the mole is not the same as the other half.
• B for Irregular borders: the mole has uneven, irregular, blurred or jagged edges.
• C for Color: the most dangerous colors are reddish, whitish and bluish on blackish lesions.
• D for Diameter: lesions with a diameter greater than 6 mm and/or that increase in size with respect to a previous measurement.
• E for Evolution: follow up and control the size of moles, and if any changes occur, consult a specialist.

When visiting a dermatologist, a detailed visual examination will be performed, which, however, will never determine a definitive diagnosis. If the mole in question has malignant characteristics, a biopsy will confirm or rule out any suspicion.

AseBio. How can we prevent skin cancer?

Jordi Valls. The main risk factor for skin cancer is exposure to ultraviolet radiation, both from the sun and from artificial sources. Prevention is important for all skin types, but especially for people with low phototypes, i.e. lighter skin.

Any measure that avoids excessive exposure is recommended, among others:

• Use physical barrier measures, such as clothing (long pants or long-sleeved shirts), hats and sunglasses, during exposure.
• Use sunscreen.
• Avoid exposure to the sun for prolonged periods, especially during the central hours of the day (between 12 noon and 4 p.m.) when solar radiation is highest.

Topical treatments with chemotherapeutic agents, immunomodulators and photodynamic agents can also be used to treat subclinical multiple field lesions and decrease the risk of subsequent cancer development.

AseBio. What are the main treatments currently available for skin cancer and what is their success rate?

Jordi Valls. Treatments for skin cancer vary according to the type of involvement and the stage of the disease. Among them, surgical excision is the most frequently used treatment. It is extremely effective and generally well tolerated, with very high cure rates, especially for superficial carcinomas. In the case of very small tumors with a low risk of recurrence, cryotherapy is also used, which consists of destroying the tumor cells by freezing.

There are also topical treatments, with chemotherapeutic agents, immunomodulators or photodynamizers, which are useful in very superficial tumors or when it is not favorable to use other types of techniques. Electrosurgery and radiotherapy are also effective in this type of cancer, the latter being used above all in cases of large carcinomas. In more aggressive cases, such as melanoma, it is necessary to administer systemic chemotherapy. We are currently witnessing major advances in immunotherapy treatments for this type of skin cancer.

In any case, periodic dermatological control is important to detect possible recurrences.

AseBio. In 2017 Almirall launched an open innovation platform with the aim of facilitating collaborations in dermatological research and thus accelerating the development of new treatments for skin diseases. Last May you started a collaboration with the Center for Genomic Regulation for the development and characterization of new preclinical models to identify treatments for non-melanoma skin cancer. What has this innovation platform entailed? What progress has been made?

Jordi Valls. AlmirallShare was launched in 2017 with the aim of facilitating the creation of collaborations in the field of dermatological research and accelerating the discovery of new skin care treatments by bringing together the science and creativity of experts from around the world with Almirall's expertise. Since then, more than 1,000 scientists have shown interest in participating and more than 500 proposals have been received. AlmirallShare represents approximately 50% of Almirall's public-private collaborations. Since its launch, 9 collaboration agreements have been implemented with academic groups and research centers.

The most recent one has been with the Center for Genomic Regulation (CRG). The aim of the collaboration is to develop and characterize new preclinical models that will help identify new treatments for non-melanoma skin cancer. This collaboration with CRG brings Almirall closer to achieving its goal of delivering world-class solutions that make a difference in people's lives and reaffirms the success of the AlmirallShare open innovation platform as a key tool for creating strategic partnerships.

AseBio. What does Almirall expect from BIOSPAIN 2023?

Jordi Valls. BIOSPAIN 2023 represents for Almirall an opportunity to show our commitment to medical dermatology, research and innovation, giving us the opportunity to attend a congress that serves as a showcase for the most relevant agents in the biotechnology sector in Spain and which also has the presence of international companies in search of alliances and collaborations in the sector within our territory.

We hope to be able to identify new opportunities for collaboration within the biotechnology sector that will facilitate the development of new therapies that contribute to improving the lives of patients.