Secondary prevention is early detection of cancer in order to be able to have control, which makes the start of therapy timelier when it comes to obtaining better results for patients at high risk of skin cancer. Population monitoring población of malignant melanoma, basal cell carcinoma and squamous cell carcinoma has resulted in an increase in the rate of detection of tumors at an early stage. That results could be enough to prevent morbidity from these in the melanoma population and should be offered as part of skin cancer prevention.
Screening and physical exams are the most important secondary prevention strategies. People with high suspicion of malignant melanoma should have the opportunity to assist the health care provider when necessary and be trained how to perform aa self-examination of the skin in order to identify abnormal skin lesions, should be informed about their risk individually, regularly examined by a trained health care provider that define at an appropriate interval, based on the individual risk profile..
Among the possible negative consequences are overdiagnosis, overtreating, psychological consequences for the patient and family and possible delays in diagnosis as a result of false negative tests. These potential risks and the negative consequences of skin cancer screening should be reduced as far as possible and discussed with patients before screening.
The physical examinations to be performed exhaustively throughout the body. To do this the examination room must be well lit, and the examiner must obtain consent to approach the patient close enough to be able to identify changes in the skin with the naked eye and must ask about changes in the skin at the beginning of the procedures. If the patient has had a self-examination, these results should be included at the beginning of the presumptive diagnostic procedures to identify and differentiate between malignant and benign skin changes.
Dermatoscopy must be included in the procedure and performed by a duly qualified professional. This can be done in people at higher risk for all skin and mucous membrane injuries in the facial, genital or anal region that would not be sufficiently investigated.
Laser scanning microscopy (CLSM) also has a high resolution in the evaluation of pigmented and non-pigmented skin lesions and can improve the diagnostic accuracy of individual, difficult-to-diagnose lesions.
Histopathological examination of a suitable tissue sample is the standard confirmatory diagnostic method used to confirm injury is suspicious.
Chemo prevention- involves the use of chemicals and biological agents to prevent or delay the development of cancerous lesions. This treatment is usually directed at high-risk patients in order to prevent initial carcinogenesis. While high school is aimed at preventing recurrence of the disease. There are currently several therapies that are in research stages that have shown preliminary efficacy that are:
- Photodynamic therapy (PDT)- consists of topical application followed by light-specific wave exposure which leads to the selective production of reactive oxygen species by killing precancerous cells. This is already approved for the treatment of some subtypes of non-melanoma skin cancer and has also been suggested for prophylaxis of non-melanoma skin cancer.
- Topical viral engineering enzymes- increases CPD repair and reduces the frequency of UV-induced mutations.
- Photolyase- is a monomer DNA repair enzyme capable of removing UV-induced CPD (carboxypeptidase D).
- Anacystis nidulans photolyase- is added to the repair enzymes of the sunscreen reduce UV-induced DNA damage.
Nicotinamide- Water-soluble substance of vitamin B3 (niacin) which has been shown to be effective in preventing non-melanoma skin cancer in high-risk patients
Retinoids – chemical compounds that derive from vitamin A, with the ability to control cell proliferation, differentiation, apoptosis, and other critical functions of cells.
Difluoromethylrnitin (DFMO)- is an irreversible inhibitor of ornithine decarboxylase (ODC). This radiation increases the regulation of the activity and increased cellular levels of polyamines that have been involved in epithelial carcinogenesis.
Celecoxib- nonsteroidal anti-inflammatory drug which selectively inhibits cyclooxygenase-2 (COX-2), which is an enzyme involved in the synthesis of prostaglandin.
- GGPO (2014, April). Evidence Based Guidelines on Prevention of Skin Cancer. Short version 1.1. Retrieved from: http://leitlinienprogrammonkologie.de/Leitlinien.7.0.html. (accessed on 06/12/2020).
- Lopez, A., Carvajal, R., Geskin, L. (2018, April 15). Secondary Prevention Strategies for Nonmelanoma Skin Cancer. Retrieved from: https://www.cancernetwork.com/view/ secondary-prevention-strategies-nonmelanoma-skin-cancer
- NIH (2020). Skin Cancer Prevention. Retrieved from: National Cancer Institute, Health professional’s version. https://www.cancer.gov/espanol/tipos/piel/pro/prevencion-piel-pdq. (accessed 06/12/2020).