Follow-up of high-risk skin cancer patients

Basal cell carcinoma is the most common cancer worldwide. Approximately one in three people will develop at least one during their lifetime, particularly at older ages. Early detection allows treatment by simple surgical excision in most cases.

Although most basal cell carcinomas occur sporadically and are primarily linked to cumulative sun exposure and skin ageing, there are rare genetic syndromes—such as Gorlin syndrome, and extremely rare conditions such as Bazex–Dupré–Christol or Rombo syndrome—that predispose individuals to developing multiple basal cell carcinomas from an early age.

Identifying and monitoring these cases is essential to ensure closer dermatological surveillance. In selected patients who develop multiple tumours, particularly at a young age or in non–sun-exposed areas, genetic assessment may be considered. When basal cell carcinoma is diagnosed at an early age or appears repeatedly in atypical locations, a detailed family history is essential to rule out associated syndromes and ensure appropriate follow-up and management.

In advanced cases where surgery is not feasible due to comorbidities or tumour extent, systemic treatments with curative potential may be considered on an individual basis.

Also known as cutaneous squamous cell carcinoma, this is the second most common type of skin cancer. It usually arises as a result of cumulative sun damage, but it may also develop in scars, chronic ulcers or areas of persistent inflammation.

Early detection is essential, as is preventive treatment of the so-called “field cancerisation” caused by precursor lesions such as actinic keratoses.

Although most cases are sporadic and related to chronic sun exposure, certain conditions—such as long-term immunosuppressive therapy (for autoimmune diseases or organ transplantation) and specific genetic syndromes—can significantly increase the risk of developing multiple or more aggressive variants. Examples include xeroderma pigmentosum or epidermodysplasia verruciformis, a rare inherited immune disorder associated with persistent HPV-related lesions that may progress to squamous cell carcinoma.

In advanced cases where surgery would involve significant morbidity, systemic treatments such as immunotherapy may be indicated. These therapies are often highly effective, achieving complete remissions after relatively few sessions. Assessment by dermatologists experienced in complex cases is essential to determine the most appropriate treatment strategy.

Melanoma is the type of skin cancer with the greatest potential for spread. While it can be completely cured if diagnosed early, it may be life-threatening when detected at advanced stages.

It is estimated that between 5% and 10% of patients who have had melanoma may develop a second melanoma during their lifetime. In addition, some patients have an increased risk of developing other cancers—cutaneous or systemic—such as pancreatic, breast or prostate cancer, depending on the genetic alteration involved.

For this reason, follow-up is not limited to the site of the original melanoma. It aims to detect any new suspicious lesions early, monitor overall skin health and provide a comprehensive preventive approach.

Melanoma follow-up combines clinical and family history assessment with detailed mapping and digital registration of moles and pigmented lesions using VECTRA®, a technology capable of detecting minimal changes suggestive of malignancy. High-resolution skin ultrasound and confocal microscopy are also used to perform virtual biopsies of suspicious lesions when required.

Based on these variables, follow-up visits are scheduled at intervals tailored to each patient’s individual risk profile.

First-degree relatives (parents, siblings and children) of patients with melanoma have an increased risk of developing the disease, particularly when there is a family history or the presence of multiple atypical moles.In most cases, melanoma is not inherited and genetic alterations are somatic, affecting only the individual patient. However, when a relevant family history is present, assessment for possible germline mutations may be appropriate, as these confer inherited susceptibility.

For this reason, preventive dermatological assessment and regular follow-up adapted to individual risk levels are recommended for family members.

Melanoma follow-up also includes patient and family education on skin protection, monitoring for changes and maintaining healthy habits.

During consultations, dermatologists provide guidance on photoprotection, skin self-examination and warning signs that should prompt medical review.

Once melanoma has been diagnosed, careful assessment of tumour characteristics is essential. By protocol, most cases require surgical margin enlargement. Pathological parameters analysed in the tumour specimen help estimate the risk of local or distant recurrence—the most important being tumour thickness, expressed by the Breslow index, which measures how deeply the melanoma has penetrated the skin.

Based on these risk factors, further management decisions may include sentinel lymph node biopsy, regional imaging studies and additional investigations. To reduce the risk of recurrence, adjuvant treatments such as radiotherapy, systemic immunotherapy, targeted therapies, or local treatments (e.g. interleukin-2) may be considered.

Our unit includes dermatologists with extensive experience in the management of advanced melanoma. Patients may request expert advice or a second opinion, including in metastatic disease.

The content of this page has been prepared by the Communication Department and the Medical Team of Grupo Pedro Jaén, in line with our editorial commitment to ensuring the accuracy and up-to-date nature of the information provided.