Skin cancer: Information & skin cancer specialists

Of all organs, the human skin has the highest number of tissue neoplasms (tumors). In most cases, however, these tumors are benign. Skin cancer refers to malignant tumors. Skin cancer is the most common cancer in Germany and can occur on all hairy and hairless areas of the skin. Here you will find further information as well as selected skin cancer specialists and centers.

Types

Mostly benign, only rarely malignant

Not every red spot is skin cancer. A large number of differently colored and differently shaped spots occur on human skin. Most of them are benign.

Malignant tumors have the ability to

• grow into neighboring tissue (invasive growth) and
• reach other organs via the bloodstream and form metastases there.

Benign tumors do not have this ability. In rare cases, however, a benign skin tumor can develop into a malignant skin tumor (skin cancer).

Benign skin tumors or skin changes include, for example

• the various forms of epithelial and melanocytic nevi (including moles, freckles and liver spots),
• but also various cysts of the skin and
• seborrhoeic keratosis (also known as seborrhoeic wart or senile wart ).

Seborrhoeic keratosis is the most common tumor of the skin.

Skin cancer is not skin cancer

In the case of malignant skin tumors, a general distinction is made between white skin cancer and black skin cancer.

The two most common forms of white skin cancer are

• Basal cell carcinoma, also known as basal cell carcinoma or basal cell cancer
• Squamous cell carcinomas, also known as spiny cell carcinomas, pinocellular carcinomas or spinaliomas. These types of skin cancer are relatively rare and usually develop from actinic keratoses (also known as solar keratoses). These are among the most common skin lesions.

Black skin cancer is also known as dark skin cancer, melanoma or malignant melanoma.

Precancerous lesions

It is assumed that melanoma can develop from benign nevi (moles). However, there are no definite findings on this yet.

Basal cell carcinoma, on the other hand, develops on inconspicuous skin and therefore has no precursor.

Frequency

The incidence of malignant skin tumors has been rising steadily for several decades, making skin cancer one of the most common forms of cancer in humans. In total, around 19,000 people in Germany are diagnosed with malignant skin cancer and around 200,000 people with fair skin cancer every year.

Black skin cancer in particular, which accounts for around 4 percent of all new cases of cancer in Germany and is responsible for around 1 percent of all cancer deaths, is very dangerous.

Symptoms

White skin cancer mainly occurs on parts of the body that are exposed to the sun particularly intensively or permanently. This includes

• the face(nose, lips, ear, forehead, etc.),
• the scalp,
• throat and neck and
• the forearms and backs of the hands.

However, they can also occur on areas that have only been exposed to the sun occasionally.

Black skin cancer, on the other hand, often occurs on areas of skin that were repeatedly affected by severe sunburns during childhood and adolescence. In principle, however, it can develop in all areas of the skin, including

• the hairy scalp,
• the mucous membranes of the eye
• in the mouth,
• the genitals (penis, testicles, vulva) and on the feet
• foot (including the sole of the foot) and
• nail (toenail and fingernail).

The often inconspicuous basal cell carcinoma

Basal cell carcinoma usually begins as a skin-colored to gray-white hardening a few millimeters in size. It grows very slowly but unstoppably. As a result, the basal cell carcinoma can expand considerably and destroy all adjacent tissue. Depending on the form, it can grow superficially or deeply.

Some types grow ulcer-like or flat, while others are nodular, scarred, look like eczema and/or itch. However, the formation of metastases is rare.

The scaly actinic keratosis and the nodular squamous cell carcinoma

The dermatologist identifies actinic keratoses by inspecting and palpating/brushing the skin. They are only a few millimeters in size, sharply defined and have a rough, scaly and slightly reddened surface. Over time, brownish-yellow cornifications form, which are easy to scrape off.

In most cases, actinic keratoses do not cause any symptoms. Sometimes there is

• itching,
• sensitivity to touch or
• inflammation.

Squamous cell carcinomas often develop at the base of these cornifications as nodular, fast-growing changes. They break open in the center and can also form metastases.

Black skin cancer does not have to be black

Melanoma is also characterized by its diverse manifestations: The skin changes are often

• brownish to reddish-blue,
• blackish or gray-white and
• often asymmetrical.

It can also weep and form crusts. As it progresses, it can spread nodularly or superficially. If it grows in depth, the melanoma can form metastases in other organs relatively quickly.

Black skin cancer can grow into the blood vessels and spread cancer cells to other organs © Christoph Burgstedt | AdobeStock

Take skin changes seriously!

If you notice any changes to your skin, you should definitely talk to your doctor about them.

Characteristics and signs of skin cancer:

• The skin spot bleeds or itches.
• The structure and surface of the skin spot changes.
• Crusts form.
• The skin spot becomes larger.
• The skin spot changes color.

These changes and symptoms do not necessarily mean that a skin spot is skin cancer. However, they must be taken seriously and examined by an experienced dermatologist.

Causes and risk factors

UV radiation as the main risk factor

Solar radiation, or more precisely UV radiation, is considered the main risk factor and cause for the development of skin cancer or its precursors. UV radiation causes damage to the genetic material, the DNA. This can lead to uncontrolled cell growth and ultimately to skin cancer.

There are studies that indicate that regular visitors to sunbeds have an increased risk of skin cancer. The risk of skin cancer is particularly high in people under the age of 20 who have visited a solarium for the first time. As the skin of children and adolescents is particularly at risk, there is a ban on tanning salons for minors in Germany.

Regular visits to tanning beds increase the risk of skin cancer © didesign | AdobeStock

As skin cancer usually develops over many years, age is also a risk factor. The likelihood of skin cancer increases with age. The risk is particularly high if certain areas of the body have repeatedly come into more intensive contact with UV radiation. If you have had frequent sunburns in the past, you have an increased risk of skin cancer.

X-rays and some chemical substances can also cause skin changes that can develop into skin cancer. These substances include

• Arsenic,
• tar and
• some cytostatics.

Immunosuppressed patients and those with certain genetic conditions are also exposed to an increased risk of skin cancer. In the case of malignant melanoma in particular, there are indications that it is also hereditary.

Risk groups

The following groups of people are particularly at risk:

• Children (especially babies) and adolescents
• People who tend to sunburn easily
• People with light skin, light or red hair or many lentigines (sunburn spots, age spots)
• People who have either many, conspicuous or congenital birthmarks/liver spots
• Immunosuppressed people, for example after an organ transplant
• People who have already had skin cancer themselves or whose first-degree family members have already had skin cancer
• People who work outdoors or spend their free time in the sun

Examination and diagnosis

Due to this variety of possible manifestations of skin cancer, it is highly recommended that an experienced specialist carries out an examination. Unfortunately, supposedly harmless eczema or moles often turn out to be skin cancer.

Skin cancer screening (skin cancer screening)

You should have your skin checked by an experienced dermatologist at regular intervals. In Germany, statutory health insurance covers the costs of this cancer screening every two years.

Shorter screening intervals are recommended,

• if you belong to a risk group, for example if you have a lot of moles, and
• you have already been diagnosed with skin cancer in the past.

At the beginning of the examination, you should inform the dermatologist of any skin changes that you or your relatives have noticed. Also let him or her know if an area of skin is itchy, feels rough and scaly or has bled.

The dermatologist will usually use a special magnifying glass, a dermatoscope, to examine the skin. With the help of this illuminated magnifying glass, the dermatologist can take a closer look at suspicious areas. It is then often possible to determine whether it is just a harmless skin change or not.

In some cases, it makes sense to take a photo of a skin change. This makes it easier to detect changes in a skin spot during the next check-up.

Examination of a suspicious skin abnormality with a dermatoscope © Keith Frith | AdobeStock

A special procedure, confocal laser scanning microscopy, can be used to distinguish melanomas from other skin changes. However, the costs of this examination are not covered by statutory health insurance.

Dark skin cancer or not - the ABCDE rule

The dermatologist can also use the so-called ABCDE rule to make an initial assessment as to whether it is a melanoma. The letters stand for the first letters of the English words for the characteristics of the skin change that indicate a melanoma:

• A(asymmetry): The skin change is unevenly shaped (not round); the texture is heterogeneous.
• B(border): The skin change is irregular, partly sharply and partly blurred bordered.
• C(colorite): The color of the skin change is brown, black, blue, red, white or gray; the pigmentation is inconsistent.
• D(diameter): The skin lesion is over five millimeters in size.
• E( elevation or evolution): The skin change rises above the skin level or increases in size.

You can also apply the ABCDE rule to your moles yourself and thus recognize changes. If at least one characteristic applies, you should show it to a dermatologist as soon as possible. However, you should see a dermatologist immediately if the mole

• bleeds or itches,
• becomes larger or
• changes shape or color.

Further examinations

If the suspicion of malignant skin cancer is confirmed by the histological examination, further examinations will follow. Imaging procedures are used to check whether metastases have already formed. These include

• Ultrasound,
• X-ray,
• CT,
• MRI and
• PET.

In addition, a physical examination and, if necessary, the determination of tumor markers in the blood are carried out.

General information on treatment

Usually no surgery for actinic keratosis

Actinic keratosis must also be treated to prevent it from developing into squamous cell carcinoma. Individual actinic keratoses are often treated using cryotherapy. This involves the doctor freezing the skin lesion for several seconds using a cold spray or in direct contact with the refrigerant. This destroys the tissue.

You may feel localized pain during the treatment. Afterwards, the skin area may swell slightly and a blister may form. In some cases, scarring or over- or under-pigmentation of the treated area may occur.

If there are several actinic keratoses, the affected skin area can be treated daily with fluorouracil cream for several weeks. After a phase of inflammation, the actinic keratoses eventually disappear. The tissue is usually not scarred afterwards.

There are also other substances, some of which have to be applied for several months.

Light therapy (photodynamic therapy) can effectively treat actinic keratoses. A cream containing so-called light sensitizers is applied to the skin. These light sensitizers then accumulate in the actinic keratoses. They destroy the tumors under the influence of either daylight or a specific artificial light source.

Surgical removal of actinic keratoses is necessary,

• if actinic keratoses do not regress using the methods mentioned,
• they are particularly raised, or
• there is a suspicion that they are already growing into neighboring tissue.

Skin cancer is excised if possible

White skin cancer is completely removed surgically. To be sure that all of the cancerous tissue has been removed, the edges of the incision are examined histologically. If the tumor has not been completely excised from the healthy tissue, the dermatologist must remove the remaining tumor remnants.

Tumors cannot always be operated on. Sometimes they are located in places where they cannot be surgically removed. Some patients are also not suitable for surgery. In such cases, radiotherapy or

• radiotherapy or chemotherapy,
• cryotherapy or curettage ("scraping out") for some tumors.

are used.

If a melanoma is discovered at an early stage, the disease can be cured by complete surgical removal of the melanoma in a healthy state.

If necessary, the wound is covered with a skin graft. If the lymph nodes are already affected, these are also surgically removed.

In the presence of metastases in other organs or in the case of melanomas that cannot be removed

• Radiotherapy,
• chemotherapy and/or
• other drug therapies

are used.

Progression and prognosis

Skin cancer can usually be cured at an early stage.

In principle, however, the earlier skin cancer is detected, the better the chances of recovery. If it is discovered at an early stage, it can be excised before it can affect surrounding tissue or form metastases.

It is estimated that around five to ten percent of actinic keratoses develop into squamous cell carcinoma. The chances of a basal cell carcinoma being cured are around 95 to 99 percent, while the 5-year survival rate for melanoma is currently around 85 percent.

Depending on the type of skin cancer and the stage of the tumor, regular follow-up examinations are recommended. The area where the tumor was removed is carefully inspected, as is the rest of the skin.

The lymph nodes are palpated and, if necessary, imaging procedures are used and tumor markers are determined. In this way, any tumor that may have grown again or appeared elsewhere can be detected and treated at an early stage.

Prevention

Avoid sunburn and excessive sun exposure!

UV radiation is the main risk factor for skin cancer and its precursors. It is therefore important that you protect yourself from intense sunlight and prevent sunburn.

Always wear clothing that covers your skin (don't forget your head!) and use sunscreen with an adequate sun protection factor on unprotected areas. You should also protect areas of skin where actinic keratosis has been treated with sunscreen.

Sunscreens must be applied sufficiently thickly, evenly and repeatedly (for example after bathing). Please note, however, that sunscreens are not suitable for prolonging exposure to the sun - not even through repeated application!

Wearing sunscreen in the sun is a good way to prevent skin cancer © AustrianImages.com | AdobeStock

Your skin can get used to the sun better if you spend time in the sun regularly, but only briefly - your skin should not become red. This is particularly important in spring and at the start of your vacation in regions with higher UV radiation (for example in the mountains or in the "south").

If you are exposed to strong sunlight, you should use suitable sunglasses. Never look directly into the sun - even if you are wearing sunglasses.

As sunbed users have an increased risk of skin cancer, you should avoid regular visits to sunbeds. Children and young people are not allowed to visit a tanning salon anyway.

Prevention starts as a child

Also make sure that your children do not get sunburnt. Babies should ideally not be exposed to the sun at all. If your children are exposed to strong sunlight, dress them in clothing that covers their skin not only on their torso but also on their arms and legs.

A cap with a wider brim protects the face and neck and suitable sunglasses protect your child's eyes.