Prof. Dr. Falk Bechara is a recognized specialist in the field of dermatosurgery and enjoys an excellent reputation far beyond the Ruhr region. As Deputy Clinic Director of the Dermatology Clinic and Head Physician of the Department of Dermatosurgery at the Catholic Hospital Bochum, he combines the highest level of medical expertise with innovative treatment methods. His focus is on the surgical treatment of skin tumors, skin cancer operations, plastic-reconstructive skin surgery and the treatment of scars and complex skin diseases such as hidradenitis suppurativa (acne inversa).
With many years of experience and extensive scientific expertise, Prof. Dr. Bechara relies on state-of-the-art diagnostic and therapeutic procedures. Thorough diagnostics are always a priority for him in order to detect pathological skin changes at an early stage and treat them in a targeted manner. He has exceptional expertise in skin tumor surgery in particular, which enables him to diagnose skin cancer in its various stages at an early stage and carry out individually tailored surgical therapies.
As former president of the German Society for Dermatological Surgery (DGDC), Prof. Dr. Bechara is not only involved in patient care, but also in scientific research and teaching. His close collaboration with national and international experts and his active participation in scientific studies ensure that his patients benefit from the latest developments in dermatological surgery.
In 2014, he was appointed Associate Professor of the Medical Faculty of the Ruhr University Bochum for his services and outstanding expertise. Patients who put themselves in the hands of Prof. Dr. Bechara benefit from individual and competent care based on sound diagnostics, modern therapeutic approaches and many years of surgical experience.
In an interview, the editorial team of the Leading Medicine Guide learned more about the development and treatment of skin cancer and about the 360° full-body scanner that Prof. Dr. Bechara uses on his patients.
Skin cancer is one of the most common types of cancer worldwide and can occur in various forms, from comparatively harmless basal cell carcinomas to highly aggressive malignant melanomas. What is particularly dangerous is that skin cancer often develops unnoticed for a long time and can only have serious health consequences in advanced stages. The skin offers a unique opportunity for early detection: changes are usually visible and can be detected early through regular check-ups. Skin cancer screening therefore plays a crucial role in the early diagnosis and successful treatment of malignant skin changes. Modern examination methods such as reflected light microscopy or digital dermoscopy make it possible to identify even the smallest abnormalities and remove them at an early stage if necessary. If you have your skin checked regularly and use sun protection, you can significantly reduce your personal risk and maintain your skin health in the long term.
The development of skin cancer is influenced by a variety of risk factors, with excessive UV radiation being the main cause.
“UV radiation is still considered to be the most important risk factor for the development of skin cancer. However, the significance and type of UV damage differs depending on the type of skin cancer. Light skin cancer - such as actinic keratoses or basal cell and squamous cell carcinomas - is clearly associated with long-term, cumulative UV exposure. You can think of it like a 'UV account': Every time you are exposed to the sun, you pay into it, and at some point the account is full - the first skin changes or precancerous lesions appear. In the case of melanoma, the data situation is more complex. Here too, there are forms, especially in the facial area, which are clearly associated with chronic UV exposure. However, many melanomas develop on parts of the body such as the torso, arms or legs that receive less sun exposure in everyday life. In such cases, it is assumed that intensive UV damage - for example sunburns in childhood or adolescence - plays a decisive role. Another risk factor is skin type: people with fair skin, blonde or red hair and light-colored eyes are at significantly greater risk than people with darker skin. Darker skin types have a certain natural protection due to a higher melanin content. A third major risk factor is a weakened immune system. People with immunodeficiency, for example due to taking immunosuppressive medication or after organ transplants, have an increased risk of developing skin cancer - especially aggressive forms. Even in people with generally healthy skin and lifestyles, strong sun exposure - such as two weeks of intensive sunbathing on vacation - can be problematic in the long term. UV protection therefore remains a central topic of prevention for all skin types and age groups,” explains Prof. Dr. Bechara at the beginning of our conversation.
The so-called “UV debt effect” means that every sunburn increases the risk of skin cancer in the long term, even if it happened many years ago. Certain groups of people are particularly at risk. These include people with fair skin (skin types I and II), blonde or red hair, blue or green eyes and a tendency to freckles. These skin types have a lower amount of melanin, the pigment that protects the skin from UV damage.
Those affected should regularly monitor their skin for changes, as skin cancer can often be recognized early on by conspicuous skin changes.
Moles and pigment spots in particular should be kept an eye on, especially if they change in shape, color or size. The so-called ABCDE rule helps to recognize conspicuous skin changes at an early stage. A stands for asymmetry, B for irregular borders, C for different colors within the spot, D for a diameter of more than five millimeters and E for elevation or a changing surface.
“When conspicuous skin changes appear, in many cases there has already been a longer phase of intensive UV exposure. It is important to differentiate between light and black skin cancer, as they show different typical symptoms. In the case of light skin cancer, patients often report spots on areas of the body that have been heavily exposed to the sun, such as the face, ears or forearms, which repeatedly break open or crust over. Typically, these sores appear to heal but reappear after a few weeks or months. This recurring pattern is a classic warning sign. A simple rule of thumb is: skin lesions that do not heal completely for more than eight weeks should be examined by a doctor. In black skin cancer, on the other hand, the focus is not on the poorly healing wound, but on the change in moles. Increasing size, irregular edges or asymmetrical shapes are particularly noticeable. A mole should be roughly symmetrical - if you mentally split it down the middle, both halves should look similar. In addition, most black skin cancers do not develop from existing moles, but as new, dark spots on the skin. Many patients report that a spot has suddenly appeared that they were previously unaware of. Such new changes should also be promptly clarified dermatologically, as early diagnosis is crucial for successful treatment,” explains Prof. Dr. Bechara.
The 360-degree full-body scanner offers a state-of-the-art and more precise method of skin cancer screening compared to conventional examinations with the naked eye or a dermatoscope.
“At first glance, the 360-degree full-body scanner looks a little futuristic, but it is best compared to the body scanners at airports. The patient stands in an upright position in the device, undressed, similar to what you might imagine in a standing solarium. At this moment, over 100 high-performance cameras simultaneously capture every square millimeter of skin. Within a few seconds, a precise, three-dimensional avatar of the patient is created, on which all skin changes are documented in detail. The great advantage of this technology is that all skin areas are recorded and stored without any gaps - nothing is overlooked. It is particularly helpful that every single skin change is not only recorded, but also directly localized and digitally stored. The integrated artificial intelligence also enables an initial analysis of the recorded lesions. Conspicuous areas of skin are marked for the doctor, who can then examine them further using a special magnifying glass or video dermatoscopy. Here too, an AI-supported evaluation is used to assess the edges, color and structural changes of the moles,” says Prof. Dr. Bechara and emphasizes:
“However, the real progress is particularly evident when it comes to monitoring progress. If a patient has several hundred moles, for example, it is almost impossible to keep a precise eye on their development over long periods of time with the naked eye. At a new appointment, the scanner compares all the saved moles with the current ones and reliably detects whether new ones have been added, existing ones have changed or whether something has grown conspicuously. This possibility of automated long-term observation represents a considerable advance over the classic examination, in which the dermatologist scans the skin for abnormalities with a handheld magnifying glass. Although this method - still the standard - is effective, it is significantly more limited in terms of the detection of large areas of skin and long-term comparability. For many patients, the last skin cancer screening may have been years ago, often carried out with a magnifying glass in which the doctor scanned the body step by step. Although this procedure is still used today, the limitations of this method quickly become apparent when a large number of skin lesions are detected. The whole-body scanner, on the other hand, offers a valuable addition here to enable reliable and long-term traceable early detection of skin cancer, especially in high-risk patients."
The device can only detect the areas of skin that it can see with the cameras. Areas such as the soles of the feet, skin folds, scalp hair, oral mucosa or the genital area are not taken into account, as these cannot be captured. “The system doesn't just work by the patient simply going into the device and getting a printout of the findings. Instead, the dermatologist must manually examine the areas that are not recorded. Any conspicuous lesions are then examined further using an electronic magnifying glass. The device can therefore only be used properly in combination with the expertise of a specialist. If the device or the dermatologist detects a conspicuous change, there are various options for how to proceed. In the case of minor abnormalities that do not require immediate surgery, the patient can initially be instructed to observe the birthmark and to come back if there are any changes. In more serious cases, if a mole raises suspicion of skin cancer, removal is recommended. At our clinic, we have developed the special feature that we offer 'just in time' treatment. This means that the patient comes in and we offer to do everything in one day. After the examination in the scanner, any abnormal lesions are removed immediately. Another advantage of our system is that the pathological evaluation of the tissue samples taken is carried out directly on our premises. This means that the patient usually receives the results within 16 to 18 hours. For example: a patient comes in on Monday, the examination reveals three conspicuous moles, which are removed on the same day. The results are available the very next morning and the patient is contacted immediately. This gives the patient quick clarity as to whether everything is in order or whether further steps are necessary. This procedure, in which diagnostics, surgery and histopathological examination are completed within 18 hours, is standard at the University Hospital. This is exceptional, as it often takes several weeks for the entire process to be completed in other institutions,” explains Prof. Dr. Bechara.
The 360-degree full-body scanner is particularly recommended for patients who have an increased risk of skin cancer.
If patients have many moles or possibly a family history of skin cancer, for example due to skin cancer in grandparents or siblings, the question arises as to how often they should go for a check-up. “In principle, we recommend that patients without a history of cancer receive a regular check-up according to set protocols. In the case of light skin cancer, follow-up care takes place every six months for the first three years, while the frequency for black skin cancer depends on the thickness of the tumor. For patients who only have many moles or a family history, we recommend a check-up at least once a year. If something abnormal is discovered during one of these examinations, the established aftercare protocols apply, which vary depending on the findings. Of course, we hope that this is not the case, but regular examinations are important in order to be able to react at an early stage,” recommends the skin specialist.
This technology is particularly beneficial as it enables continuous monitoring of the skin and small changes can be tracked over a longer period of time. In addition, people who are regularly exposed to intense UV radiation in their work or leisure time also benefit from using a 360-degree full-body scanner. This applies, for example, to people who work outdoors a lot or frequently sunbathe. The scanner also offers an effective method of detecting skin changes caused by UV exposure for people who have frequently used sunbeds in the past.
St. Josef-Hospital - Klinikum der Ruhr-Universität Bochum is one of the largest university hospitals in Germany, both in terms of number of beds and size. The clinic places particular emphasis on the treatment of skin cancer. An outstanding feature of the clinic is the close integration of diagnostics, surgical treatment and histological processing in a single step. This efficient combination, supported by well-coordinated teams, enables comprehensive and high-quality care for skin cancer patients.
There are many different opinions about how much sun is actually healthy, especially with regard to vitamin D levels.
On the one hand, we often hear that vitamin D is important and that the sun is generally good for you. On the other hand, people wonder how to find the right amount. There are often misconceptions about how much sunlight is needed to maintain vitamin D levels. “If you take a closer look at the facts, you realize that it is often enough to expose yourself to the sun for about 15 minutes a day - with your hands and forearms. This short period of time is enough to maintain vitamin D levels. The idea that you need to spend an hour or more in the sun to cover your vitamin D requirements is therefore not true. Of course, the sun also has other positive effects, such as the feel-good effect caused by serotonin production. But if it's just about vitamin D levels, it's not necessary to spend hours in the sun. For children, of course, the situation is somewhat different. Many people think that children get used to the sun and then no longer need protection to get a healthy tan. Unfortunately, this is a misconception. Every sunburn and every reddening that is accepted in the hope of a beautiful skin color always causes damage. It is therefore particularly important to ensure that children are properly protected from the sun at an early age. The earlier you start, the better for skin health,” states Prof. Dr. Bechara.
The treatment of white and black skin cancer differs primarily in terms of the type of cancer, the stage of the disease and the patient's general state of health. In recent years, the chances of recovery have improved considerably, particularly in the case of melanoma, thanks to new treatment methods.
White skin cancer, consisting of basal cell and squamous cell carcinomas, is usually treated surgically, as it does not usually metastasize quickly. In advanced cases or in areas that are difficult to reach, radiotherapy or chemotherapy is used. Systemic therapies such as chemotherapy are rarely required. In contrast, the treatment of black skin cancer (melanoma) is more complex. In the early stages, the tumor is surgically removed, possibly with adjacent lymph nodes. In advanced melanomas that have metastasized, immune and targeted therapies such as checkpoint inhibitors (nivolumab, pembrolizumab) have proven to be very successful and significantly improve the prognosis, even in treatment-resistant cases.
Prof. Dr. Bechara comments: “If you look at the developments in the treatment of malignant melanoma in recent years, a lot has changed, especially in the advanced stages. If you look back 15 to 20 years, malignant melanoma, especially in advanced forms or in metastatic cases, was usually a death sentence for patients. In the past, the only hope for a cure was early detection and surgical removal of the tumor, which remains the best treatment option for early forms today. The big problem, however, was that advanced malignant skin cancer, especially if it had already metastasized, almost always led to death. But in the last ten years, therapy has changed fundamentally - and that is revolutionary. The introduction of immunotherapy, for which the Nobel Prize in Medicine was awarded, is a decisive advance. Targeted therapy has also played a major role. These two developments have completely changed the treatment options and significantly improved patients' prospects. Today, we can achieve long-term remissions in around half of patients with advanced skin cancer using these new therapies. Although malignant melanoma remains a major therapeutic challenge, it has lost much of its terror thanks to these advances. The results we are seeing today would have been unthinkable a few years ago - the advances are truly impressive and represent a real quantum leap in dermato-oncology."
In recent years, awareness of skin protection has unfortunately declined somewhat, especially due to the influence of social media, which glamorize tanning and the sun.
“20 to 30 years ago, there were major educational campaigns that focused intensively on the topic of skin protection. In recent years, however, a kind of trend has developed, mainly through social media, in which tanning and spending time on the beach are glorified. Unfortunately, this has led to a decline in awareness of the risks of the sun, especially among young people. I would like to see this trend reversed and more people understand the importance of skin protection. As far as therapy is concerned, we have made great progress, especially in advanced skin cancer, where many patients can now be controlled in the long term with the new therapies. However, many patients still do not respond to the new drugs and there is still a lot of research to be done. It is particularly important to find solutions for these difficult cases,” states Prof. Dr. Bechara and adds:
“There is also a cultural change in the way we deal with the sun. Social media in particular is selling a lifestyle in which sun and a tan are seen as a sign of happiness and joie de vivre. Advertising and images from vacation destinations also promote this trend. People are out in the sun more than ever - not just in summer, but also during the winter, when people like to sit in the sun in a café. That's great in principle, but there are also risks if you don't protect yourself properly. There's nothing wrong with enjoying the sun as long as you protect yourself properly - be it with clothing or sunscreen. The problem arises if you don't protect yourself or are exposed to the sun for too long, especially in the hours between 12 noon and 4 pm when the sun is at its strongest. In many countries, even locals are not seen outside during these hours, and these are important behaviors that need to be reminded again and again. Even if we believe we have long since overcome these risks, protection from the sun remains an important challenge that must not be lost sight of." This concludes our conversation.
Thank you, Professor Dr. Bechara, for the important information on skin cancer, the 360° scanner and the right way to deal with the sun.
