Basalioma, spinalioma, melanoma: one will have to get used to these terms from dermatology, the science of skin diseases. Although the terms for the various types of skin cancer are no longer completely foreign, the rapid increase in skin cancer cases in Germany will soon ensure that basalioma and the like are well known. More than 100,000 people contract one of the various forms of skin cancer in Germany each year – up to 10,000 people die each year from the most malignant form, melanoma.
Love sun, evil sun ?
These forms of cancer arise mainly in the light-exposed areas of the body: that is, on the face, nose and ears, bald patches and lips, hands and forearms. Initially, the diseases affected only people who spent most of their time outdoors, such as road workers, farmers, mountain guides and sailors. However, the change in leisure behavior has led to a sharp rise in the number of cases among the entire population. Experts blame sunburns and other light damage to the skin for this in every case, although the results of individual studies are not always entirely conclusive. The constant expansion of the ozone hole leads to an increasing natural UV exposure of the population, which does its part to promote skin cancer through solarium visits and extensive sunbathing.
Basal cell carcinoma as the most common form of skin cancer
Basal cell carcinoma (basal cell cancer) is the most common form of skin cancer, with approximately 80,000 new cases per year. As the most common tumor of the outer skin, basal cell carcinoma grows in an infiltrative fashion and rarely forms daughter tumors. It is considered to be easily treatable. In many patients, basal cell carcinomas do not change or change only minimally over the years, so they are often not taken seriously or even overlooked, although they lead to superficially visible skin changes. Depending on their appearance, a distinction is made between different basaliomas, all of which do not cause pain. Basaliomas are problematic, however, because they can cover a large area, for example in the facial region, which can then cause both cosmetic and medical problems when they are removed. In addition, some forms of basal cell carcinoma form spurs that cannot be seen superficially. Basal cell carcinomas are particularly common on the eyelid and can cause extensive damage to the eye and optic nerves. Typical of basal cell carcinomas of the eye is loss of eyelashes.
Diagnosis of basal cell carcinoma
Men and women are equally affected by basal cell carcinoma. As a rule, people from the age of 60 develop the disease, but if there is a family history of the disease, young people from the age of 30 can also suffer from basal cell carcinoma. Basaliomas are generally the color of normal skin. However, they can also appear brown to black-brown, which can lead to confusion with melanoma, i.e. black skin cancer. This is then referred to as pigmented basal cell carcinoma. The dermatologist can usually diagnose “basal cell carcinoma” on the basis of the typical skin changes during the examination. To confirm the diagnosis, a tissue sample is usually examined for fine tissue. However, patients with poorly healing wounds should also consult a dermatologist to have basalioma ruled out. Basal cell carcinomas can be removed surgically as well as irradiated with good success.
Treatment: photodynamic therapy
The choice of therapy depends on the location and size of the basal cell carcinoma as well as the general condition of the patient. Chemotherapy is not an option for treatment. For some time now, a new therapeutic approach has been giving hope to basal cell carcinoma patients: photodynamic therapy using a sensitizing skin cream and cold red light. What sounds scientifically complicated is quite simple for patients. The cream is applied one millimeter thick for three hours after removing the crusts of the tumor. Then the area is irradiated with a so-called cold red light for a maximum of 10 minutes. In the cancer cells, free oxygen radicals are formed by a chemical reaction, which kills the cells. Occasionally, this may cause a skin rash or a slight burning sensation. The treatment is performed in two sessions, seven days apart. This treatment has also been shown to be effective for a certain variant of spinalioma.
Spinalioma – prickle cell cancer
Spinalioma, or prickle cell cancer, like basal cell carcinoma, belongs to the so-called “light” skin cancer.This designation is intended to distinguish these cancers from the “black” skin cancer, malignant melanoma. With about 20,000 new cases per year, it occurs much less frequently than basal cell carcinoma, but can also be far more dangerous. The prickle cell layer (stratum spinosum) is, viewed from the inside out, the second of the five layers of the epidermis. The name “spinalioma” is derived from the stratum spinosum.
Origin of spinalioma
Genetic changes, as well as chronic damage to the skin, are responsible for the development of the malignant growths. Because of its superficial location, spinalioma could theoretically be noticed early. However, the transition from chronic pre-damage to cancer often takes place unnoticed. At first, the tumor looks like a rough lump that may bleed easily but does not cause pain. Later, the lump transforms into an ulcer. It often develops on the lower lip, in the oral mucosa, or in the genital area and can cause both lymph node and distant metastases.
Diagnosis and treatment
As with basal cell carcinoma, the diagnosis of spinalioma can often be made based on the typical skin changes. After a fine-tissue examination, the tumor is usually surgically removed as early as possible and radically. This also applies to suspicious lymph nodes. If surgery is not possible, the patient is treated with a combination of radiation therapy and chemotherapy.
Melanoma: black skin cancer
Melanoma, also called “black skin cancer,” is due to exposure to UV rays in 90% of cases. Primarily because melanoma often takes many years to develop from moles, annual screening of high-risk patients is essential. This includes fair-skinned, freckled children who spend a lot of time in the sun and in whose families moles occur more frequently. Although sunscreen protects against sunburn, it offers no protection against moles. In corresponding studies at the University Dermatological Clinic in Tübingen, it was found that long-sleeved clothing serves best as light protection against the sun. Recognize skin cancer – these pictures show how it works!
Examine moles regularly
According to the experts, the educational campaigns of recent years have definitely paid off. The increased motivation of German citizens to have their skin examined for suspicious moles does not contradict the rising disease figures. German Cancer Aid advises light-skinned, blond or reddish-blond skin types in particular to check themselves once a month for conspicuous skin changes. At least once a year, a dermatologist should take a look at moles and other skin changes. He or she can identify noticeable skin conditions and provide consistent treatment and observation.
The ABCD rule
The so-called ABCD rule has proven to be particularly helpful. Moles are evaluated according to the criteria of asymmetry (A), border/margin (B), color (C), and diameter (D):
- A: Early melanomas often have an asymmetric shape, so the aspect of asymmetry is an early warning sign of melanoma.
- B: With jagged or fringed edges distinguish many early melanomas, so the edges are given special attention during an examination. Often, the dermatologist also takes a magnifying glass to help.
- C: The dark blue, often black color (color) gives melanomas their name. Moles that suddenly become significantly darker are therefore considered particularly suspicious.
- D: Skin lesions that grow larger very quickly and have a diameter of more than 2 mm should be checked in any case.
In the clinic, another point is often added to these criteria. With E, attention is paid to the loftiness of the skin lesion. All four criteria are assigned a point value between zero and eight. The sum is used to calculate a score that, if greater than 4.75, indicates melanoma is very likely. In this case, the tumor is immediately removed radically and extensively.
Poor prognosis in melanoma
The prognosis for melanoma patients is good only in the early initial stages. Melanomas are markedly malignant and can metastasize very quickly.In addition to conventional treatment methods, possible vaccinations, the treatment of superficial skin metastases with the aid of a cream applied to the skin that induces cell death in melanoma cells are coming to the fore. However, no research approach has yet produced a decisive breakthrough. Therefore, dermatologists still recommend avoiding sunburns and long unprotected stays in the sun. Long-sleeved clothing, sun hats and sunglasses are just as much a part of protection as the timely application of sun cream with an appropriate sun protection factor. Visiting a solarium only increases the risk of skin cancer and does not improve the skin’s sensitivity to light.
