Definition
Skin cancer is a malignant new formation of the skin. Different cells can be affected and depending on this, skin cancer is described in more detail. The term “skin cancer” most frequently refers to malignant melanoma (black skin cancer), but basal cell carcinoma or spinalioma can also be meant.
Epidemiology/frequency distribution
The most common types of skin cancer are basal cell carcinoma and spinalioma, which account for over 90% of cases. In 10% of all skin cancer cases it is a malignant melanoma. With regard to the age peaks, spinalioma mainly affects 60- to 80-year-olds; basal cell carcinoma also mainly affects older patients.
In the case of malignant melanoma, on the other hand, the age range is more widely spread, with the peak age being between 30 and 70 years. The incidence (incidence) of the skin cancer form “basalioma” in Europe is 20 to 50 per 100,000, that of spinalioma 25 to 30. The incidence of malignant melanoma in Germany is 12.3 per 100,000, with an increase of 8% per year.
In Australia, the incidence of skin cancer is much higher. For basal cell carcinoma the incidence is 250 per 100,000 and for malignant melanoma 60. In Black Africa, however, the incidence of malignant melanoma is very low, at 0.1 per 100,000.
Skin cancer is diagnosed on the basis of the clinical picture, i.e. the appearance of the skin change. This is supported by reflected-light microscopy, a method for magnified imaging of the suspected skin cancer change. However, the diagnosis “skin cancer” can only be confirmed by a microscopic examination (histology).
The ABCD rule is also used to evaluate the clinical picture of a malignant melanoma. More under skin cancer symptoms. In this rule, the letters stand for a criterion that indicates the malignancy of the skin change and thus skin cancer.
Important for the diagnosis of “malignant melanoma” are also a classification (staging) and an immunohistochemical examination of the affected tissue with certain antibodies (against melan-A, MART-1). The criteria for staging are tumor thickness, the presence of possible metastases in the surrounding lymph nodes, the presence of distant metastases and certain markers in the blood (MIA protein = melanoma inhibiting activitiy protein, LDH = lactate dehydrogenase). Skin cancer screening is used for the early detection of skin cancer so that therapy can be initiated at an early stage in the event of illness.
This results in a better prognosis for the diseased patient. In the early stages, skin cancer is usually curable. In Germany, skin cancer screening for insured persons aged 35 and over is reimbursed by the health insurance company every two years.
Procedure: Skin cancer screening is covered by physicians who have acquired an additional qualification in this field. These are often family doctors or dermatologists (dermatologists). At the appointment, the doctor first records the patient’s previous illnesses and general state of health.
Then the entire body surface is inspected. A targeted search is made for skin abnormalities that could correspond to a malignant melanoma (black skin cancer), a basal cell cancer or spinocellular carcinoma (white skin cancer). The doctor uses a lamp with bright light to illuminate the body parts in order to make skin changes visible.
Since skin cancer can not only develop on parts of the body that are exposed to frequent sunlight, the mucous membranes of the mouth and the spaces between the toes are also inspected, just as the scalp is examined. For this purpose, the hair is parted successively so that the entire scalp can be seen. On the day of the doctor’s visit, therefore, elaborate hairstyles should be avoided.
The armpit and pubic region are also examined for conspicuous areas of skin, as skin cancer can also develop in these areas. Finger– and toenails are also examined, which is why you should remove nail polish beforehand. Make-up, earrings and piercings should not be worn on the day of the examination in order not to cover the skin.
In addition to the physical examination, the skin cancer screening includes education about skin cancer in general and its risk factors. The doctor will explain how to deal with exposure to sunlight and give tips on how best to protect yourself against skin cancer.Anomalies were discovered: If conspicuous skin areas were discovered during skin cancer screening, the treating physician can take a sample of the tissue, which is then sent in. The tissue sample is then prepared and cut so that it can be assessed under the microscope.
A pathologist can then decide whether it is really skin cancer or whether the tissue appears inconspicuous. This is the basis for further therapy. Regular self-examination is very important for early detection of skin cancer.
Everyone should regularly examine their own body for suspicious skin changes. Use a well-lit room or daylight for this purpose, as this is the only way to get an optimal view of skin changes. Don’t forget to check between your toes and under your feet for abnormalities.
For the inspection of the back and parts of the body that are difficult to see, ask a person close to you to check. Almost everyone has moles on their body. In principle, these are harmless.
Often they exist from birth, but they can also develop over the course of a lifetime. Nevertheless, all moles should be examined by a physician, especially from the age of 35, as part of a skin cancer screening. You yourself can also take care of your moles and check whether they change over time.
It is considered conspicuous if the birthmark suddenly increases in size, changes its shape and/or color, suddenly itches or bleeds. In this case a medical clarification would be helpful. As a guideline for the self-examination of birthmarks, there is the so-called ABCDE rule, which can be used as an orientation.
If one of the following characteristics occurs in your birthmark, a medical clarification is recommended: If you are unsure, you should generally opt for a medical examination of the corresponding area of skin. By having your own skin examination, as well as the two-year skin cancer screening from the age of 35, you are optimally prepared for the early detection of possible skin cancer.
- A(=Asymmetry): This is true, if the birthmark is irregularly shaped, i.e. it does not have a smooth, round/oval/elongated shape, but looks rather jagged and unshaped.
This criterion is also considered to be fulfilled if a pre-existing birthmark begins to change its shape.
- B(=limitation): It is considered conspicuous if the birthmark has no sharp edge, but is blurred or jagged and fused with the surrounding skin. Thereby, many smaller runners are often formed, which radiate into the healthy skin. A sharp contour is no longer distinguishable.
- C(=Color): “Color” means “color” translated from English.
A birthmark is conspicuous if it consists of different colors, i.e. if it is not uniformly colored. Especially if the birthmark contains pink, grey or black spots or crusty coatings, it should be examined by a dermatologist. There could be a malignant skin cancer behind it.
- D(=diameter): In general, all moles that exceed a diameter of 5mm at the widest point should be examined by a dermatologist.
The same applies to moles that have the shape of a hemisphere.
- E(=Evolution): Evolution in this case means as much as further development. If the birthmark has suddenly changed in the last three months in its shape/color/texture, you should consult a dermatologist.
The term skin cancer covers various malignant diseases of the skin. The initial stage can differ significantly depending on the specific disease and the type of degenerated cell.
It is important to watch your own skin carefully because skin cancer, if detected in its early stages, has a very good prognosis. Thus, a careful examination of the skin with knowledge of the characteristics of early stage skin cancer can be of great importance in the fight against skin cancer. All forms of skin cancer have in common that they affect a larger area of the skin as the disease progresses.
Rapidly growing moles and liver spots in particular should be closely monitored. In the early stages, the skin cancer is usually small and relatively unobtrusive. Conspicuous features can only be detected with a magnifying glass if necessary.
A distinction must be made between black and white skin cancer.There are several factors that should be taken into account and which can help in the early stages of skin cancer. A pigmented skin area is always conspicuous if it is asymmetrical, blurred and very large (diameter over 5mm), has different coloration and has changed in the last three months. Even if a pigmented skin area begins to itch, the skin should be examined closely.
The so-called white skin cancer usually develops at an advanced age and in places exposed to UV light (for example on the face or hands). In the early stages, hardening of the skin is often found in the corresponding area. The hardening is called actinic keratosis.
A gray, reddish or brownish nodule is also typical of the early stages of these skin cancers. In general, symptoms in the early stages of skin cancer can only be perceived very discreetly. Nevertheless, if the small changes in the skin are interpreted correctly, skin cancer can be detected and the affected person can be cured. A regular visit to a dermatologist including skin cancer screening is therefore generally recommended.
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