Skin cancer screening (HKS; Hautkrebsvorsorge) is used for the timely detection of malignant (malignant) tumors of the skin at a curable stage. It is considered a cancer screening measure (KFEM).
Skin cancers
The incidence (prevalence) for skin cancer has increased greatly in the Western world in recent decades. This is mainly due to increased sun exposure. Annual screening is highly recommended because skin cancer, if diagnosed early, is curable. Since July 1, 2008, every legally insured patient over the age of 35 has been entitled to so-called skin cancer screening every 2 years.Skin cancer is a disease in which malignant cells of the skin multiply unhindered and destroy their immediate surroundings and can also affect the entire body. The main risk factor for the development of skin cancer is excessive exposure to UV radiation from sunlight and tanning beds. Skin type II according to Fitzpatrick (Germanic type: fair skin, blond hair) is more than twice as likely to be affected by skin cancer. In one study, blue iris periphery (iris = iris in the eye) was significantly more common in skin cancer patients than in control group participants (48 percent versus 22 percent). This was also true for blue iris ruff (collarette) (23 percent versus 9 percent). The most common iris patterns associated with skin cancer were: blue periphery with light brown collarette and spots, followed by blue periphery, blue collarette and spots. Redheads are another risk group; they appear to be more likely to develop malignant melanoma even in the absence of ultraviolet radiation. According to the type of cancer, the main distinctions are malignant melanoma, basal cell carcinoma (BCC; basal cell carcinoma) and squamous cell carcinoma (PEK) of the skin (synonyms: cutaneous squamous cell carcinoma (SCC); spinalioma; spinocellular carcinoma; prickle cell carcinoma).The so-called “black skin cancer” – malignant melanoma – accounts for about three quarters of cases of skin cancer. The other forms of skin cancer are called “white skin cancer“. White skin cancer rarely forms metastases (daughter tumors) and, if detected in time, can be treated well and safely.
Malignant melanoma
In the last 15 years, the number of new cases of malignant skin tumors in Europe has almost doubled.About 2-3% of Germans are newly affected each year. About 1% of cancer deaths are due to malignant melanoma.Malignant melanoma is the most dangerous skin cancer because it often forms daughter tumors, so-called metastases in other organs. Malignant melanoma is a tumor of the melanocytes (pigment-forming cells of the skin) that can develop spontaneously or at the base of a melanocytic nevus (mole).Description of a melanoma: Brown to black, in some cases also blue or reddish-brown pigment deposits. Warning signs are enlargement, change of color as well as itching of moles (moles are the origin of 40% of the diseases) or changes in skin areas that appear darker, i.e. pigmented. The assessment is made according to the ABCDE rule.
| A | Asymmetry |
| B | Limitation |
| C | “color variation” (inhomogeneous color) |
| D | Diameter |
| E | Sublimity/Evolution (Development) |
It occurs predominantly on exposed areas of the body – face, décolleté, and hands – but also in other locations. Malignant melanomas resemble birthmarks (nevi). These nevi must be checked regularly and removed if any abnormal change is noticed.
Actinic (solar) keratosis
An actinic keratosis (light keratosis; rough light calluses) is a cornification disorder of the skin. It is caused by solar radiation – or solarium – (chronic light damage) and therefore occurs particularly in people who are frequently exposed to this radiation. Affected are mainly fair-skinned people from the age of 50.Description of actinic keratosis: Actinic keratosis presents itself differently. Initially, it is only a millimeter-sized rough, blurred skin change, which ranges in color to reddish. Advanced forms turn whitish due to hyperkeratosis, become thicker and spread. Later, the changes appear as warty, humpy skin growths that are firmly fused to the underlying surface.In some cases, actinic keratosis can develop into squamous cell carcinoma (PEC) of the skin. Therefore, actinic keratoses are also referred to as precancerous lesions (precancerous lesions).
Squamous cell carcinoma of the skin
Squamous cell carcinoma (PEC) of the skin (synonyms: cutaneous squamous cell carcinoma (SCC); spinalioma; spinocellular carcinoma; spiny cell carcinoma) – is common, with 50 in 100,000 women and 100 in 100,000 men developing new cases each year. It is triggered by radiation – both solar radiation and radiation in tanning beds. This tumor is prone to bleeding and often forms crusts and coarse nodules. The following types of squamous cell carcinoma are distinguished:
- Cornified squamous cell carcinoma It arises preferentially on chronically inflamed skin as well as on chemically or radiation damaged skin and on tight scars (face, mouth and lips, arms).
- Unkeratinized squamous cell carcinoma Unkeratinized squamous cell carcinoma arises on the mucous membranes of the body, i.e. in the area of the vagina, urethra, anus, tongue, esophagus and the conjunctiva. It is triggered, in addition to radiation, by chemical toxins such as tobacco smoke or arsenic, as well as HPV (human papilloma viruses).
- Dedifferentiated squamous cell carcinoma (a special form)This arises from actinic keratosis and develops very quickly.
Description of squamous cell carcinoma (PEK) of the skin:PEK usually grows initially completely inconspicuous. In the process, wide and only slightly raised skin-colored spots are formed, which become keratinized over time. The tumor that forms later has a yellowish to brown color. It is often crusted and the surrounding area may be reddened with inflammation. Ulcers (boils) may also form within the tumor, which is not painful.Squamous cell carcinoma (PEK) of the skin is surgically removed. It is always important that the tumor is removed “in the healthy”. This means that not only the tumor but also part of the surrounding tissue is removed to make sure that no tumor remnants remain. To rule out lymph node involvement, these must also be examined. Radiation therapy is sometimes required.
Bowen’s disease
Bowen’s disease is an in situ squamous cell carcinoma of the skin and transitional mucous membranes. It is referred to as intraepidermal carcinoma in situ and is considered a precursor of squamous cell carcinoma (PEK; spinocellular carcinoma; formerly spinalioma, prickle cell carcinoma). Histologically, Bowen’s disease is an intradermal carcinoma. It can progress to invasive, then usually bowenoid differentiated (pleomorphic poorly differentiated) PEK (Bowen’s carcinoma). If this precancerous lesion is located in the mucosal area, it is referred to as erythroplasia queyrate. A spontaneous (by itself) regression of Bowen’s disease does not occur. The course is always chronic, so that the complete surgical removal of the focus is necessary. In approximately one-third of cases, erythroplasia Queyrat progresses (progresses) to invasive spinocellular carcinoma (squamous cell carcinoma).
Basal cell carcinoma
Basal cell carcinoma (BCC; basal cell carcinoma) – used to occur particularly on sun-exposed skin sites in more elderly people. It now affects younger people as well. This cancer does not metastasize, but can grow very deeply into the skin and damage underlying tissue. The mortality rate is about 1% of those affected. The skin consists of several layers. The lowest skin layer, from which the new skin cells grow upwards, is called the basal cell layer. In it lie the so-called basal cells, which are diseased in basal cell carcinoma. There are different forms of basal cell carcinoma with diverse external appearances:
- Nodular (nodular, solid) basal cell carcinomaTypical are yellow to grayish-reddish nodules that often form crusts and on which vascular networks (telangiectasias) are visible. Sometimes a large nodule is surrounded by many small nodules like a string of pearls.
- Superficial basal cell carcinoma – trunk skin basal cell carcinomaThis basal cell carcinoma is rather flat and covered by scales, at the edge fine nodules are strung together to form a seam.
- Pigmented basal cell carcinoma It occurs either in nodular form or flat and is sometimes reminiscent of malignant melanoma by its strong pigmentation, so an accurate diagnosis is urgent here.
- Sclerosing growing basal cell carcinoma Sclerosing basal cell carcinoma is characterized by scar-like tissue.
- Exfoliating growing basal cell carcinoma In this ulcer-like basal cell carcinoma, there is no spread to deeper tissue layers.
- Destructive growing basal cell carcinoma Here, the destruction of tissues occurs, as the cancer grows in depth and can thus destroy even deep-lying tissues, such as bone.
Basal cell carcinoma is usually surgically removed (in healthy) or if it is a low-risk BZK ablated by laser.
The procedure
Skin cancer screening includes the following:
- Thorough anamnesis (medical history).
- Complete inspection of the skin: this includes looking at the scalp, oral mucosa, lips, gums and external genitals.
- Examination with the reflected-light microscope (dermatoscope): here, for example, with the help of a video dermatoscope suspicious skin symptoms can be magnified on a monitor.
- If necessary, photo documentation: pictures of moles on the entire body, but especially on light-exposed parts of the body (eg, face, scalp, neck or arms) are digitally archived. Cataloging facilitates the comparison of any changes that may have occurred in a subsequent examination.
- Skin profile: the patient is informed about the nature and sensitivity of his skin.
- Individual preventive measures: The patient is educated about ways to avoid skin cancer. This includes using sunscreen, avoiding tanning beds and preventing sunburns.
Skin cancer screening is required for the following individuals:
- Pronounced and frequent sunburn reactions in childhood and adolescence.
- Exposure to intense solar radiation over a long period of time – for example, in people who spend most of their time outdoors
- Fair-skinned and red-haired people.
- With a high number of pigmented moles (patients with more than 40 pigmented moles carry a 7- to 15-fold increased risk of skin cancer)
- One or more cases of skin cancer in the family
- Frequent work with arsenic or tar
- Exposure to strong radioactive rays – for example, after radiation therapy.
- Taking immune system-inhibiting drugs due to organ transplantation
The skin cancer check (= visual, standardized whole body inspection (whole body examination; GKU) of the entire skin including the hairy head and all body skin folds) is free of charge for legally insured persons from the age of 35, every 2 years. Note: Also perform a routine skin self-examination (“skin self-examination”, SSE).
Benefit
Skin cancer is a steadily increasing and dangerous disease that affects many patients each year. You can protect yourself from both the cancer and its serious consequences through regular skin cancer screening. Conspicuous changes that are suspicious of cancer can be detected and removed in time.