The goal of skin cancer screening is the early recognition of malignant changes in the skin. When recognized early, malignant skin tumors, such as basal cell carcinoma, squamous cell carcinoma and malignant melanoma are not life-threatening! As long as the malignant cells are confined to the upper layers of the skin, these tumors can be completely excised and cured. Thus, the transition to an invasive tumor, which is potentially dangerous, cannot occur. Everyone should be examined periodically by a dermatologist; it is the easiest way to avoid trouble with skin cancers. In addition, a monthly self-examination from the scalp to the soles using a mirror and ideally with the help of a partner is also valuable. You, and also your partner, know your skin best! If you notice changes in a mole or other new or rough spots, then it is wise to show them to a dermatologist.
A self-examination is useful about once a month, from head to toe, possibly with the help of a mirror or together with your partner. You or your partner know your body best! If you notice individual skin regions or a change in moles, please have them clarified by a doctor. Pigmented birthmarks are conspicuous if they have changed in shape, color or size.
Asymmetry: irregular, non-symmetrical shape
Boundary: outgoing pigmentation, irregular at the edge
Color: light and dark spots, different colors
Diameter: bigger than 2mm
The highest risk factor for the development of malignant melanoma is the number of pigmentary moles acquired after birth. With more than 40 pigmented moles, the risk is increased by a factor of 7-15. Sunburns in childhood and adolescence increase the risk of skin cancer by a factor of two to three. People with fair skin (skin types 1 and 2), with reddish or blond hair, with a tendency to freckles, sunburn spots or a family history of malignant melanoma may have up to a 120-fold increased risk of developing malignant melanoma themselves. Sun protection is therefore a very important issue in the prevention of skin cancer. The main reasons for the increase in skin cancer cases are a change in leisure time behavior, extended sun vacations all around the year and the frequent use of solariums. The motto must be: avoid sunburn!
Change your attitude about sun exposure!
Long stays in the sun and sunburns should not be an expected part of your recreational and vacation activities. Unfortunately, a good tan is still considered attractive and a sign of good health. Each of us is attractive in our own way – with our skin type, color and tan. „A good sunburn followed by a good tan“ is no good strategy. Every sunburn is an injury which leaves behind damaged tissue.
Change your daily habits!
Avoid the more intensive sun rays from 11 AM to 3 PM. In the shadows, such as under an umbrella, awning or tree, your UV exposure is reduced by 50%. Nonetheless, the reflection of light, especially from water, sand or snow, means that shadows are by no means totally protective!
Wear protective clothes!
Wearing a broad-brimmed hat provides shadows and thus protection for the eyes, nose, ears and neck. Sunglasses with 100 % UVA und UVB protection reduce the risk of eye damage. Today one could say: „Don’t take your clothes off in the sun; put them on.” The garments should be long-sleeved, tightly woven and loose. Many companies manufacture special sun protective clothing which is attractive and provides guaranteed protection.
Apply a water-resistant sunscreen with a skin protection factor (SPF) of 50 to all exposed areas 30 minutes before going out in the sun. The average adult needs around 40 ml of sunscreen to cover their entire body; the tendency is to apply far too little sunscreen. Even when using a water-resistant sunscreen, it is wise to re-apply it after bathing. Some high-risk areas require extra protection, as they are most exposed: bald scalp or area exposed by part, bridge of nose, eyelids, upper part of cheeks, ears, lips, shoulders, décolleté and even the backs of hands and feet. Try to keep these areas covered or consider using a sunscreen with an SPF of 50.
Remember: sunscreens protect against sunburn, but not against skin cancers! For that reason, you should use sunscreens to protect areas you cannot cover with clothing, not to make it possible for you to stay out in the sun for much longer periods of time!
Avoid tanning parlors!
The additional UV exposure using sunbeds in tanning parlors is definitely not recommended, especially not as a preparation for a vacation in the sun.
Skin cancers are worldwide the most common human malignancies. In Europe, around one of 10 individuals develops a skin cancer by the age of 75 years. The risk increases with advancing years. The main factor behind the dramatic increase in skin cancers is the change in recreational activities coupled with a dramatic increase in exposure to the ultraviolet (UV) rays of sunlight. The best-known and most-feared skin cancer among the public is melanoma, known colloquially as „black skin cancer“. Basal cell carcinoma and squamous cell carcinoma are more common but less well-known. Together these tumors are referred to as non-melanocytic skin cancers, or „white skin cancers“. They are closely related to total UV exposure during lifetime and the risk increases with age. Advice on how to avoid having trouble with a skin cancer is discussed under Skin Cancer Screening. Superficial tumors that only involve the epidermis, the outer layer of the skin, and have not broken through the basal membrane, are designated „in situ“ carcinomas or melanomas. Over time these tumors can invade deeper layers of the skin – if they are untreated -, and can even cause metastases, spreading to local lymph nodes in rare cases. Therefore it is absolutely essential to treat skin cancers in their earliest stage. The early diagnosis and treatment of skin cancers lead to an almost 100% cure rate.
The malignant melanoma
Melanoma is the most dangerous skin tumor because it frequently causes metastases. In Switzerland with 8,7 million inhabitants there are 2.450 new cases annually and 310 deaths. The most affected age group is 40-50 years. The number of patients with melanoma has roughly doubled every ten years. The greatest risk factor for the development of a malignant melanoma is the number of melanocytic nevi which are acquired after birth. An individual with more than 40 nevi has a 7-15 fold increased risk of developing melanoma. Sunburns during childhood or adolescence also increase the risk of skin cancer by 2-3 fold. Individuals with pale skin (skin types 1 and 2), red or blond hair, freckles, frequent sunburns or a family history of melanoma have up to a 120 fold increased risk of melanoma. Melanomas can easily be confused with harmless melanocytic nevi (moles). Around 80% of these tumors are found on body sites that are normally covered. Tumors may occur on the scalp, under the nails or even on the sole. Each patient deserves a total body examination with each pigmented lesion according to the A-B-C-D rule. The goal of skin cancer screening is to decide which of the pigmented lesions are potentially malignant and thus identify melanomas at the earliest possible stage. Dermatoscopy has become an indispensable tool in this search. Examining lesions with 10x magnification makes possible a much more accurate evaluation. Most dermatoscopes today are connected to a computer; using a video documentation system, lesions can be photographed, analyzed with computer programs and later multiple images of the same lesion over time can be compared. If a lesion clearly shows changes, it must be surgically removed. If a malignant melanoma is suspected, the pigmented lesion is immediately surgically excised with a small safety margin. The tissue sample is examined under the microscope by a dermatopathologist (physician specialized in the microscopic study of skin tumors and diseases). If the microscopic examination confirms the presence of a melanoma, then the further treatment is based on the tumor thickness measured under the microscope.
The basal cell carcinoma
Basal cell carcinoma is the most common malignant skin tumor. In Germany around 120,000 new cases are identified yearly in a population of 80 million, while in Switzerland with 8,7 million inhabitants, there are an estimated 25.000 new cases. This number seems to be doubling every 10-15 years. The main cause in almost every case is long-term and intensive sun exposure over a lifetime. At greatest risk are those who have worked for many years in outdoor jobs or spent extensive recreational time in the sun. The tumors are most often diagnosed in those who are 60-70 years of age. Other risk factors include pale skin (Skin types 1 and 2), blond or red hair, and blue, green or gray eyes.
Basal cell carcinomas arise in the bottom of the basal layer of the epidermis. They are appearing anywhere on the body but favor those areas most intensively exposed to sun, such as the nose, ears and chin. Basal cell carcinomas do not develop metastases. Typically they show a slowly invasive growth pattern, extending both laterally and into the depth. They can damage all underlying structures such as the eyelid, ear or nose cartilage, or in extreme cases destroy muscles or bone. Thus it is crucial to identify them early before they have damaged adjacent tissues. This also insures the highest possible cure rate, which in expert hands is well over 95%.
Basal cell carcinomas typically present as a small glassy nodule which contains numerous tiny blood vessels. More advanced tumors show a central depression surrounded by slightly elevated border, made up of many small nodules. Later the tumor may become ulcerated with drainage. Other tumors may resemble a scar or a persistent patch of eczema, as the clinical appearance is highly variable! If a basal cell carcinoma is suspected, the tumor is immediately surgically excised with a small safety margin. The tissue is examined under the microscope by a dermatopathologist. If the microscopic examination confirms the presence of a basal cell carcinoma, then all the lateral and deep borders of the excision are carefully examined (micrographic surgery)to insure the tumor has been completely removed. If tumor cells are found extending to a margin of the excision, a re-excision in this area is performed. Once the dermatopathologist has confirmed that the entire tumor has been removed, then the defect can be closed used a variety of plastic surgery approaches. Through skin cancer screening, basal cell carcinomas can be discovered at an early stage, when only a small excision is required to assure complete cure. The smaller the tumor, the smaller the operation, and the less apparent the scar. Conversely, the larger the tumor, the more complicated the operation. After one or more procedures to remove the entire tumor, the defect is larger and more difficult to close with good cosmetic results. In special situations, especially in elderly patients with multiple health problems and medications who have relatively superficial tumors, alternative therapeutic approaches can be considered. Two good options are photodynamic therapy (PDT) – using a light-sensitizing cream and phototherapy to destroy the tumor – or an immune-stimulating cream (imiquimod) which helps the body’s natural mechanisms to destroy the tumor.
The squamous cell carcinoma
Squamous cell carcinoma is the second most common malignant skin tumor. In Germany around 54,000 new patients are identified yearly in a population of 80 million, while in Switzerland there are around 5,000 new cases among 8 million inhabitants. Once again, the incidence is increasing. The main cause in almost every case is long-term and intensive sun exposure. At greatest risk are those who have worked for many years in outdoor jobs or spent extensive recreational time in the sun. The tumors are most often diagnosed in those who are over 70 years of age. Other risk factors include pale skin (Skin types I and II), blond or red hair, and blue, green or gray eyes.
Most squamous cell carcinomas develop from actinic keratoses. These common lesions are typical rough or crusted, slightly red and minimally raised spots. They occur in sun-exposed skin; thus typical sites are the nose, forehead, cheeks, bald scalp, temples, ears, lower lip and backs of the hands. Actinic keratoses are very early precursors of squamous cell carcinoma and can be easily treated. If there is any question about the diagnosis, a small biopsy can be taken to confirm the clinical suspicion. The standard therapeutic approach is cryotherapy, spraying the lesions with liquid nitrogen to destroy them. There are many other effective approaches. Two good options are photodynamic therapy (PDT) – using a light-sensitizing cream and phototherapy to destroy the tumor – or an immune-stimulating or cytostatic cream (imiquimod / 5-fluoruracil), which helps the body’s natural mechanisms destroy the tumor. Actinic keratoses can also be removed with curettage (scraping them off with a sharp spoon-like instrument) or a superficial tangential (shave) excision; the latter approaches provide tissue for dermatopathologic examination.
If actinic keratoses are not treated, a small percentage will develop into squamous cell carcinomas. Squamous cell carcinomas greater than 1cm in diameter have the potential to cause metastases. Skin cancer screening makes it possible to recognize and treat actinic keratoses easily before they can evolve into a squamous cell carcinoma!
Let me advise and help you! I look forward to performing a skin cancer screening on you and then in a personalized consultation discussing with you how you can best avoid the risk of skin cancers, or if needed, making recommendations for the treatment of any problem we identify.