Skin cancer: Causes, Symptoms, Treatment

Skin cancer is a malignant change of the skin - one distinguishes between white and black skin cancer. Black skin cancer is also known as malignant melanoma and is the most vicious form because it tends to form metastases. The main risk factor for skin cancer is UV radiation. Physical symptoms often do not affect those affected until the time of diagnosis, which is why regular skin cancer screening - skin cancer screening - is particularly important. Which types of skin cancers exist and how you can prevent them.

 The life dose of UV radiation determines the risk of skin cancer in humans.
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Incidence of skin cancer is increasing

The incidence of white skin cancer has been steadily increasing for decades. Also increasingly younger people are affected by skin cancer. The reason is the UV radiation. For example, according to World Health Organization (WHO) estimates, there are two to three million new cases of basal cell carcinoma or squamous cell carcinoma in the world, each of which is white on the skin. In the US alone, the number of cases increased by 77 percent between 1992 and 2006, ie by more than three quarters.
Even malignant melanoma occurs more frequently. Of those born in the 1930s, one in 1500 still has black skin cancer during their lifetime, and it is likely to be one in 75 of those born in 2000. In Germany, women had about 9,500 new cases in 2010 and just under 9,600 new cases in men. The disease causes about one percent of all cancer deaths here.

Which skin cancers are there?

Skin cancer distinguishes between malignant melanoma (black skin cancer) and white skin cancer. The white skin cancer is further divided into basal cell carcinoma and squamous cell carcinoma. There is also a precursor to squamous cell carcinoma - actinic keratosis.
  1. The malignant melanoma
  2. The white skin cancer:
    • Basal cell carcinoma
    • squamous
    • actinic keratosis

1. The malignant melanoma

Malignant melanoma (from Latin malignitas: 'malignancy') is the most aggressive form of skin cancer. The tumor usually arises spontaneously on previously unremarkable skin. Triggers are mainly mutations caused by UV damage. Experts suggest that the development of melanoma primarily determines the number of childhood sunburns.

2. The white skin cancer

What is a basal cell carcinoma?

Basal cell carcinoma - also called basalioma - is the world's most common form of skin cancer. The semimalignant tumor is much less dangerous than the malignant melanoma. A basalioma starts from the embryonic hair germ - in simple terms the hair root - and can attack neighboring tissue. In most cases, however, the tumor does not form metastases. Chronic light-exposed areas of the skin, such as the palm of the hand or the face, especially the nose, are particularly affected. This form of white skin cancer rarely develops into a life-threatening disease. The safest treatment is the complete surgical removal of basal cell carcinoma. A cold treatment, radiation or laser therapy, depending on the stage of cancer, can also be considered.

What is a squamous cell carcinoma?

Squamous cell carcinoma - also a form of white skin cancer - is the second most common skin cancer and is also caused by UV. Therefore, body areas that are very often in sun contact, particularly at risk. If timely detection is not performed, squamous cell carcinoma may rarely metastasize. Treatment is usually by surgical removal of the tumor. In difficult localization, radiotherapy is often performed in addition to surgical removal In most cases squamous cell carcinoma is preceded by actinic keratosis.

What is an actinic keratosis?

The actinic keratosis is a precursor of squamous cell carcinoma and arises like the same on sun-exposed skin areas. In about ten percent of cases, actinic keratosis continues to develop into malignant squamous cell carcinoma. Therefore, the precursor of white skin cancer should not be left untreated. To rid the skin of actinic keratosis, the affected area is often treated with liquid nitrogen or laser or cold therapy. The fabric can also be scraped or cut out.

UV radiation is the most important risk factor

For experts, there is no longer any doubt about the causal relationship between ultraviolet (UV) radiation and skin cancer. The radiation penetrates the skin and triggers a series of biological reactions. Initially it was assumed that only the UV-B content of sunlight has a carcinogenic effect. Meanwhile, the UV-A component is attributed such an effect. In addition, experts assume that UV rays already damage the skin before a visible sunburn has occurred.

Life dose and number of sunburns are crucial for skin cancer

The skin can protect itself against the effects of UV rays only to a certain extent. This is how melanin is released in response to the sun. It absorbs, reflects and scatters the sun's rays so that they are blocked in the upper layers of the skin. On the skin there is a pigmentation: the skin tan.
However, if the sun's rays are too intense, the self-protection of the skin is no longer enough. The rays then penetrate into deeper layers, where they lead to a release of inflammation-mediating messengers that cause the typical sunburn with redness, swelling, burning and itching.
How long the skin can be exposed to the sun unprotected without causing damage depends on the skin type and the intensity of the sun's rays. Basically, however, no more than 20 minutes per day are recommended.

The radiation in the solarium is also carcinogenic

Not only the natural sun, but also the UV radiation of artificial sunbeds can cause sunburn and promote the development of skin cancer. Study results show that tanning salon users have about 75 percent higher risk of developing black skin cancer compared to people who have never been in a tanning salon. With a frequent visit to the tanning salon, the risk can even increase by two and a half to three times.
The International Agency for Research on Cancer (IARC) therefore classifies artificially produced UV radiation (UV radiation with a wavelength of 100-400 nm) as well as the natural one in the highest risk level for skin cancer. In Germany, minors are therefore prohibited from visiting solariums for cosmetic purposes.

Who is particularly at risk of developing skin cancer?

  • People with very light skin and freckles, as they have only a very low self-defense mechanism against UV radiation, which lies mainly in the pigment cells under the cornea.
  • People who have been exposed to high levels of UV radiation, both daily and over the years, for example because of work, may be at a higher risk of developing skin cancer.
  • The genes also play a role. If there are already known cases of skin cancer in the family, the risk may be increased.
  • Those who have many liver spots may also be more vulnerable, as birthmarks can be precursors of skin cancer.

How to prevent skin cancer:

UV radiation is the biggest risk factor in all skin cancers. An optimal sunscreen is therefore the alpha and omega. In addition, the prognosis is most favorable the earlier the tumor is detected.
  • Avoid long sunbathing and do without the walk to the solarium. Always protect your skin and those of your children on sunny days with a sun protection factor adapted to your skin type. Pay attention to the parts of the body that are quickly forgotten because the ears, neck and soles are no less sensitive to light. With skin-covering clothing, you can also protect your skin from too much sun exposure. 
  • Self-examination of the skin: A regular self-examination for suspicious skin lesions is recommended to anyone, as early detected skin cancer has the best chance of recovery. Examine your skin regularly and carefully monitor possible skin changes. If you have already noticed a conspicuousness or a change in a liver spot (for example, itching, changes in color or size), you should definitely point this out to your doctor. 
  • Check- ups with the doctor: Have your skin checked regularly with the dermatologist. Find out if and how often you have the right to a skin cancer screening and how the investigation is going: 

Skin cancer screening allows early detection

As the chances of a cure for skin cancer decrease with the progression of the tumor, early detection by screening can save lives. The skin cancer screening, which was introduced several years ago in Germany, enables the timely diagnosis and treatment of light and black skin cancer. Studies show that, especially in malignant melanoma, early detection has a decisive influence on the prognosis. Going to the dermatologist or a properly trained GP seems to be worthwhile: In one study - although not the original reason for the visit to the doctor - more than half of all tumors and 60 percent of cases in which a tumor is not in the had spread deeper skin layers, discovered by dermatologists.

Expiration of a skin cancer screening

The right to participate in the skin cancer screening have statutory health insurance from the age of 35 years. Every two years, you can have your skin examined over the entire body. In addition to dermatologists, general practitioners and internists who have undergone special training are entitled to this examination.
During skin cancer screening, the doctor first asks the patient's medical history and possible skin cancers in the family ( anamnesis ). In addition, he advises the patient on his individual skin type, the risk factors for skin cancer, a sensible sun protection behavior as well as the possibilities for self-control of the skin. The doctor then examines the entire skin, including the scalp, all visible mucous membranes and nails. For this the patient has to undress completely. If a conspicuous finding results, further examinations are arranged by a dermatologist.
The entire screening takes about 20 minutes. The costs are covered by the health insurance.


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