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How does a skin cancer develop?
Due to Josephine Baker, suntanned skin is considered chic. Unfortunately, the brown colour caused by the ultra-violet solar irradiation is not good for your health; it is a protection mechanism of our skin. Under UV irradiation, after a period of time pigment cells begin to develop protecting pigment, the skin turns brown.
Under a short but intensive irradiation, the skin turns red after a short period of time, which differs from person to person, sunburn appears.
This results in damaging of genetic substance of the cells in the upper skin layers. This damage is partly compensated by body-own repair mechanisms, but not always perfectly well. During repeated sunburns damage in the genotype of the cells by and by remains, multiplies and can lead to degeneration.
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Prevention:
Definition of a light type can become an approximate guideline to application of sun cremes, and to behaviour in the sun at work and at leasure. Yet even the best sun creme does not protect from the skin cancer for sure, since cancer can also appear on the areas that have not been under the sun. Anyway, it makes sense to spend as little time under the sun as possible, and if you still do it, then to use as much protection as possible. The skin “records” every solar irradiation and it is irrevocable. For this reason visit your dermatologist every year and undergo a skin examination. Almost everyone has birthmarks or pigmented lesions. It is important that they are observed on a regular basis. If there are any changes in shape, colour, size and behaviour (itching, encrustation, bleeding), turn to your dermatologist. He will remove the suspicious changes and send them for a laboratory examination. Often after a through examination with the help of reflected light microscopy all concerns can be forgotten.
Hornifications, that feel like sandpaper on the skin in the beginning, are also first signs of light damage. Such preliminary stages can develop into a so-called white skin cancer after a long period of existence, which can metastasize as well.
Further warning signs are spots or nodules that do not heal in the course of 1 or 2 weeks, or may bleed spontaneously. Such changes should be shown to your doctor as soos as possible.
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Different types of skin cancer
Malignant melanoma / black skin cancer
Malignant melanoma / black skin cancer is the most malignant skin tumour, since it can metastasize at an early stage. Through skin cancer early recognition measures, it is diagnosed early enough in the most cases, in its beginning stage. Therefore, the survival rate has significantly improved. German Cancer Society and German Dermatologic Society offer further information about malignant melanoma.
Basal cell carcinoma
Basal cell carcinoma is mostly located in the face and neck area. They metastasize extremely seldom, that is why they earlier underestimated as tumours. Still if located near the eyes or on other critical locations (sides of the nose) they can lead to problems because of their continious spreading into the depth regardless of organ structures.
Spinalioma / Spinocellulare carcinoma
Spinalioma develops from solar precancerious conditions (also called spinocellulare carcinoma in situ). These look like reddenings with sandpaper surface, which later become painful on palpation. Even early stages that do not metastatize should be treated.
Prevention:
Definition of a light type can become an approximate guideline to application of sun cremes, and other important protection measures. Yet even the best sun creme does not protect from skin cancer. The only effective protection is to spend as little time as possible in the sun and ifyou still do it then to use as much protection as possible. While the skin never forgets.
Let your dermatologist examine you once a year for critical changes. Every person has birthmarks and/or pigmented spots. It is important to keep an eye on them. Does a birthmark grow? Has the border become irregular? Is the pigmented spot darker then two weeks before? If you have doubts, please make sure to consult your doctor. He can assess whether it can be skin cancer already, or, as it happens in the most cases, that this birthmark should be observed by him on a regular basis. If necessary, a suspicious spot is removed and examined in a laboratory.
ABCDE rule:
A: Assymetrie (whether the spot is round, oval etc)
B: Border (whether the spot has a distinctive border with the surrounding skin, or the border is indistinctive)
C: Colour of the spot (whether it is black, brown, red, grey, or a mixture of these colours)
D: Diameter. To begin with, find out whether the spot is bigger, smaller or has a 5 mm size.
E: Evolution. A birthmark which constantly grows, is suspicious
Therapy:
Surgical removal
In the case of suspected skin cancer, the suspicious spot is cut out under local anaesthesia. If the suspicion were strong enough, an additional safety margin would make sense. The removed material is sent to the laboratory, and examined under a microscope. If suspected tumour is confirmed, an additional cut, the size of which will depend on the penetration depth of the melanoma is required.
In the case of skin-deep basal cells carcinomas or solar precancerous state, freezing with liquid azote is applied, to destroy the affected areas of skin. This method is especially used in the case of contra indications to surgical removal (for example in patients with blood coagulation disorders).
Photodynamic diagnostics (PDD) followed by photodynamic therapy (PDT) is an invaluable treatment option.
Chemotherapy
To treat melanoma, chemotherapy is used either alone or in combination with various chemotherapeutika or with immunotherapy if metastases are present.
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