Information material from the Skin Tumour Centre (HTZ) for patients

 

Dear patients,

Information and communication are essential components of holistic and comprehensive tumour therapy. That is why we would like to provide you with information material on this page, which covers the clinical-pathological basics of different types of skin tumours, their diagnosis and the various treatment options. Among other things, you will find patient brochures from German Cancer Aid on malignant melanoma and various types of white skin cancer (basal cell carcinoma, spinocellular carcinoma), the correct way to deal with the sun and the new skin cancer screening programme introduced by the statutory health insurance funds in 2008. We hope that this information will help to answer some of your questions.

If you have any further questions about your illness, please feel free to contact us directly:

Contact HTZ Ulm

 

Skin cancer, a widespread disease?

Every year, around 220,000 people in Germany are newly diagnosed with skin cancer. Around 150,000 of these new cases are basal cell carcinoma, 21,000 are spinocellular carcinoma and around 18,000 are malignant melanoma. The remaining new cases are rarer skin tumours such as Merkel cell carcinoma or sarcomas of the skin. These new cases have increased dramatically in recent decades. The reasons for this are, on the one hand, the demographic development with people getting older and older and, on the other hand, leisure behaviour with increased exposure to ultraviolet (UV) radiation from sunlight or artificial radiation sources. Excessive sun exposure is therefore one of the main risk factors for the development of skin cancer. With regular exposure to the sun, there is a risk that the genetic material in the skin cells will be intensively damaged - even if no sunburn occurs. At the same time, the ultraviolet radiation in sunlight suppresses the skin's immune defence, which normally recognises and repairs such damage to the genetic material of the cells. As a direct consequence, precancerous tumours can form (e.g. so-called actinic keratoses), which then develop into various forms of white skin cancer over the course of time (often years later).

Sun exposure also plays a significant role in black skin cancer, but it is not the only factor in the development of this malignant tumour. We know, for example, from the rare clinical cases of a familial clustering of black skin cancer that certain genetic constellations can significantly contribute to the development of such a malignant pigment tumour.

In addition to skin contact with chemical carcinogens, other causes of skin cancer include excessive exposure to X-rays and radioactive radiation.

 

What types of skin cancer are there?

The following types of skin cancer are categorised according to their cellular origin in the skin:

  • Basal cell carcinoma
  • Spinocellular carcinoma
  • Malignant melanoma (black skin cancer)
  • Lymphomas of the skin (lymph cell cancer localised in the skin)
  • Rare tumours (carcinomas of the skin appendages, sarcomas of the skin)

 

Basal cell carcinoma is the most common tumour in humans. Chronic exposure to ultraviolet light is a major risk factor. Basal cell carcinomas therefore occur particularly often in sun-exposed areas (e.g. on the face). It is a tumour of middle to old age. If the basal cell carcinoma is recognised early, it is very easy to operate on. After prolonged development, however, basal cell carcinomas tend to ulcerate painlessly. Rarely and only after years of growth can deeper structures such as bones, muscles and tendons be infiltrated. For this reason, a treatment option should be chosen that safely removes the tumour from the healthy tissue. The procedure of choice here is surgery with fine-tissue section control. Radiotherapy can be seen as an alternative to surgery, which is chosen more frequently, especially in older people. Basal cell carcinoma almost never leads to organ metastases.

 

Spinocellular carcinoma or squamous cell carcinoma of the skin also occurs in the vast majority of cases in so-called sun-exposed areas such as the face and hands. Squamous cell carcinomas of the skin are also curable in the majority of cases if they are recognised early. Here, surgery with complete removal of the tumour is the method of first choice. However, squamous cell carcinomas that grow over a longer period of time and are therefore extensive have a not inconsiderable risk of developing secondary tumours. This applies in particular to carcinomas on the lower and upper lip as well as tumours in the mucous membranes (genital, anal, mouth and throat area).

 

Malignant melanoma, or black skin cancer, is one of the most malignant tumours in humans. It most frequently develops on skin that has not previously been altered by a pigmented mole and less frequently on the basis of an existing pigmented mole. For this reason, every new pigmented spot on the skin should be presented to a dermatologist for examination if it changes. The same applies to malignant melanoma: if it is recognised early, it can be cured by simple surgery in over 90% of cases. However, if this early stage is exceeded, there is an increasing risk of secondary tumours developing in other organs, meaning that the diagnostic and surgical procedure for these more advanced melanomas becomes more extensive. The adequate assessment of the disease situation (staging) and the resulting treatment of a patient with malignant melanoma is based on the guidelines of the Working Group of Dermatological Oncology (ADO) and the system of the American Joint Committee on Cancer (AJCC). Patients with a vertical tumour penetration depth of less than 1 mm can be cured in 89 to 95 percent of all cases by surgical removal of the melanoma. Subsequently, a re-excision is performed with a safety margin, which is chosen depending on the vertical penetration depth of the tumour. In melanomas with a tumour thickness of more than 1 mm, the so-called sentinel lymph node is also removed. In rare cases, this is also carried out in special constellations with less than 1 mm TD according to Breslow. This is the first lymph node in the drainage area of the surgically removed melanoma. The excision (surgical removal) of the sentinel lymph node serves as diagnostic staging in order to detect micrometastases and thus represents an important prognostic parameter for planning further therapy. Malignant melanomas that have formed tumour metastases require complex diagnostics and individual treatment. If the tumour has metastasised to the skin, muscles or internal organs, the disease is unfortunately no longer curable, but the course of the disease can often still be influenced favourably with appropriate therapy.

 

Lymphomas of the skin are rare diseases. These are metastases of the body's own immune cells in the skin. In most cases, however, such metastases of malignant immune cells in the skin are very slow-growing and can be inhibited in their progression for years to decades with appropriate treatment. In rare cases, lymphoma of the skin requires aggressive treatment such as chemotherapy. This is only necessary if it is a very rare case of a rapidly growing lymphoma of the skin or a late stage of a lymphoma.

 

Rare tumours (such as carcinomas of the skin appendages, sarcomas of the skin). These tumours usually appear as rapidly growing lumps, which can have different colours and often appear coarse and fused with the deeper tissue. If a lump appears within a few weeks and grows rapidly, you should consult a dermatologist immediately. If diagnosed early, the treatment options are good in the vast majority of cases.

 

Patient information brochures to download

 

Here are selected links to further information about skin cancer on the Internet for you as a patient:

 

Links to the Dermatological Prevention Working Group

 

Link to the Dermatological Oncology Working Group (ADO)

 

Links to self-help for skin cancer

 

Link to "Young cancer portal"