DermatologY

Treating skin cancer – Detecting and treating malignant tumours

The most common malignant tumours of the skin include black and white or light skin cancer. Although black skin cancer is the best known, white skin cancer remains the most common malignant skin tumour.

White or light-coloured skin cancer is particularly dangerous, as its appearance is very diverse. This is because light skin tumours rarely tend to metastasise and look harmless, which is why they are often not detected and treated at all or only very late. Black skin cancer, on the other hand, develops from moles and liver spots. However, a malignant melanoma can also develop on inconspicuous skin.

At the ETHIANUM, our dermatology specialist Amira Ballout and our specialists in plastic and aesthetic medicine are at your disposal for the treatment of skin cancer. The interdisciplinary co-operation of experienced, experienced specialists guarantees you the best medical care with the most modern treatment accents according to the latest state of knowledge. We have compiled some information on black and light-coloured skin cancer for you. You will also find information on the treatment of skin cancer, depending on the stage of development.

Please note, however, that this information does not replace a skin screening appointment. Only a dermatologist can make a diagnosis and give you detailed advice and treatment. So please do not hesitate to contact us for a skin screening appointment if you suspect skin cancer or see any signs of a change in your skin. You can find out how a skin cancer screening works here.

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Amira Ballout is the head dermatologist at the ETHIANUM. Get to know this dedicated and friendly specialist.

Dermatology

White or light-coloured skin cancer

White or light-coloured skin cancer is usually inconspicuous. There are four precursors of white skin cancer that we would like to inform you about.

• Actinic keratoses (solar keratoses): This keratinisation disorder of the skin caused by UV radiation usually occurs in people in the second half of life. Areas that are exposed to intense sunlight are frequently affected. Initially, actinic keratosis is only a millimetre-sized rough area. However, this can develop into a wart-like elevation that is firmly fused into the skin. Solar keratosis is classed as a precancerous condition (precancerous lesion). It can remain unchanged for many years. However, there is a risk that actinic keratosis will develop into prickle cell cancer. A risk that can be avoided with early detection and treatment.
• Bowen’s disease: Bowen’s disease is characterised by reddish-brown, dry, scaly patches that can easily be mistaken for eczema or psoriasis. It mainly affects older people. Bowen’s disease does not disappear spontaneously. Sooner or later it develops into a prickle cell cancer. The skin change can also occur on mucous membranes or at the transition from skin to mucous membrane, e.g. in the anal and genital area. This is then referred to as “erythroplasia Queyrat”. Caution: Bowen’s disease must be treated as early as possible.
• Basal cell cancer (basal cell carcinoma): Basal cell carcinoma is the most common skin tumour in Central Europe. It can appear very differently. Sometimes as a yellow-reddish, nodular tumour, then often with a beaded edge, with small blood vessels shimmering through on the surface. However, a basal cell carcinoma can also hide behind red patches and scarred changes. Basal cell carcinoma grows aggressively. It infiltrates and destroys the surrounding tissue and can even spread to cartilage and bone, leading to severe disfigurement. Basal cell carcinoma hardly ever metastasises.
• Spinal cell carcinoma (spinalioma): Spinalioma is the second most common malignant skin tumour. It appears as a wart-like lump with an encrusted surface that bleeds easily when you try to remove it. The cancer develops on severely photodamaged skin, often from actinic keratosis. However, it can develop – albeit rarely – from wounds or burn scars. Spinalioma can also develop on the tongue or in the genital area. If left untreated, spinal cell carcinoma can send tumour cells into the lymph nodes and form metastases in other organs. This happens very rarely. The earlier this tumour is detected and treated, the better. Tumours with a diameter of less than one centimetre have the best chances of recovery.

If white skin cancer is recognised early, preferably at the precancerous stage, specialists can promise a complete cure with a clear conscience. In order to make an accurate diagnosis, a small tissue sample is taken and analysed histologically. Depending on the localisation and progress of the disease, the therapy is determined.

The safest treatment method is always the complete surgical removal of the skin tumour. Sometimes this requires a two-stage operation. The tumour is cut out. However, the wound is only covered with a sterile dressing for the time being. This is because the excised tumour is first examined under a microscope in the laboratory. This is because all cut edges must be free of tumour cells. However, this examination takes at least 24 hours. Only when it has been established that no tumour cells remain in the wound is it closed in the second operation. Depending on the size and location of the tumour, this operation can be performed on an outpatient or inpatient basis.

The head dermatology specialist at the ETHIANUM, Amira Ballout, favours so-called “photodynamic therapy” (PDT) for the above-mentioned superficial preliminary stages of white skin cancer. PDT is carried out using an ultra-modern daylight lamp and offers an effective form of treatment. At the ETHIANUM, we use the medisun PDT 1200 Indoor-Daylight.

The advantages of indoor daylight PDT with the compact mobile medisun PDT 1200 system are obvious to our specialist. It has a large LED lamp module with 12 high-performance LEDs, which, depending on the distance, enables a treatment area of approx. 720 cm². The system works with a continuous light spectrum of 400 nm-750 nm. This means that both small and large areas (field carcinogenisation) can be treated individually on the entire body. The exposure is not only pain-reduced, but even pain-free. For you as a client of our clinic, this means that you can relax during the exposure, listen to music or read.

Before treatment with PDT takes place, our specialist will provide you with detailed information in a consultation. On the day of the treatment, the specialist will then mark the areas to be treated. The scaly crust is then carefully removed using a curette. Alternatively, the skin can also be pretreated with a Fraxel CO2 laser. This makes the skin more receptive to the light sensitiser.

A thin layer of aminolevulinic acid or methyl-5-amino-4-oxopentanoate hydrochloride is then applied to the affected areas and left to act for an hour under a bandage. This causes prophyrins – photoactive, fluorescent compounds – to accumulate in the cells of the diseased skin lesion. Compared to healthy skin, this substance accumulates 10 times more in the tumour cells. This is followed by a further 60 minutes of irradiation with the artificial daylight of the medisun PDT 1200. If necessary, sunglasses can be worn during the irradiation. After irradiation, the specialist removes the photosensitiser with saline and applies a skin moisturiser. The treatment is then checked. As fluorescent light is used for this, the client must wear protective goggles.

For the next 48 hours after the treatment, you should avoid exposure to sunlight if possible. The treated areas should also only be washed with water. It is also necessary to apply sun protection with SPF 50+ and moisturising skin care every day. Increased crust formation or inflammation of the treated area may occur during this time. However, this is a sign that the treatment has worked. These symptoms are usually most pronounced from the second or third day after treatment. As a rule, the crusts and scabs heal after a week. Four to six weeks after the therapy, you will have a follow-up appointment with your specialist.

There are also other alternative therapies against light skin cancer. Their use depends on how extensive the skin cancer is, where it is located and when it was detected.

These therapy options are

• Curettage (scraping)
• CO₂ – laser
• Diclofenac sodium gel
• Imiquimod cream

Dermatology

Melanoma – Recognising malignant melanoma and treatment methods

Das maMalignant melanoma, or black skin cancer, is insidious. On the outside, it resembles a harmless birthmark. Unfortunately, however, malignant melanoma quickly develops aggressive growth. In contrast to white skin cancer, malignant melanoma also forms metastases, so it can spread early via the lymphatic system and form metastases in other organs. These metastases are life-threatening. It is therefore extremely important to treat a melanoma immediately, i.e. to have it removed.

The ABCDE rule serves as a guide for self-assessment of a mole. If any of the points apply, you should definitely consult a dermatologist as soon as possible.

A = Asymmetry of the birthmark

B = Boundary of the birthmark is blurred, irregular

C = Colour; multi-coloured nature of the birthmark

D = Diameter of the birthmark is larger than five millimetres

E = Elevation of the birthmark, it protrudes more than one millimetre above the skin level A malignant melanoma can also appear in different forms.

These are

• Superficial spreading melanoma: superficial growth, later deep growth with nodule formation
• Nodular melanoma: early deep growth
• Lentigo malignant melanoma: shallow formation, different colours (light brown, dark brown, black, reddish)
• Acro-lentiginous melanoma: localisation exclusively on the palms of the hands and soles of the feet as well as under fingernails and toenails

If you notice one or more of these spots, symptoms such as itching, bleeding or growth, these are alarm signals. We strongly recommend that you make an appointment with a dermatologist.

The safest and most important treatment method for malignant melanoma is surgical removal of the tumour. This prevents melanoma cells from remaining in the body and growing again. Aesthetic factors must also be taken into account, especially in the case of melanoma on the face. A microscopic incision margin control can be used here. The removed tumour is examined microscopically for completeness. This ensures that the resulting scar can be kept as small as possible.

To rule out the possibility that the melanoma has metastasised to other organs, a thorough follow-up examination is necessary. Doctors refer to this as “staging”.

This follow-up examination includes an ultrasound scan of the lymph nodes and abdomen. The lungs are also x-rayed. In certain cases, computer and magnetic resonance imaging are also part of the follow-up examinations. In individual cases, the experts also advise the removal of the sentinel lymph node. This is the lymph node in which the tumour cells would settle first. If no cancer cells are found there, no further lymph nodes need to be removed.