Skin cancer is one of the most common forms of cancer worldwide and affects millions of people every year. In Germany, the number of new cases is rising steadily, mainly due to the increasing amount of time spent in the sun, the trend towards tanning and inadequate UV protection.
Whether white skin cancer, light skin cancer or black skin cancer, all types of skin cancer have one thing in common: they are usually caused by too much UV radiation.
It is particularly important for private households, care services and care staff to inform people at risk and support them in early detection. The earlier a tumor is detected, the higher the chances of recovery and the lower the impact on quality of life.
The skin - our largest organ and important protective shield
The skin is the largest organ in the human body. It protects against pathogens, regulates body temperature and fends off harmful UV rays. Its outer layer, the epidermis, consists of millions of skin cells that are regularly renewed.
The basal layer contains the so-called basal cells, which constantly form new cells. If these are damaged by UV radiation, this can lead to long-term skin changes that later develop into skin cancer.
Skin cancer types at a glance
Not all skin cancers are the same; there are various types that differ significantly in terms of cause, progression, appearance and treatment.
Basically, medicine distinguishes between two large groups: light (white) skin cancer and black skin cancer (melanoma). Both are caused by a change in the skin cells, usually as a result of many years of exposure to UV radiation.
The two main types of skin cancer
Medicine distinguishes between two main types of skin cancer:
- White skin cancer (light skin cancer): This includes basal cell carcinoma (basal cell carcinoma) and squamous cell carcinoma (spinalioma).
- Black skin cancer (melanoma): a more aggressive form that often forms metastases.
While white skin cancer grows slowly for the most part, black skin cancer can spread to other organs at an early stage. Both forms should be taken seriously and require medical treatment.
White skin cancer (light skin cancer)
White skin cancer mainly occurs on parts of the body that are frequently exposed to the sun, such as the face, ears, shoulders or forearms.
It is divided into two main forms:
Basal cell carcinoma (basal cell carcinoma)
Basal cell carcinoma, also known as basal cell carcinoma, develops from the basal cells on the surface of the skin. It is the most common type of skin cancer in Germany.
Typical signs are
- Small, shiny nodules or growths
- Open sores that do not heal
- Areas that bleed or crust over easily
A basal cell carcinoma rarely metastasizes, but can penetrate deep into the tissue and cause permanent damage to areas of skin. If it is detected early, the chances of recovery are high.
Squamous cell carcinoma (spinalioma)
Squamous cell carcinoma develops from the keratinized skin cells of the upper layer. It often develops from a preliminary stage, actinic keratosis.
This appears as a rough, scaly patch of skin that feels like sandpaper.
Without treatment, it can develop into a spinalioma, which can penetrate into deeper layers of tissue and form metastases.
Black skin cancer (melanoma)
Melanoma, also known as black skin cancer, develops from pigment-forming melanocytes. It is considered the most dangerous type of skin cancer, as it can spread cancer cells to other organs at an early stage.
A melanoma can develop from an existing mole or be newly formed.
Typical symptoms are
- Dark, irregular spots
- Color changes or blurred edges
- Itching, bleeding or swelling
The earlier the melanoma is detected, the better the prognosis.
Causes and risk factors
The development of skin cancer is a gradual process that often takes place over many years. It usually begins with tiny skin changes that initially appear harmless, but can develop into a serious tumor disease through repeated damage to the skin cells.
UV radiation as the biggest risk factor
The most important cause of skin cancer is excessive UV radiation, whether from natural sunlight or artificial sources such as solariums.
UV rays damage the genetic material of skin cells. If the DNA is repeatedly damaged, at some point the body can no longer fully repair these errors. As a result, individual cells begin to divide uncontrollably, a process that leads to the development of tumors in the long term.
People with fair skin, blonde or red hair and blue eyes are particularly at risk. Their skin contains less melanin, the pigment that protects the skin from UV rays. The lighter the skin type, the lower the natural protective barrier against sunlight. People who get sunburnt easily or have many moles also have a significantly increased risk of developing white or black skin cancer.
However, it is not only the intensity of the sunlight that plays a decisive role, but also the total duration. The skin "remembers" every single exposure to the sun, this is known as the UV account. Every excessive exposure to the sun, especially during childhood and adolescence, adds to this lifetime dose of radiation. If the UV account is overloaded over many years, the likelihood of basal cells, squamous epithelial cells or melanocytes being permanently damaged increases.
Artificial UV radiation from sunbeds is also dangerous. Studies show that regular tanning under a sunbed increases the risk of melanoma by up to 60 %. The artificial lamps usually emit a combination of UVA and UVB rays, which penetrate into the deep layers of the skin and can accelerate skin ageing and cause cell mutations.
Indirect solar radiation should also not be underestimated: water, sand, snow or light-colored facades reflect UV light and increase the exposure of the skin's surface. Even in the shade or on cloudy days, up to 80 % of UV radiation still reaches the skin. Sun protection measures such as clothing, headgear and sun cream are therefore not only important in the height of summer, but all year round, especially for children, the elderly and people with sensitive skin.
In the long term, excessive UV exposure can not only cause skin cancer, but also other skin changes such as pigmentation spots, wrinkling and actinic keratoses, which are considered to be a precursor to squamous cell carcinomas.
Certain medications, such as antibiotics or anti-inflammatory drugs, can also increase the skin's sensitivity to UV rays. People who regularly take medication should therefore be particularly careful with sun exposure.
Other risk factors
In addition to UV radiation, there are a number of other risk factors that can promote the development of skin cancer, particularly white skin cancer and malignant melanoma. Many of these influences have an effect over many years, which is why prevention and regular skin checks are particularly important.
Family history
A genetic predisposition plays an important role in many types of cancer, including skin cancer. If there are already cases of melanoma, basal cell carcinoma or squamous cell carcinoma in the family, there is an increased risk of developing the disease yourself.
Certain genetic mutations can impair the repair mechanisms of skin cells, meaning that damage caused by UV rays can no longer be repaired properly. People with a family history of exposure should therefore pay particular attention to early detection and consistent UV protection.
Age over 50 years
The risk of skin cancer increases significantly with age. The reason for this is what is known as cumulative UV exposure: the skin "remembers" every hour of sunshine and every sunburn, even if they happened decades ago.
The skin's protective and repair mechanisms slow down with age, making it easier for damaged cells to degenerate. This is why basal cell carcinomas and squamous cell carcinomas often occur in older people, particularly on areas of the body that are heavily exposed to the sun, such as the face, ears or back of the hands.
Immunodeficiency due to medication or illness
A weakened immune system is another important risk factor. People who have to take immunosuppressive medication after an organ transplant are particularly at risk. Chronic illnesses such as HIV or certain autoimmune diseases can also weaken the body's own defenses against altered skin cells.
The immune system normally recognizes abnormal cells and eliminates them before they develop into a tumour. If this protective function is impaired, the risk of skin tumors increases considerably.
Many birthmarks
The number of moles plays a particularly important role in black skin cancer (melanoma). People with many moles, especially those with an irregular shape or color, have a higher risk of developing melanoma.
Atypical moles, which may already show cell changes, are particularly dangerous. If you have more than 50 moles or a family history of skin cancer, you should have regular skin cancer screenings.
Previous sunburns, especially in childhood
Sunburns are one of the biggest preventable risk factors. Even a few severe sunburns in childhood or adolescence can drastically increase the risk of skin cancer in later life.
This is because the skin cells are particularly sensitive at a young age and the damage accumulates over time. Even if the skin heals externally, microscopic DNA damage remains, which can later turn into cancer cells.
This is why protecting children and young people from excessive sun exposure is one of the most important measures in skin cancer prevention.
Other influences: Skin type, lifestyle and environment
Other factors can also increase the risk. People with pale skin, freckles or blonde hair are particularly sensitive to UV rays.
Smoking, alcohol consumption and chronic skin irritation (e.g. from scars or wounds) can also promote the development of skin tumors. Certain chemical substances or tar products used in industry are also considered to cause skin cancer.
Occupational and everyday risks
People who work outdoors a lot, such as care workers, construction workers or farmers, are particularly at risk.
Care services that accompany their clients on walks should also ensure that they have adequate UV protection.
Skin cancer: signs and symptoms
The signs and symptoms of skin cancer are often inconspicuous and are easily overlooked at first. However, the earlier a skin change is detected, the greater the chances of recovery.
Recognizing skin cancer - warning signals of the skin
Skin changes are the most important sign of a possible disease.
Any new or changing areas of skin should be observed.
This applies in particular to:
- Moles that change shape or color
- Crusts that do not heal
- Scaly patches of skin that last longer
Typical signs of white skin cancer
White skin cancer rarely causes pain.
It usually manifests itself through:
- Waxy or reddish lumps
- Rough, slightly bleeding skin areas
- Slowly growing growths
These changes mainly occur on the face, forehead, nose and ears.
Typical signs of black skin cancer
The symptoms of black skin cancer are often more pronounced:
- Dark, irregular birthmarks
- Asymmetrical shape and multiple shades
- Enlargement, itching or bleeding
Melanoma can also occur in unusual places on the body, such as under the soles of the feet or on the fingernails.
As the symptoms vary depending on the type of skin cancer, it is important to monitor your own skin regularly and consult a dermatologist at an early stage if you notice any abnormalities.
The ABCDE rule for the early detection of skin cancer
This rule helps you to recognize suspicious skin changes yourself:
- Asymmetry - uneven shape
- Boundary - blurred or frayed
- Color - different colors
- Diameter - greater than 5 mm
- Development - change in size or color
Anyone who notices any of these signs should consult a dermatologist immediately.
Skin cancer: diagnosis and early detection
Early diagnosis is the key to successfully treating skin cancer. As skin changes often develop slowly, regular skin examinations can help to detect suspicious areas in good time.
The earlier a tumor is detected, the higher the chances of recovery, which is why early detection and skin checks are important for all age groups.
Regular skin checks at the dermatologist
From the age of 35, health insurance companies cover skin cancer screening every two years. The dermatologist examines the entire surface of the skin and can detect suspicious skin areas using special equipment such as a dermatoscope.
Biopsy and laboratory examination
If skin cancer is suspected, a small tissue sample is taken. This is examined microscopically in the laboratory.
This makes it possible to determine whether it is a basal cell carcinoma, a squamous cell carcinoma or a melanoma.
Early detection saves lives
Early diagnosis can significantly improve the chances of recovery. If the tumor is removed in time, the prognosis is usually excellent.
Therefore, it is better to go to the dermatologist once too often than once too little.
Stages and progression of skin cancer
A skin tumor develops in several stages.
Actinic keratosis is considered a precursor to squamous cell carcinoma. If it is detected early, the development of cancer can be prevented.
In the case of melanoma, the stage depends on the depth of invasion and any metastases.
Metastases and spread in the body
If cancer cells penetrate blood or lymph vessels, they can spread to other organs, mainly the lungs, liver or brain.
There they form metastases, which make treatment more complicated. Nevertheless, modern therapies offer good chances of recovery even in advanced stages.
Treatment options for skin cancer
- Surgical removal
Surgical removal is the most common and most effective treatment method for skin cancer, removing the tumor together with a small margin of healthy tissue to ensure that no cancer cells remain.
For small basal cell carcinomas, a short procedure under local anesthesia is often sufficient and can be performed on an outpatient basis.
Wound healing is usually uncomplicated and the chances of recovery are excellent.
- Radiotherapy and chemotherapy
If surgery is not possible or the skin cancer is already at an advanced stage, radiotherapy or chemotherapy is used.
Radiotherapy specifically destroys remaining cancer cells in the affected area and prevents recurrence, while chemotherapy is mainly used for melanomas with metastases to slow down or stop tumor growth.
Both procedures can also be used in addition to surgery.
- Immunotherapy and targeted treatment
New forms of therapy rely on the body's own immune system: it is activated to specifically recognize and destroy cancer cells, and so-called checkpoint inhibitors and targeted therapies have made great progress, particularly in the case of melanoma.
These drugs block certain signals that tumor cells use to evade the immune system.
This significantly improves the treatment options and chances of recovery, even in advanced cases.
- Aftercare and monitoring
After successful treatment, regular aftercare is essential.
Check-ups with a dermatologist help to detect relapses or new skin tumors at an early stage and those affected should keep a close eye on their skin for the rest of their lives and take any changes seriously.
Psychological support, skin care and sun protection in everyday life also help to maintain quality of life after skin cancer.
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Prevention and UV protection
Prevention is the best measure against skin cancer.
Important measures are:
- Use of sun cream with a high sun protection factor
- Wear a hat, sunglasses and protective clothing
- Avoid the midday sun (11-15 h)
- Regular skin care
Protection in everyday life and at work
UV protection should also be a matter of course in everyday life, not just on summer vacation.
Care services should train their staff to protect both themselves and those in need of care from excessive sunlight.
Solariums and artificial UV radiation
Visiting sunbeds significantly increases the risk of white and black skin cancer. Young people in particular should avoid artificial tanning in order to prevent skin damage later on.
Tips for self-control
Once a month, the entire skin should be checked for skin changes, including areas of the body that are difficult to see, such as the back, scalp and soles of the feet.
If you are unsure, you can also ask a second person for help.
When to see a doctor?
If an area of skin changes, becomes discolored or begins to itch or bleed, a dermatologist should be consulted immediately.
Early detection is the key to successful treatment.
Support from care services
Caregivers and relatives can play an important role by paying attention to conspicuous skin areas during daily personal hygiene and informing those affected of the need to see a doctor.
Skin health and quality of life
Skin cancer can severely impair quality of life due to scars, pain or psychological stress.
However, with modern therapy and early treatment, a normal life can be led in many cases.
Education and awareness
Regular educational campaigns in care facilities, schools and companies promote awareness of skin health.
Everyone can actively contribute to prevention by adapting their behavior in the sun.
Frequently asked questions about skin cancer
Is light skin cancer dangerous?
Yes, even light skin cancer is a serious disease that can destroy tissue if left untreated.
However, if detected early, the chances of recovery are excellent.
How do I recognize a melanoma?
A melanoma is often a dark, irregular birthmark. If it changes color, shape or size, a visit to the dermatologist is strongly recommended.
Which parts of the body are particularly at risk?
The face, ears, hands, arms, shoulders and back are particularly at risk.
However, hidden areas such as the feet, scalp and genital area should not be forgotten when carrying out self-checks.
