Skin cancer

Classification according to ICD-10
C43.-	Malignant melanoma of the skin
C44.-	Other malignant neoplasms of the skin
ICD-10 online (WHO version 2019)

Skin cancer is a generic term for all malignant changes ( cancer ) of the skin . In everyday language it is often equated with malignant melanoma . Depending on the degenerate cell type, one can differentiate between different types of skin cancer.

Basalioma of the face

Skin cancer originating in the skin epithelium

Nodular spinocellular carcinoma (spinalioma)

Melanoma: margins and color are irregular

This is also known as “white skin cancer” and occurs mainly in older people. A distinction is made between basalioma ( synonym : basal cell carcinoma ) and spinalioma (synonym: spinocellular carcinoma ). Both types of cancer are mainly caused by UV light and therefore often form on the face. They can be preceded by certain changes (so-called precanceroses ), e.g. B. actinic keratosis or Bowen's disease . These types of skin cancer are operated on in most cases and metastasize almost never (basalioma) or very rarely (spinalioma) . If left untreated, however, they can locally destroy the surrounding tissue, making the operation difficult for large tumors.

Malignant melanoma

The malignant melanoma , also known as "black skin cancer", is the most feared form and provides for most skin cancer deaths. The cells that produce the skin pigment melanin degenerate and form a very aggressive cancer. Melanomas can grow in size quickly and then metastasize to lymph nodes and internal organs.

Skin cancer of the immune cells

The lymphocytes are cells of the immune system that can be found anywhere in the body. In addition to in the blood or on the inner mucous membranes, they can also form lymphomas of the skin, so-called cutaneous lymphomas. The most common cutaneous lymphoma is mycosis fungoides , which despite its name has nothing to do with fungi. In the early stages, mycosis fungoides can look like eczema . In the later stages, larger lumps then form on the skin, which can also break open. The tumor can also affect other organs via the lymphatic and blood systems. Mycosis fungoides can be treated with local ointments, UVA irradiation (so-called PUVA ), with interferon or with chemotherapy , depending on the severity of the disease.

Less common forms of skin cancer

In addition to the above-mentioned types of skin cancer, other skin cells can also degenerate, but these tumors are very rare. There are, for example:

• Kaposi's sarcoma isa rarityin otherwise healthy (especially immunologically competent) people. It occurs mainly inpeople who are immunocompromisedby AIDS .
• Fibrosarcomas (connective tissue cells) mostly affect men over 40 years of age. These are tumor cells from the connective tissue of the dermis . The tumor grows quickly (preferably on the lower leg), destructive and often metastasizes; The prognosis is correspondingly unfavorable, therapy of choice: surgical removal with a safety margin and subsequent (combined) radio-chemotherapy.
• Sweat gland carcinoma ( porocarcinoma , adenoid-cystic carcinoma , mucinous carcinoma , malignant cylindroma , malignant spiradenoma , hiradrenocarcinoma )
• Sebum carcinoma
• Angiosarcoma (vascular cells), as hem angiosarcoma (haima, Greek the blood), or lymph angiosarcoma; Hemangiosarcomas are very rare, occur in old age preferentially on the head (face) and on the female breast, the first sign is a flat bluish infiltration (similar to a "bruise"). Lymphangiosarcoma very rarely occurs due to chronic lymphatic congestion. See elephantiasis such as B. occurs in Stewart-Treves syndrome . Affected are almost exclusively women of older age, often patients with a history of radical removal of the mammary gland and axillary lymph nodes (these patients often suffer from chronic lymphedema of the arm).
• Myosarcomas (muscle cells)
• Merkel cell carcinoma (from special touch cells, also known as "trabecular Ca or Merkel cell carcinoma") of the Merkel cells in the basal cell layer of the epidermis or around hair follicles. Between the ages of 70 and 80, regardless of gender, a hard, insensitive, reddish-purple or pink-colored, rapidly growing lesion occurs predominantly in the facial area. The hemispherical or spherical, sometimes plaque-shaped, tumor can have a diameter of less than 2 cm. The extremities are further sites of predilection. The course can be very rapid and highly malignant. In addition to local removal or radiation therapy, lymph node dissection should be performed in the affected area if possible.

Pseudocancerous diseases

They are not real tumors in the sense of degenerate metastatic cells, but epithelial growths with symptoms of inflammation.

• Keratoacanthoma
• Pseudocarcinomatous hyperplasia
• Bowenoid papulosis

Skin cancer as an occupational disease

The recognition of skin cancer as an occupational disease in the German construction industry and the precise registration of the cases has led to the result that white skin cancer is the most common occupational disease in the industry. "In 2018 there were 2,944 cases, and the trend is rapidly increasing," confirmed Klaus-Richard Bergmann, General Manager of the Construction Employers' Liability Insurance Association, where 2.8 million construction workers are insured against accidents and occupational diseases. In the first half of 2019, according to a preliminary evaluation, the status was already 1,400 reports. BG BAU General Manager Bergmann and the German Cancer Aid Foundation demanded that they do more “preventive work against skin cancer” against the background of climate change . The course has to be set in order to protect against UV radiation in the construction industry and to contain skin cancer diseases.

frequency

Every year in Germany around 207,000 people develop white skin cancer (basal cell cancer 137,000, squamous cell carcinoma 70,000). In 2010, 19,220 people (9,640 men and 9,580 women) developed malignant melanoma and 2,711 people died from it. According to GEKID , the numbers for 2018 have even worsened: Every year over 293,000 people develop new skin tumors, around 35,000 of them with malignant melanoma.

The risk of developing skin cancer depends on the individual skin type and on UV radiation exposure. A dark skin type is cheaper than a low UV exposure. This explains why New Zealand and Australia have the highest incidence of skin cancer in the world. In African countries, the risk of a new disease is rather low. Germany ranks 13th in a current comparison.

early detection

High-risk patients with such examples must strive for careful early detection

Noticeable changes in the skin can usually be treated well if they are recognized early. Since July 1, 2008, all persons with statutory health insurance in Germany over the age of 35 have been entitled to a skin cancer screening examination every two years.

In the context of early detection and investigation of suspicious findings is often used as method in practice, the dermoscopy applied. A specially illuminated magnifying glass is used to allow a precise view of the individual skin areas. The use of such a hand-held LED incident light microscope or dermatoscope - the one-off purchase costs of which are around 150 to 300 euros - raises problems, however, especially when it comes to reimbursement, as its use has not yet been reimbursed by the statutory health insurance .

therapy

The therapy of various clinical pictures is dealt with in the respective articles.

Research and prevention

Cancer researchers, dermatologists and the German Cancer Aid see solariums as a major risk for skin cancer of all kinds. Currently, 3.5 million under 35-year-olds use sunbeds. The group of frequent users is particularly at risk: women between the ages of 18 and 25. Scientists and health organizations unanimously demanded regular, strict controls of solariums so that the UV protection regulation that has been in force in Germany since January 2012 is actually implemented.

Research results from 2008 indicate a connection between infection with human papillomaviruses from the genus Betapapillomavirus and the occurrence of squamous cell carcinoma of the skin [ cutaneous squamous cell carcinoma (SCC)].

Worldwide there are connections with the thinning of the ozone layer , which has a particular effect on the southern hemisphere. Skin cancer kills around 1,500 people each year in Australia . Genetic factors play a role here because, for example, people with a melanin deficiency in the skin are at a higher risk.

See also : skin cancer screening

literature

• Ingrid Moll: Dermatology . 8th edition, Thieme Verlag, Stuttgart 2016, ISBN 978-3-13-126688-0 .

Web links

Commons : Skin Cancer  - Collection of Pictures, Videos and Audio Files

Wiktionary: skin cancer  - explanations of meanings, word origins, synonyms, translations

• Skin cancer: basal cell carcinoma, squamous cell carcinoma, malignant melanoma , cancer information service of the German Cancer Research Center (DKFZ), Heidelberg. February 13, 2013. Last checked September 4, 2014.
• German Cancer Aid: Skin Cancer. Answers - Help - Perspectives. (PDF file, 5.4 MB), The Blue Guide

Individual evidence

1. ↑ https://www.deutschlandfunkkultur.de/ungeschuetzt-auf-dem-bau-hautkrebs-ist-die-berufskrankheit.976.de.html?dram:article_id=457252 , accessed on September 5, 2019
2. ↑ https://www.deutsche-handwerks-zeitung.de/baugewerbe-das-ist-die-haeufigste-berufskrankheit/150/3094/392516
3. ↑ Beate Tenfelde: "Sizzling brown is out" - German Cancer Aid: Climate change exacerbates the UV problem. In: NOZ . August 16, 2019, accessed August 23, 2019 .  
4. ↑ skin cancer. Rethink! Actively preventing cancer. In: krebshilfe.de. German Cancer Aid, archived from the original on April 14, 2011 ; Retrieved April 14, 2011 . 
5. ^ Robert Koch Institute (editor): Krebs in Deutschland 2009/2010. 9th edition, 2013, pp. 60ff. (accessed on May 19, 2014)
6. ↑ skin cancer. April 19, 2018, accessed July 26, 2019 . 
7. ↑ Lara Hensel: That makes us too much sun. (No longer available online.) In: That makes too much sun with us. Women's health, June 16, 2016; archived from the original on August 5, 2016 ; accessed on August 5, 2016 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  
8. ↑ Market check of the consumer center NRW for skin cancer screening, March 2015
9. ↑ JN Bouwes Bavinck, EI Plasmeijer, MC Feltkamp: Beta-papillomavirus infection and skin cancer. In: Journal of Investigative Dermatology . Volume 128, Number 6, June 2008, pp. 1355-1358, ISSN  1523-1747 . doi: 10.1038 / jid.2008.123 . PMID 18478011 .
10. ↑ MM Asgari, NB Kiviat a. a .: Detection of human papillomavirus DNA in cutaneous squamous cell carcinoma among immunocompetent individuals. In: The Journal of investigative dermatology. Volume 128, Number 6, June 2008, pp. 1409-1417, ISSN  1523-1747 . doi: 10.1038 / sj.jid.5701227 . PMID 18185530 . PMC 3268673 (free full text).
11. ↑ Report in WELT-Wissen Ozonloch: Unfiltered radiation is so dangerous , online December 8, 2015
12. ↑ Report on Deutschlandfunk : Australia tries to save its skin , August 15, 2014, accessed on January 23, 2018
13. ↑ Ursula Berger: Diagnosis of skin cancer - the disease, its causes and treatment methods , Baltic Sea Press, Rostock 2009, page 65

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !