White skin cancer • This is what its symptoms look like!

White skin cancer is the most common cancer. Since the main risk factor for light skin cancer is strong sun exposure, it usually arises on the nose, forehead, lips or on the ear. What you should know about the prognosis, appearance and therapy of white skin cancer.

Strong sun exposure is the main risk factor for white skin cancer – so avoid extensive sunbathing.
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The term light skin cancer (non-melanoma skin cancer, also: non-melanoma skin cancer) is used to summarize basal cell carcinoma (also: basalioma or basal cell epithelioma) and squamous cell carcinoma of the skin (also: spinalioma, spiked cell carcinoma; Greek: carcinos = cancer).

Recognize and treat skin diseases

Recognize skin diseases with these pictures

In contrast to black skin cancer, malignant melanoma, they are also called light or white skin cancer. Unlike black skin cancer, non-melanoma skin cancer has only a slight tendency to spread from the skin to other organs and form daughter tumors (metastases).

Light skin cancer (non-melanoma skin cancer) is the most common cancer. The World Health Organization (WHO) estimates that two to three million new cases occur worldwide each year, and the trend is rising. However, there are no precise figures on the incidence of disease, since most cancer databases do not record non-melanoma skin cancer. However, studies in Australia, Canada and the United States showed that the incidence of non-melanoma skin cancer increased more than twice between the 1960s and 1980s alone.

In Germany, too, cases of non-melanoma skin cancer are not registered across the board. It is known from epidemiological studies that around 120 out of 100,000 inhabitants in Germany suffer from a non-melanoma skin tumor every year. By far the largest proportion of this is due to basal cell carcinoma.

Basalioma (basal cell carcinoma)

Basal cell carcinoma, also called basalioma or basal cell epithelioma, is the most common light skin cancer (non-melanoma skin cancer). It starts from the top layer of skin, the epidermis, but can spread into the layers below and lead to serious tissue damage. In contrast, his tendency to form daughter tumors in other organs is low. Around 100 out of 100,000 inhabitants in Germany develop basal cell carcinoma every year. Men and women are affected equally. The average age is 60 years, with a trend towards a younger age of onset being observed in recent years. Basal cell carcinoma occurs in the head and neck area in about eight out of ten cases.

Squamous cell carcinoma

The squamous cell carcinoma of the skin begins in the uppermost layer of the skin, the epidermis, but can grow destructively into the underlying layer of skin, the dermis. It has a slightly greater tendency to spread than basal cell carcinoma – in an estimated five percent of cases, daughter tumors, so-called metastases, develop in other organs.

The spread occurs through the lymphatic vessels. Every year, around 20 to 30 per 100,000 inhabitants in Germany develop squamous cell carcinoma of the skin. Men are affected more frequently than women. The average age is currently 70 years. Squamous cell carcinoma of the skin on the face occurs in nine out of ten cases.

Symptoms and pictures of white skin cancer: watch out for these signs!

In white skin cancer, the symptoms depend on which carcinoma is present. Depending on the disease, it manifests itself in different ways.

Squamous cell carcinoma: horny areas that are tight

actinic keratosis white skin cancer spinalioma

Squamous cell carcinomas appear rough-horny and reddish.

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The appearance of squamous cell carcinoma is less variable than that of basal cell carcinoma. In the early stages it is often similar to actinic keratosis, which means that the tumors appear as reddish, rarely skin-colored, firmly adhering skin spots.

In the further course, nodes develop with firmly adhering small horn beads that are difficult or impossible to remove with the finger and then bleed frequently. Like basal cell carcinomas, squamous cell carcinomas can grow deep and destroy the surrounding tissue. In about five percent of the patients, the tumors spread to other organs via the lymphatic system and settle there, so-called metastases.

Basalioma: skin spots and bleeding

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Not easy to recognize: basaliomas can look reddish-raised, have a pearl string edge or appear more like scars. Blood vessels can also be visible.

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The appearance of basal cell carcinoma is diverse. Most often they begin as flat, raised, yellowish-reddish tumors, which are occupied by a pearl cord-like border, and on the surface of which small blood vessels shine through. Other forms are red spots, mostly on the trunk, or scarred changes in the skin.

Basal cell carcinomas develop over months to years and gradually change into weeping ulcers, from which minor bleeding can emerge. The tumors grow into the deeper layers and even destroy cartilaginous and bony structures in severe cases. In order to remove the tumor tissue and at the same time restore the damaged structures as far as possible, complex operations are sometimes necessary.

Why does white skin cancer grow? Causes of basalioma and spinalioma

Light skin cancer – both basal cell carcinoma and squamous cell carcinoma – is most common in areas of the body exposed to the sun, such as the face, ears, neck and upper arms.

UV light is considered the main cause of both types of cancer. In response to solar radiation, the skin first turns brown by forming pigmentation. As a result, the UV radiation is blocked in the uppermost layers of the skin and can no longer reach the deeper layers.

However, if the sun is too strong or the skin has not yet pigmented enough, self-protection is not enough. The sun's rays then lead to inflammatory reactions in the deeper layers of the skin, which become noticeable as sunburn. The risk of skin cancer increases with every sunburn.

The incidence of non-melanoma skin cancers has increased rapidly in recent decades. The reasons for this are believed to be:

  • a changed leisure behavior with frequent sunbathing without sun protection (both in natural sunlight and in the solarium)

  • increased solar radiation due to the decrease in the ozone layer

Additional risk factors for basal cell carcinoma

  • an hereditary tendency, characterized by light skin pigmentation (light skin color, light or reddish hair)
  • arsenic
  • long-term use of drugs that inhibit the immune system (immunosuppression, for example after an organ transplant)

In addition, basal cell carcinoma can develop as part of certain syndromes, such as Xeroderma pigmentosum (light shrink skin or moonlight disease), basal cell nevus syndrome and albinism. Basal cell carcinomas usually grow directly without a preliminary stage, but they can begin to grow on scars or birthmarks, so-called nevi sebacei.

Additional risk factors for squamous cell carcinoma

The most important risk factor for the development of squamous cell carcinoma of the skin is the presence of so-called actinic keratoses. These are reddish, sometimes skin-colored, firmly adhering roughnesses of the skin surface, which are triggered by UV light. They are considered to be the precursor of squamous cell carcinoma – some experts even mean it as early squamous cell carcinoma. Their frequency increases with age.

Older age and light skin pigmentation are also considered risk factors for squamous cell carcinoma of the skin. In addition, squamous cell carcinoma of the skin can develop on the floor of chronic wounds and inflammation, such as how to properly treat burns and scalds, ulcers or scars. If the immune system continues to be weakened, for example after an organ transplant or after an HIV infection and AIDS: symptoms and therapy, the risk of developing the disease is higher and the course of the disease is usually less favorable. Like basal cell carcinomas, squamous cell carcinomas can also occur in the context of certain syndromes such as xeroderma pigmentosum and albinism.

Diagnosis: examinations and stages in white skin cancer

Many sufferers themselves recognize signs of white skin cancer. The doctor will look at the respective area through a microscope and, if necessary, examine the tissue.

The sooner white skin cancer is detected, the easier it is to treat it. The big advantage of skin cancer over cancer of the internal organs is that it can be seen with the naked eye. Therefore, regular self-examinations for skin changes (ABCD skin test) can help to identify the cancer in good time before major damage has occurred.

Above all, the areas that are often exposed to sunlight, such as the face, décolleté and arms, should be looked at regularly, but also less exposed areas of the body such as the back and legs should not be forgotten.

This is particularly true for people who spend a lot of time outdoors or in their work or who are prone to sunburn, as well as for patients with a weakened immune system. If there are any abnormalities, a dermatologist should always be consulted. He can determine whether it is actually white skin cancer or not.

Legal screening

In addition to self-examination, statutory screening is the second pillar for the early detection of light skin cancer (non-melanoma skin cancer). In Germany, people with statutory health insurance from the age of 35 can have their skin examined for skin cancer every two years. Participation in this early detection screening appears to be paying off, as studies show. According to this, at least in the case of malignant melanoma: Black skin cancer recognizes tumors that are recognized by the dermatologist more often at an early stage than tumors that those affected themselves discover.

In addition to dermatologists, resident general practitioners can also carry out skin cancer screening if they have completed special training. The screening takes about 20 minutes and includes a detailed discussion of any complaints and risk factors, a thorough examination of the skin on the entire body, and subsequent advice. If skin cancer is suspected, the patient is referred to the dermatologist, who carries out further examinations.

Diagnosis by a dermatologist

Most of the time, the dermatologist can see with the naked eye or a magnifying glass whether it could be a form of white skin cancer or not.

To be sure, a microscopic tissue examination must take place. In most cases, suspicious foci are removed in one piece with a small operation and the tissue is then examined histologically for any changes.

This procedure ensures that any tumor is actually completely eliminated. Diagnosis and therapy therefore take place in one step. Only in rare cases will the dermatologist recommend taking a tissue sample from a suspicious area, a biopsy.

If the diagnosis of white skin cancer is confirmed, further examinations often follow to determine the degree of spread of the tumor. Since squamous cell carcinomas of the skin can spread to the rest of the body via the lymphatic pathways, sonography of the lymph nodes is carried out. Computed tomography (CT) and / or magnetic resonance imaging show how deep the tumor has spread.

If it is suspected that daughter tumors may be present in other organs, special examinations such as an X-ray examination of the chest area or an ultrasound examination of the abdominal area are carried out.

Assessment of the stage of the disease in white skin cancer

The stage of the disease is assessed on the basis of the size and degree of spread of the tumor. The stage classification is based on the so-called TNM classification:

T = tumor, N = involvement of organic lymph nodes (Nodi lymphatici), M = metastases (daughter tumors) in distant lymph nodes or other organs.

In the case of squamous cell carcinoma of the skin, the disease stage is of primary importance for the further therapeutic procedure and the prognosis. Basal cell carcinoma is practically irrelevant in everyday clinical practice because the T classification is too coarse and the N and M categories are virtually non-existent.

TNM classificationTumor features
TXStarting tumor (primary tumor) cannot be assessed
T0No evidence of an initial tumor (an initial tumor cannot always be identified, even though, for example, daughter tumors are present in other organs and can be clearly attributed to skin cancer)
TisCarcinoma in situ (CIS, "cancer on the spot") – early stage, tumor only grows in the uppermost layer of the skin or mucous membrane
T1Tumor ≤ 2 cm in its greatest extent
T2Tumor ≥ 2 cm u. ≤ 5 cm in the largest dimension
T3Largest tumor ≥ 5 cm
T4Tumor has spread beyond the skin, e.g. in cartilage, skeletal muscle or bone
NXSurrounding lymph nodes cannot be assessed
N0The surrounding lymph nodes are not affected
N1The surrounding lymph nodes are affected
MXThe presence of daughter tumors in other organs (distant metastases) cannot be assessed
M0No distant metastases
M1Distant metastases

Staging

stageInitial tumorLymph nodesDistant metastases
Stage 0TisN0M0
Stage IT1N0M0
Stage IIT2N0M0
T3N0M0
Stage IIIT4N0M0
Every TN1M0
Stage IVEvery TEvery NM1

Treatment: The treatment options for white skin cancer

Therapy depends on the type and stage of the carcinoma. As a rule, it is removed; further measures are sometimes necessary.

Various methods are available for the therapy of white skin cancer:

radiotherapy

Radiation therapy can be used if the tumor turns out to be inoperable or if the entire tumor tissue could not be removed during an operation and a second operation is not possible. Radiation therapy is prohibited for basal cell nevus syndrome, a hereditary disease in which not only one but a large number of basal cell carcinomas are present.

Cryotherapy

Cryotherapy is a cold therapy. The application of liquid nitrogen cools the skin to very low temperatures within a few seconds. The tissue dies due to the cold shock. Cryotherapy is suitable for small superficial tumors, especially on the eyelids. It is particularly suitable for older patients, for whom surgery would be a major burden.

curettage

Scrapping, known as curettage, is used when there are many superficial basal cell carcinomas, especially in the trunk area and on the arms or legs.

Photodynamic therapy (PDT)

In phototherapy, light is used in combination with an agent that makes the tumor tissue more sensitive to the effects of light, a so-called photosensitizer. This sensitizer is first administered to the patient. It accumulates almost exclusively in the tumor tissue. If this is subsequently irradiated with light of a suitable wavelength, toxic substances are generated as a result of photochemical processes, which damage the tumor tissue. The surrounding healthy tissue is spared because the photosensitizer has not accumulated in it.

Immunological therapy

Small, superficial basal cell carcinomas can be treated with imiquimod cream for six weeks. Imiquimod is a so-called immunomodulator. It activates the skin's immune system to act against the cancer cells.

Local chemotherapy

For superficial basal cell carcinomas and basal cell nevus syndrome, local chemotherapy with 5-fluorouracil can be carried out for four to six weeks.

With all non-surgical procedures, it cannot be reliably assessed whether the entire cancerous tissue has been destroyed and removed or not. There is therefore a significantly greater risk of relapse than surgery.

Preventing white skin cancer: Responsible use of the sun is essential!

The main cause of white skin cancer is UV light. The following applies: every sunburn counts. Effective sun protection is therefore the best way to prevent white skin cancer. This includes …

  • use a sunscreen with the highest possible sun protection factor
  • in spring the skin slowly get used to the longer and more intense sun radiation
  • during the lunchtime, when the sun is most intense, stay in the shade if possible
  • to wear airy long clothes and a hat

People with fair skin type and / or a weakened immune system, for example as a result of an organ transplant, should protect themselves particularly well from the sun.

Black skin cancer or birthmark? These pictures help to recognize!

Black skin cancer or birthmark? These pictures help to recognize!