Besides general information
on skin cancer that you can get from many sources, our idea is
- to name the early signs
of a starting skin cancer
- and show representative
examples of some cases
to encourage you, the reader,
to contact a physician to get a proper diagnosis.
The information provided
here is as a first step on the two most important skin cancer
- Squamous cell carcinoma (SCC)
The malignant melanoma starts
to grow from the pigment cells in the skin surface.
It can occur on
any area of the body. It is found in one of 7000 persons per year in
Europe in caucasians in the middle of their lifetime.
In most cases melanoma is
discovered as a flat, growing, irregular shaped pigment
spot often without symptoms that only later grows in thickness and in
some cases perhaps might itch. Bleeding is a late sign. Not all melanomas
are dark brown or black.
Half of the early
melanomas do not look
typical at all in the beginning.
Early SSM type melanoma
There are different types
of melanomas defined :
melanoma type (SSM) is the most common type representing 75% of
the cases (see above).
As it grows in a thin layer first, it is mostly discovered early enough
to be removed timely.
The malignant age spot Lentigo
maligna melanoma (LMM) is the second most common melanoma type.
starts on sunexposed body areas as the face or the arms of
elderly people. Only late
it would start growing deeper into the skin.
The type of nodular
melanoma (NMM) is present in about 5% of the cases. It can look
and from the beginning grows deeper into the skin, which makes it more
dangerous than the other types.
A melanoma type on hands
or feet is called acro-lentiginous
It can start under a nail
or hide between fingers or toes and therfore is sometimes misdiagnosed
as fungal infection or wart for some time and is left growing. This
This melanoma type is rare
but is the most common type in persons with dark coloured skin.
To diagnose a melanoma is
not always simple and often a dermatoscope is being used
to get deeper insight into
the pigment structure of a skin tumor.
There are also some computer
systems in use that offer image analysis as a second expert oppinion
for correct melanoma recognition. There are several ways to find
out what a pigment spot is, but some doubt is left with a precision
of 95% in expert physicians. That means an uncertanty
of one case in 20.
So, if there is a doubt, a pigment spot should better
be taken out.
Known risk factors to develope
- fair coloured skin with,
freckles and red coloured hair,
- easy sun burn
- persons with numerous
moles, adults with more than 50 moles,
- severe sun burns in childhood,
- melanoma in first degree
Standard treatment is surgical
removal of the
suspicious spot soon in
local anaesthesia. For melanomas there are
safty margins around the
melanoma known to be necessary, depending on
the thickness of the melanoma,
which is expressed in the tissue
analysis later. This makes
a second excicion necessary in case of an unexpected melanoma,
according to the known guidelines
in your country.
if it is clear
it is a melanoma and it is assumed to be less than
2mm thick, it can be removed at once with 1cm safty margin. (valid for
For precursor melanomas
(in-situ melanomas) 0.5cm is necessary.
For melanomas up to 2mm tumor thickness 1cm margin is needed.
For melanomas with more
than 2mm thickness 2cm safety margin is recommended.
For melanomas with more
than 1mm thickness also the removal and examination
of the sentinel lymph node is recommended, to be able to give an accurate
and decide, if more treatment options are applicable.
In more advanced cases an adjuvant treatment with interferon or other
chemotherapy modalities sometimes are considered, but this is
not a gereral rule and needs an expert doctor
or clinic as a reference
for the patient.
As for melanomas with less
than 1mm thickness metastazation is very unlikely,
up the full examination
of the skin and of all moles is what is recommended twice a year
in the first 5 years, after that once a year.
With tumor thickness above
1mm besides sentinel lymph node removal ultrasound of local
lymph nodes, chest x-ray and some blood tests are recommended:
AP and S100.
More details can be found in the national guidelines .