Skin Cancer Screening & Early Detection

Overview

Three main forms of skin cancer are distinguished: basal cell carcinoma and squamous cell carcinoma (together known as light-coloured skin cancer) as well as malignant melanoma (black skin cancer). Skin cancer – and malignant melanoma in particular – is increasing markedly worldwide. Frequent sunburns, cases of skin cancer within one's own family and a large number of pigmented moles (naevi) additionally raise the risk.

When skin cancer is detected early, it is in many cases readily treatable and curable. The key to this is regular – usually annual – preventive and follow-up examinations, which are especially important to us in our practice. If a skin cancer has already been diagnosed, regular follow-up examinations are important alongside treatment.

The most effective protection is prevention. Children in particular need consistent sun protection – infants in their first year of life should, if possible, not be exposed to direct sunlight at all. In adults the so-called sun terraces are particularly at risk, that is, areas with intense UV exposure such as the bridge of the nose, ears, lips, chin, shoulders, back, the tops of the feet and – in the case of balding – the scalp.

Areas of application

• Annual skin cancer screening in adulthood – possibly more frequently if the risk is increased
• Many or conspicuous pigmented moles (naevi)
• Cases of skin cancer within one's own family
• Fair skin type, frequent sunburns in the past, intensive use of UV light or tanning beds
• New, growing or changing skin lesions
• Monitoring the course of known moles (mole atlas)
• Follow-up after previously treated skin cancer

Procedure

1. Medical history and whole-body inspection

   First we discuss your medical history and possible risk factors. We then systematically examine the entire skin – including areas that are difficult to see.

2. Computer-assisted mole mapping (FotoFinder®)

   Using the FotoFinder® system, which is based on digital incident-light microscopy (epiluminescence), we create an individual whole-body mole atlas where appropriate. The medicam 1000s delivers micro-images at up to 400-fold magnification; the Moleanalyzer pro® displays colour, borders, symmetry and structure and supports the assessment with an artificial intelligence developed at the universities of Tübingen and Heidelberg. In this way, conspicuous changes can be detected early and their course compared objectively.

3. 20-MHz ultrasound (high-resolution sonography)

   20-MHz sonography is an imaging, non-invasive procedure with very high resolution. It depicts the skin and underlying structures in detail and is particularly valuable for measuring tumour thickness before an operation and thus for treatment planning.

4. Electrical impedance spectroscopy (Nevisense®)

   If uncertainty remains regarding a mole, electrical impedance spectroscopy, developed at the Karolinska Institute in Stockholm, can be used as a supplement. It measures, almost painlessly and without drawing blood, how the tissue conducts electrical signals – healthy and altered tissue behave differently. The result is provided on a scale from 0 to 10 and supports the medical decision with objective additional information.

5. Discussion of findings and recommendation

   From the combination of procedures we work out the next steps together with you – from simple monitoring through to a recommended removal with histological examination. The aim is the most reliable assessment possible with as few unnecessary procedures as possible.

What to expect

• All of the examinations mentioned are non-invasive and usually low-pain.
• The result of impedance spectroscopy (Nevisense®) is usually available within about 10 minutes.
• Nevisense® can also be used during pregnancy and on darker skin types.
• The mole atlas that has been created allows an objective comparison over time at follow-up appointments.
• The recommended interval is usually once a year – in the case of an increased risk or after a skin cancer, possibly at shorter intervals.
• Statutory skin cancer screening is usually covered by the statutory health insurers from the age of 35 every two years; the supplementary procedures (FotoFinder® mapping, high-resolution ultrasound, Nevisense®) are usually self-pay or IGeL services – we will discuss the framework with you in advance.

Risks & notes

• The preventive examinations themselves are non-invasive and carry no notable risks.
• No diagnostic procedure offers 100-per-cent certainty – which is why we combine several methods and recommend regular check-ups.
• If a conspicuous finding arises, surgical removal with subsequent fine-tissue (histological) examination may be necessary in order to establish a reliable diagnosis.
• Self-examination at home is a sensible supplement but does not replace the medical examination.
• The computer- or AI-assisted evaluation serves solely to support the medical decision and does not replace the physician's assessment.

10 golden sun rules

If you expose yourself to the sun, please observe the following recommendations:

• Avoid any reddening of the skin.
• Wear sun-tight clothing (textile sun protection).
• Protect all uncovered parts of the body with a sufficient sunscreen (at least SPF 30).
• During the first days of your holiday, stay in the shade in particular.
• Apply sunscreen about 30 minutes before sunbathing.
• Avoid the midday sun and give your skin breaks.
• When bathing, use water-resistant sunscreens.
• Watch out for photosensitising medicines if you take medication regularly.
• In the sun, avoid perfumed products (perfume, fragranced cosmetics) – their fragrances can, in combination with UV light, encourage pigment spots.
• Wear sunglasses to protect your eyes as well.

Self-examination: the ABCDE rule

You can keep an eye on suspicious pigmented moles yourself between appointments using the ABCDE rule:

• A – Asymmetry: the mole has an irregular shape.
• B – Border: the edges are blurred or appear to have run.
• C – Colour: irregular colouring with light and dark, sometimes deep-black tones.
• D – Diameter: the mole is larger than 6 mm.
• E – Evolution: the mole changes over time (size, shape, colour, elevation) or begins to itch or bleed.

When you should see a dermatologist promptly

Have the following changes assessed by a physician quickly:

• bleeding of a skin lesion
• itching
• a rough, sandpaper-like surface
• new or increasing localised discolouration
• rapid change in size, shape or colour

Frequently asked questions

How often should I have a skin cancer screening?

Usually once a year. In the case of an increased risk – for example many moles, a fair skin type, skin cancer in the family or after a previously treated skin cancer – shorter intervals may be sensible. We determine the appropriate interval with you individually.

Is the examination painful?

No. The inspection, the mole mapping (FotoFinder®), the 20-MHz ultrasound and the impedance spectroscopy (Nevisense®) are all non-invasive and usually low-pain. With Nevisense® you merely feel the contact of the sensor on the skin.

What do FotoFinder® and Nevisense® offer compared with mere visual inspection?

They provide objective additional information: high magnification, AI-assisted assessment and, when monitoring the course, an exact comparison over time. This helps to detect conspicuous changes early and at the same time to avoid unnecessary operations.

What is the ABCDE rule?

A simple memory aid for the self-examination of moles: Asymmetry, Border, Colour, Diameter and Evolution (change over time). It does not replace medical screening, but it helps you to notice changes between appointments.

Is screening also possible during pregnancy or on dark skin?

Yes. The procedures are suitable for this; impedance spectroscopy (Nevisense®) can expressly also be used during pregnancy and on darker skin types.