Skin cancer FAQ: What are the risks and what signs should I see a doctor about?

Within two decades, the number of hospital treatments for skin cancer has nearly doubled. This is reported by the Federal Statistical Office (Destatis) . Most of those affected suffer from what is known as non-melanoma skin cancer. What is it? And what are the risk factors? An overview of the disease, prevention, and diagnostics.

The number of hospital treatments for skin cancer has increased dramatically over the past two decades. While there were approximately 62,000 inpatient treatments in 2003, the number rose to 116,900 in 2023. This represents an almost 88 percent increase in cases, according to Destatis .

In particular, treatments for so-called non-melanoma skin cancer increased. They more than doubled within 20 years: from 41,900 cases in 2003 to 91,000 in 2023 (an increase of 117 percent).

In 2023, there were around 26,000 inpatient treatments for so-called melanoma, a good quarter (27 percent) more than in 2003.

Men are more frequently affected than women, according to Destatis. They recently accounted for 56 percent of inpatient treatments for skin cancer, compared to only 48 percent of all hospital treatments overall. The number of deaths from skin cancer also increased, according to statisticians: In 2023, around 4,500 people were recorded as having died of skin cancer, almost 61 percent more than in 2003 (2,800 deaths).

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More than half (53 percent) of those who died of skin cancer in 2023 were aged 80 or older. Relatively speaking, however, the risk of dying from skin cancer was highest in the 30- to 34-year-old age group. Among them, skin cancer was the cause of death in 1 percent of deaths, while the proportion across all age groups was only 0.4 percent, according to the statisticians.

The German Cancer Society's website states that the incidence rates for men and women are expected to double in the next 20 to 30 years. "So far, there is no evidence that this trend has been stopped."

According to experts, a significant part of the increase is due to demographic changes in society. "We have an aging population, and skin cancer occurs primarily in older people," dermatologist Jochen Utikal of the German Cancer Research Center (DKFZ) recently explained. However, there are also many younger patients with melanoma.

The skin damage we see today is often related to damage in the 1970s and 1980s. Back then, people paid less attention to sun protection. Furthermore, the sunscreen filters weren't as effective, says Utikal. Severe sunburns among children and adolescents during this time could therefore be the reason why people in their 50s and 60s today are particularly affected by melanoma.

A doctor examines a patient's skin area in the practice.

Source: Peter Kneffel/dpa

According to the Barmer health insurance company, another factor contributing to the increase is that since 2008, insured persons have been entitled to early detection screening for skin cancer starting at the age of 35. This means that the disease is less likely to be overlooked than before.

According to the German Cancer Aid, the most common form of skin cancer is non-melanoma skin cancer, which is a basal cell or squamous cell carcinoma. It very rarely metastasizes and is curable in the vast majority of cases. Life expectancy is barely reduced. More dangerous is malignant black skin cancer, also known as malignant melanoma. This can metastasize, meaning the cancer can spread to other organs. It can then be fatal. How long one can live with it depends, among other things, on the stage at which the cancer is discovered and how aggressive the cancer cells are.

Malignant melanomas are usually dark or black spots, but their appearance can vary. They can be flat, raised, or lumpy. Basal cell carcinoma initially looks like a small, porcelain-like pimple with tiny blood vessels visible on its surface. As the disease progresses, the surface sinks in the center, forming a depression with a wall-like edge. Bleeding can occur repeatedly there.

The most reliable way to detect skin cancer is through an examination by a dermatologist. A screening is free every two years for all those with statutory health insurance over the age of 35. Furthermore, examinations by a dermatologist for any unusual skin changes are covered by statutory insurance at any time. The so-called "ABCDE rule" can help classify skin abnormalities:

• A for asymmetric: The spot on the skin is irregularly shaped.
• B for boundary: The spot is not clearly defined, the outer line is blurred
• C for Color: The stain has multiple shades.
• D for diameter: More than three to five millimeters.
• E for raised: The spot rises above the skin level.

The most significant risk factor for almost all types of skin cancer is UV radiation from the sun. Even weak UV rays that don't cause sunburn cause long-term skin damage. According to the German Cancer Aid, the decisive factor is the number of moles acquired after birth. Sunburns in childhood and adolescence increase the risk of skin cancer by two to three times.

Genetic predispositions also play a role: People with fair skin, reddish or blond hair, freckles, and sunburn spots have a higher risk of developing skin cancer. There also appears to be a certain genetic predisposition: If a family member has already been diagnosed with skin cancer, there is a statistically increased likelihood of developing skin cancer themselves.

Visits to a tanning bed also significantly increase the risk of skin cancer. According to the World Health Organization (WHO), artificial UV radiation from tanning salons, like the sun's natural UV radiation, is a particularly cancer-causing factor. Health experts consider UV radiation to be as risky as tobacco and asbestos. The WHO advises against visiting a tanning bed, especially for people with fair skin types. Tanning salons are also prohibited by law for those under 18.

The line between moles and skin cancer is fluid. "If anything seems suspicious to you or you doubt whether a mole is benign, consult a doctor you trust," advises the German Cancer Aid, "preferably immediately." In any case, those affected should see a doctor if they have an above-average number of moles. If they change in shape, color, or size, this should also be investigated.

The doctor will examine the skin thoroughly. Suspicious tissue will be examined under a microscope. Blood tests will provide information about the patient's general condition. If there is a specific suspicion, ultrasound examinations may be performed to determine whether metastases have formed in lymph nodes or other organs.

In most cases, non-melanoma skin cancer is removed surgically, but can also be treated with radiation or medication. Melanoma skin cancer is also removed surgically. Depending on whether and how far the cancer has spread, additional treatments may be necessary: ​​radiation therapy, immunotherapy, or local therapy. Follow-up care and regular checkups are important in all cases, as skin cancer can recur.

With material from dpa

This text was first published on November 3, 2022 and has been updated.