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If benign or malignant skin changes require surgery, dermatosurgery offers the right treatment.
Gentle treatment is particularly important for skin changes caused by UV rays on the face or other aesthetically sensitive areas.
Our experienced specialists in dermatology and plastic surgery work hand in hand to precisely recognise skin changes, remove them using the latest procedures to preserve the tissue and treat any skin cancer effectively and comprehensively.
Regular self-examinations of the skin are important in order to notice changes such as new growths, changes in the colour or shape of moles, unusual skin lesions or other suspicious skin changes. Ideally, these examinations should be carried out every few months.
ABCD rule
This rule can be helpful in the assessment of moles:
Photographic documentation
Regular photography of moles or suspicious skin changes can help to recognise changes over time.
Skin screening by a dermatologist
Regular skin examinations by a dermatologist are very important for people with an increased risk of skin cancer, such as those with more than 100 moles. The dermatologist can examine suspicious skin lesions more closely and perform biopsies if necessary.
Depending on the initial situation, various methods are used to diagnose skin cancer.
Medical history and physical examination
The doctor will first take a detailed medical history to gather information about your medical history, symptoms and possible risk factors for skin cancer. A thorough physical examination will then be carried out, during which the doctor will examine your skin for signs of skin cancer.
Dermatoscopy
In this procedure, the dermatologist uses a dermatoscope, a special handheld device with a magnifying function and polarised light, to examine moles and skin lesions in more detail. This enables the doctor to look at structures under the surface of the skin and recognise suspicious features.
Biopsy
If the doctor identifies a suspicious lesion, a tissue sample (biopsy) can be taken to be analysed in the laboratory. There are different types of skin biopsies, including excisional biopsy, punch biopsy and peel biopsy. The type of biopsy depends on the size and location of the lesion. The biopsy enables the pathologist to examine the tissue under the microscope and determine whether it is skin cancer and, if so, what type.
Molecular diagnostics
In some cases, the doctor may use molecular diagnostic tests to determine the risk of skin cancer or the presence of certain gene mutations associated with skin cancer.
Imaging techniques
In advanced cases or if the cancer is suspected to have spread, imaging techniques such as CT scans, MRI scans or PET scans may be used to assess the extent of the cancer and detect metastases.
The diagnosis of skin cancer often requires a combination of these diagnostic procedures. Once the skin cancer has been diagnosed, the doctor will recommend an appropriate treatment plan, which may vary depending on the type and stage of the cancer.
The different types of skin cancer are distinguished by their appearance, aggressiveness and treatment options.
Melanoma, also known as malignant melanoma, is the most aggressive form of all skin cancers. It develops in the melanocytes, the pigment-forming cells of the skin that are responsible for the production of melanin and therefore for the tanning of the skin. In the case of melanoma, these cells degenerate and multiply uncontrollably. Although melanomas most commonly occur on the skin, in rare cases they can also develop on mucous membranes or in the eye.
Melanoma is the fourth most common type of cancer in Switzerland. Every year, around 33 out of 100,000 people in Switzerland are newly diagnosed with this form of skin cancer, which amounts to a total of around 3,000 new cases per year. The number of melanoma cases is also rising steadily worldwide.
In over 80% of cases, melanoma can be successfully treated with surgery. However, in around 15% of those affected, the tumour can form metastases in other organs, leading to potentially life-threatening situations.
Cancer cells spread when they enter the lymph nodes or internal organs via the lymphatic or blood vessels and form new tumours there. The risk of such spread depends primarily on the thickness of the melanoma: the thicker the melanoma (measured by the depth of penetration), the more likely it is to metastasise. Early treatment of melanoma increases the chances of a cure, as the tumour is then usually smaller and less deep, which improves the chances of survival.
The primary cause for the development of melanoma is UV radiation, to which people are exposed both through direct sunlight and by visiting sunbeds. There is an increased risk of melanoma for people who:
● have more than 100 moles or liver spots on their skin or have a light skin type (type I-II) = reddish-blonde hair, blue eyes or freckles
● have a family history of melanoma,
● have a weakened immune defence, for example after an organ transplant or due to a disease such as HIV
● have previously been diagnosed with melanoma
● have suffered severe sunburns (especially as a child or adolescent)
Your own skin should be checked regularly for changes. Areas such as the hairy scalp, the back of the ears, the neck and the genital region must also be taken into account - possibly with the help of a mirror.
It is particularly advisable for people with a light skin type and many moles to check for conspicuous skin changes themselves every three months. If you are unsure, you should consult a doctor.
This is a general guideline for the assessment of moles, which should be checked more closely and presented to a doctor if necessary:
Moles that show changes in shape, colour or size should be examined immediately by a dermatologist. This also applies to moles that are different from others, itch or bleed in the event of minor injuries.
Suspicious moles or skin spots are usually completely removed under local anaesthetic (excision biopsy). This is followed by a microscopic examination of the tissue (histology).
When a melanoma is diagnosed, additional examinations such as an ultrasound of the lymph nodes or a whole-body examination using PET-CT (positron emission tomography / computer tomography) are carried out, depending on the depth of penetration.
The lymph node drainage is often also checked and the sentinel lymph node surgically removed. This enables the identification of small metastases and, if necessary, the recommendation of further treatment.
Your doctor will discuss the necessary examinations with you individually.
The treatment of melanoma depends primarily on the depth of penetration of the tumour.
In patients with high-risk melanomas, where the tumour has been completely removed, there is still a certain risk of the melanoma recurring. In such cases, the aim of therapy is to achieve a long-term cure through preventive measures, which is known as adjuvant therapy.
For patients with metastases in the organs, a complete cure is no longer possible in many cases. At this stage, therapy is focussed on slowing down the progression of the disease and improving quality of life. Even at this advanced stage, the disease can often be stabilised for years. This approach is known as palliative therapy.
Neoadjuvant therapy
If there is only one (or a few) surgically removable metastases, immunotherapy can be carried out prior to surgery. This procedure provides information on the long-term outcome and improves the chance of cure. In this case, careful co-operation between dermatologists, surgeons and pathologists is important.
The mainstays of melanoma treatment are surgical procedures, drug therapies and radiotherapy.
Surgery
A newly discovered melanoma must be completely removed immediately. Depending on the depth of penetration of the tumour into the skin, different safety margins are required. A sentinel lymph node biopsy is also recommended for certain tumour thicknesses.
Drug therapy
The drug treatment of melanoma has made significant progress in recent years. Effective drugs are now available.
Recent findings have shown that drug therapies can also be used preventively. Both immunotherapeutics and kinase inhibitors are used for this purpose. The duration of preventive therapy is usually one year.
Radiotherapy
Radiotherapy can be an effective treatment option for some tumours. Early stages of melanoma or superficial skin metastases can be treated in dermatology with marginal radiation.
In radiation oncology, higher-energy beams are used to target inaccessible parts of melanoma, such as bone or brain metastases. This method is known as stereotactic radiotherapy.
Immunotherapy
This modern form of therapy aims to activate the patient's own immune cells so that they can specifically fight the cancer cells. Various active substances are also used in combination as required.
Around 40 % of patients achieve a lasting effect with this form of therapy. The combination of several immunotherapies is increasingly being used to increase effectiveness.
Targeted therapy with kinase inhibitors
This therapy attacks specific genetic changes in the tumour in order to stop its growth or cause the tumour to shrink completely. The prerequisite for the use of these drugs is the presence of certain genetic mutations, which are examined in advance in a specialised laboratory.
Injection with TVEC
A specially modified herpes virus is injected directly into the tumour. The virus is modified in such a way that it kills tumour cells directly and at the same time attracts the body's own defence cells. This means that tumour metastases that have not been treated directly can also be affected.
Chemotherapy
Chemotherapy uses cytotoxins to combat the tumour. Today, chemotherapy is often no longer considered the first choice for melanoma, although it is still used in certain cases.
Regular follow-up checks with a dermatologist are essential for melanoma patients in order to determine at an early stage whether metastases have formed or a new melanoma has appeared.
Depending on the severity of the disease, your doctor will determine the appropriate period for the check-ups and decide which additional examinations, such as ultrasound, X-rays or laboratory tests, are required.
Personalised melanoma treatment
There is no universal treatment for melanoma. That is why we develop a customised treatment concept for every patient. Our comprehensive range of services includes all treatment options for melanoma. We have our own surgical department, a day clinic for infusion treatments and TVEC treatments.
Comprehensive care
Our range of services covers the entire spectrum from tumour screening and diagnosis to aftercare and treatment of metastatic melanoma. Our facilities also include a specialised ward.
Tumour prevention and early detection
Our aim is to detect skin cancer at the earliest possible and most treatable stages. Our services include dermoscopy, computer-aided follow-up, whole-body photography and confocal microscopy.
Tumour diagnostics and treatment
We use the latest imaging techniques and work closely with our colleagues in radiology and nuclear medicine. Tissue samples, such as skin and lymph node samples, are analysed according to the latest standards.
Sentinel lymph node biopsy
The histological examination of the sentinel lymph node is carried out professionally by us. Firstly, a second examination of the original melanoma is carried out. The sentinel operation is performed by experienced surgeons at the same time as the re-excision so as not to impair the lymphatic drainage and to identify the correct lymph node. The fine tissue analysis of the sentinel lymph node is then compared with the tissue of the primary melanoma.
Tumour board
Our skin tumour board takes place once a week, bringing together all specialists involved in melanoma - including dermatologists, ENT specialists, plastic surgeons, neurosurgeons, oncologists and radiation oncologists. Other specialist disciplines are also consulted if necessary. This enables complex problems to be discussed quickly and effectively and treatment to be provided in accordance with the latest international standards.
