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.
Skin cancer
Skin cancer is one of the most common types of cancer - and is usually caused by too much UV radiation from the sun or solarium. It often develops gradually and goes unnoticed for a long time, but can be treated very effectively if detected early.
There are different types of skin cancer: basal cell cancer (basal cell carcinoma), squamous cell cancer (spinalioma) and malignant melanoma (black skin cancer). It is therefore important to monitor your own skin regularly and look out for new or changing spots, moles or non-healing 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.
Black skin cancer
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.
The following symptoms can be an indication of melanoma:
- Dynamic changes: new growths, discolouration, bleeding or changes to existing moles, skin patches or warts can be the first sign of skin cancer.
- Asymmetrical shape: An irregular shape or asymmetrical appearance of moles or skin lesions.
- Irregular borders: The borders of a mole or skin lesion may be uneven, frayed or unclear.
- Changes in colour: Changes in the colour of a mole or skin lesion, especially dark patches or different colouring within the same area.
- Size: An increase in the size of an existing mole or skin lesion may be an indication of skin cancer.
- Itching or pain: Moles or skin lesions that itch, hurt, bleed or flake may indicate skin cancer.
- Sores that do not heal: Sores or lesions that do not heal within a reasonable amount of time could be a sign of skin cancer.
- Changes in texture: Changes in the texture of the skin, such as roughness or thickening, may indicate skin cancer.
Frequently asked questions & answers
How often are people diagnosed with melanoma?
How dangerous is melanoma?
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.
What are the most common causes or risk factors of melanoma?
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)
How is melanoma treated?
The treatment of melanoma depends primarily on the depth of penetration of the tumour.
- In most cases, thin melanomas without metastases can be cured by surgery.
- However, if the melanoma has already penetrated deeper into the skin or small foci of melanoma have been discovered in the lymph nodes, it is categorised as a high-risk melanoma. Although such melanomas have not yet metastasised to distant organs, they carry an increased risk of doing so.
- If the melanoma has already spread to other organs, it is referred to as metastasised melanoma.
Which treatment strategies are used?
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.
What are the most important pillars of melanoma treatment?
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.
How important are follow-up checks?
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.
Why book a consultation with us?
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.
White skin cancer
White skin cancer mainly comprises basal cell carcinoma and squamous cell carcinoma. Compared to black skin cancer (melanoma), white skin cancer usually grows slowly and rarely metastasises, but can progress locally and damage tissue if left untreated. Early detection is therefore important.
The main cause of white skin cancer is UV radiation, particularly through long-term exposure to the sun. Other risk factors are
- Light-coloured skin type
- Frequent sunburns, especially during childhood
- genetic predisposition
- certain skin changes or scars
- immunosuppression
Typical signs can be
- reddish or skin-coloured nodules that grow slowly
- scaly or keratinised areas
- small open wounds that do not heal
- thickened or hardened areas, especially on the face, neck, hands or arms
What should patients be aware of?
New or changing skin areas should be checked by a dermatologist as soon as possible. People with risk factors should have regular skin checks to ensure early detection.
How is skin cancer diagnosed?
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 (histology) 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.
When diagnosing a melanoma, 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 invasion.
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 diagnosis of skin cancer often requires a combination of these diagnostic procedures. Once the skin cancer has been diagnosed, the doctor will recommend a suitable treatment plan, which may vary depending on the type and stage of the cancer.
What treatment options are available?
Treatment depends on the type, size, location and aggressiveness of the tumour:
- Surgical removal: standard for most tumours, complete removal with control of the edges
- Photodynamic therapy (PDT): for skin cancer precursors, superficial basal cell carcinomas, only after specialist clarification
- Drug treatment: topical creams or systemic therapies for special cases
- Aftercare: Regular check-ups for early detection of recurrences or new tumours
Reconstruction
Sometimes a larger area needs to be reconstructed after tumour surgery. The use of reconstructive plastic surgery after skin cancer removal is a crucial aspect of comprehensive cancer treatment. Together with the dermatologists and reconstructive surgeons in our team, we offer a multidisciplinary skin cancer treatment that restores the functionality and appearance of the affected area in addition to the complete removal of cancer cells.
Why is a specialist check-up so important?
Specialists in dermatology can:
- correctly assess the skin change
- select the appropriate therapy
- ensure complete removal
- plan long-term aftercare
The examination also protects against the risks of cosmetic or laser treatments, as potentially malignant changes are recognised at an early stage.
