We know how dangerous the sun can become to our skin. Especially the Celtic skin types with light skin have a high risk of skin cancer. But also the so-called European type should not expose themselves to sunlight too much. But genetic predispositions can also forster skin cancer. Dr. Martin Schomaker is a senior physician at the Vivantes Skin Tumor Center in Spandau and, as a proven expert, he operates on skin tumors every day.
What types of skin cancer do you deal with?
Dr. Martin Schomaker: By far the most dangerous is malignant melanoma, there are also basal cell carcinoma and spinaliom. The latter occurs mainly on the so-called "sun terraces", i.e. skin areas that are particularly exposed to the sun, such as the lower lip, the ear or the nose.
Why is malignant melanoma so dangerous?
Malignant melanoma can lead to death because it sends metastases, for example to the liver, lungs, bones, or brain. Skin cancer is more common today than it used to be, but it is less likely to be fatal. In the meantime, people are better informed, the cancer is detected earlier, also through preventive screenings, there are drugs that can stop the spread of a tumor – nevertheless, there are no cure guarantees.
Can a developing skin cancer be detected even as a non-professional?
Yes, if moles change within a few months, you should have it clarified. There can be various changes: black spots form, it bleeds, the birthmark grows, or the edges change, it becomes darker, increases in volume, begins to itch – or even disappears completely.
How do you proceed when a patient with malignant melanoma comes to you?
Patients either come to us pre-operated by a practicing dermatologist, surgeon or family doctor who has already had the tissue samples examined, or are operated on at our clinic. The complete, close excision of the suspicious mole is called an excision biopsy.
What happens to this narrowly excised tissue?
We send it to our pathology department, where a histological report is made. After that, we know if it is indeed a skin cancer and how deep it has already penetrated into the tissue, i.e. how "thick" it is.
What does it mean if the skin cancer is "thin" or "thick"?
If it is thin, i.e. less than one millimeter in size, it is usually not that advanced, and for further diagnosis of spread (staging), clinical examination and lymph node sonography are sufficient, and the melanoma is then re-cut with a safety margin of one centimeter. However, if it is more advanced, a more extensive spread diagnosis is performed. This includes examinations such as a full-body CT, a cranial MRI and a so-called shield guard lymph node biopsy in which the lymph node downstream of the melanoma is also removed. The safety margin for post-excision of thicker melanomas is then always two centimeters.
What results are obtained by this "staging"?
It is possible to find out whether the tumor has already spread and formed metastases in other organs. The patient is then presented at an interdisciplinary tumor conference. There, specialists from other fields discuss whether a particular metastasis can be surgically removed or whether other modern therapies should be used.
What treatment options are available if surgery is not possible?
In addition to immunotherapy, in which tumors are fought with the help of the patient's own immune system, we also offer targeted therapy, which inhibits the growth of the tumor, as well as the well-known chemotherapy and, of course, all modern radiological therapies. These therapies are also often used adjuvantly, i.e. as a supportive measure, if there are currently no metastases, but the patient has an increased likelihood of metastasis due to the thickness of the tumor.
How many operations do you perform per year?
Basal cell carcinoma is operated on most frequently (about 600 times a year), spinaliom about 400 times and malignant melanoma 200 to 250 times.
The treatment is interdisciplinary, is it performed in the oncology department?
As a skin tumor center and thus oncological dermatology, we have been certified by the German Cancer Society and perform the entire spectrum of necessary operations and treatments here in the clinic and in close cooperation with our internal oncologists. Starting with the operations, through systemic therapy to aftercare. In a holistic approach, however, we accompany the patients psycho-oncologically, socio-medically as well as palliatively.