© Anna Tarazevich
Healing chances for white skin cancer and its precursor stages are generally very good for treatment and curable nowadays.
February 3, 2025
Christine Bürg
The specialty of dermatologists Dr. Annette Zimpfer-Keese and Dr. Christine Zimpfer is dermato-oncology. In the interview, the two doctors explain what types of skin cancer exist, how to detect them early, how to protect oneself from them, and how to treat them.
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Dermato-oncology is a specialty that is becoming increasingly important. Because skin cancer is one of the most common types of cancer. The dermatologists and nurses Dr. Christine Zimpfer and Dr. Anette Zimpfer-Keese jointly run an owner-managed MVZ in Mannheim and have specialized in dermato-oncology.
Around 450,000 people in Germany are diagnosed with a form of skin cancer every year. Trend increasing. What is the reason for this? Actually, people are much more informed today about the dangers.
Dr. Annette Zimpfer-Keese:The increasing incidence of skin cancer cases in Germany is due to various causes. Demographic change with increasing life expectancy, environmental influences, genetic predisposition, lack of sun protection during sun exposure among young people, solarium visits and other causes are factors that promote skin cancer.
Skin cancer often occurs without symptoms and is therefore only noticed at a late stage. Although people are better informed today about the dangers of skin cancer, there are still many who do not protect themselves adequately from UV radiation either privately or at work.
Black skin cancer is extremely aggressive and dangerous. Why?
Dr. Annette Zimpfer-Keese:Black skin cancer is the most aggressive form among skin tumors and develops from the pigment-producing cells (known as melanocytes) of the skin. Black skin cancer is also known as malignant melanoma.
Black skin cancer can spread unnoticed without symptoms through the blood and lymphatic system in the body. The spread of the melanoma in the bodyis also called metastasis and can affect and destroy other body tissues and organs.
In the advanced stage of melanoma, metastases can spread through the skin, lymph system, lungs, brain, liver, and bones.
This is why the early detection of black skin cancer is so important, so that it cannot spread in the body and the chance of cure is given through early detection.
What are the chances of cure or treatment options for melanoma? Are there any new developments?
Dr. Annette Zimpfer-Keese:The art is to discover and remove an early form of melanoma that has not yet spread - then you can really help people. This means that early detection and complete surgical removal definitely offers a chance of cure.
There are now also tumor-specific vaccination strategies
We select the treatment options according to the stages of the disease. The development of new immunotherapies and targeted therapies has significantly improved the chances of cure for advanced malignant melanoma. There are now also tumor-specific vaccination strategies that are promising.
Certified cooperating skin tumor centers support us on an outpatient basis in providing high-quality care to our patients, in order to offer them the latest therapy options.
Fortunately, there is now a better prognosis and chance of cure for metastatic patients due to new treatment options.
White skin cancer (basal cell carcinoma and squamous cell carcinoma) is much more common than black skin cancer. Older people are more affected than younger ones. Why?
Dr. Christine Zimpfer:White skin cancer is a collective term for various types of skin cancer. There are two types of white skin cancer, the basal cell carcinoma, also known as basal cell carcinoma, and the squamous cell carcinoma, also called squamous cell carcinoma.
Both types are less aggressive than melanoma and very rarely form metastases, so-called secondary tumors. However, basal cell carcinoma is the most common form.
There are 2 skin types of white skin cancer
The causes and risk factors include, on the one hand, intensive UV radiation exposure over the course of one's life from the sun or artificial radiation exposure from visits to tanning salons in the past.
Furthermore, the predisposition of a person's skin type also plays a role, so the fair skin type with blue eyes, freckles, and reddish hair is much more susceptible to sunburns and later skin damage.
Many sunburns in youth and, of course, not to forget the leisure activities in certain sports. Tennis, golf, sailing... one or the other profession outdoors and frequent vacations in the high mountains or by the sea in the past.
Older people are more affected because they have spent more time in the sun over the course of their lives and have been exposed to intensive UV radiation and have experienced one or the other sunburn in their lives.
It is important to pay attention to adequate sun protection even in advanced age.
In addition, the skin's ability to regenerate decreases with age, which increases the risk of skin cancer. It should also not be forgotten that with the current state of medicine, we are living longer than in the past.
It is therefore important to pay attention to adequate sun protection even in advanced age and to have regular skin cancer screenings.
In summary, it can be said: It all depends on the lifelong intense UV exposure or sunbathing. Because: The skin does not forget.
How can you recognize white skin cancer and what are the chances of recovery?
Dr. Christine Zimpfer: Of course, we see many skin cancer diseases in our specialized dermatology-oncology practice, as well as their precursors, but most often precursors of white skin cancer.
It must be explained to patients that this is a chronic sun damage to the skin that has developed over decades of UV light exposure to the skin, but does not yet represent a tumor.
The most common type of skin cancer is basal cell carcinoma, also known as basal cell carcinoma, followed by the second most common skin cancer tumor: squamous cell carcinoma, also known as squamous cell carcinoma.
White skin cancer can be versatile and preferably occurs in the facial area, often showing a pearly – skin-colored nodule or a nodule that bleeds and ulcerates or even a non-healing small wound lesion with crusting. If a skin lesion does not heal, please see a doctor.
In the precursors of white skin cancer, actinic keratoses, reddish/brownish scaly skin lesions rather like eczema form preferentially in the facial area. It feels rough and scaly.
White skin cancer develops preferentially in the facial area
White skin cancer and its precursors are usually very treatable these days. Optimal early diagnosis should take place, i.e. recognize quickly and early. Both tumors can be cured today through complete surgical rehabilitation.
In recent years, PDT treatment has become established in precursors, actinic keratoses, which is a non-invasive local light therapy without surgery. In our practice, this novel method is carried out with great success.
Why is skin cancer screening so important? What should it ideally look like – keyword AI diagnostics?
Dr. Annette Zimpfer-Keese:Regular skin cancer screenings can help detect suspicious skin lesions early, remove them, and thus prevent the development of skin cancer.
Ideally, skin cancer screenings should consist of a thorough dermoscopic examination of the skin by a dermatologist, combined with digital dermoscopic imaging diagnostics.
This digital diagnostic is regularly used in our skin cancer screening to support detecting and analyzing irregularities or minor changes early, even during follow-up checks. This way, we can identify suspicious lesions more quickly.
In our skin center specializing in dermato-oncology, over 63,000 digital dermoscopic examinations have been conducted in the last 10 years.
In addition to this diagnostic, other modern AI technologies now support us in the practice to avoid unnecessary surgeries, improve the accuracy of diagnoses in the future, and optimize patient care.
How often should you get a skin screening? Who covers the costs?
Dr. Christine Zimpfer:A skin cancer screening should be conducted once a year, especially if there is an increased risk of skin cancer. For example, due to family history, many sunburns in childhood and adolescence, past solarium visits, occupations that are predominantly carried out outdoors, fair skin type, or many moles on the body.
From the age of 35, all those with statutory health insurance are entitled to skin cancer screening every 2 years. Even younger patients may have skin cancer screening covered by the insurance, but this varies depending on the insurance. We recommend clarifying this personally with your insurance company.
A skin cancer screening should generally be done once a year.
However, there are also patient cases where it is medically advisable to have a skin check every six months, although this must be paid for by the patient as a self-paying service.The costs can vary depending on the federal state.
The sun is important for us - on the one hand, because it is good for the psyche, but above all for the production of vitamin D (bone health, protection against colon cancer). A dilemma. What do you advise here?
Dr. Christine Zimpfer:It is indeed a dilemma because the sun can have both positive and negative effects. We need sunlight for a part of our health, namely for vitamin D production.
Vitamin D is an essential vitamin and nowadays widely discussed.We need vitamin D to maintain our bones, it plays a role in the immune system, and at the same time, it regulates important metabolic programs in our body.
We need sunlight for vitamin D production
In adults, a deficiency can lead to osteoporosis. We also know today that a deficiency can cause colon cancer. The body is not able to produce vitamin D on its own, only a small portion is absorbed through our diet.
What is still not widely known among the public is that it is, for example, sufficient to take a sunbath three times a week with the face, hands, and both forearms for about 15-20 minutes to stimulate vitamin D production.
Otherwise, in our holistic practice, we recommend conducting a vitamin D blood analysis for risk patients or skin cancer patients, which we offer in our practice to determine the vitamin D level and then specifically compensate for deficiencies individually.
My advice would be to enjoy the sun in moderation to take advantage of vitamin D while also protecting against excessive sun exposure. Avoid sunburns in the future to minimize the risk of skin damage and skin cancer.
Vitamin B3 (niacin) is said to protect the skin from UV damage. Does it make sense to supplement it?
Dr. Christine Zimpfer:Vitamin B3, also known as niacin, is a water-soluble vitamin and part of the vitamin B complex group.
It plays an important role in protecting against the effects of UV radiation. Vitamin B3 stimulates repair mechanisms in the skin and helps protect against DNA damage to skin cells and thus also against cell degeneration.
This vitamin shows a positive effect in patients with an increased risk of non-melanocytic skin cancer diseases, for example in white skin cancer and its precursors, it reduces the risk of their development by about 30-35%.
Niacin is also an important nutrient for skin health
However, I always advise having laboratory diagnostics performed before taking supplements to determine the current and individual status and find out what is actually missing. Then you can supplement in a targeted manner.
Good niacin sources in foods include meat (especially beef liver, naturally from organic cattle), fish, brown rice, onions, nuts, and seeds.
In summary: Niacin is an important nutrient for skin health as well, it can reduce the risk of skin cancer, strengthens the skin barrier, and is also known for maintaining healthy mucous membranes.
The protective effect of Vitamin B3 is relatively short, and therefore, it should be taken at least 24-48 hours before sun exposure. Recommendation: Administer 500mg of Niacin as a supplement 2-3 times daily.
Sun protection is essential for prevention. On the other hand, UV filters harm the environment. What is being done in terms of sustainability?
Dr. Annette Zimpfer-Keese:Of course, sunlight is not only harmful. The sun also supports our health. However, ultraviolet light is a component of sunlight that promotes the development of skin cancer and accelerates skin aging.
My recommendation is always to avoid sunburn and skin redness, as well as direct sunlight; one should rather stay in the shade and wear UV textiles or other sun-appropriate clothing.
For direct sun exposure, you need sunscreen that is applied to the skin. I emphasize sustainable and environmentally friendly sun protection for the whole family.
LITTLE KNOWN is that sunscreen harms the underwater world and coral. Some manufacturers now offer so-called reef-safe sunscreens that are free of ingredients such as octinoxate and oxybenzone.
Sustainable sunscreen products should also be free of nanotechnology, microplastics, and parabens whenever possible.
Opened sunscreen should be used up promptly and not used after a year, as they can become carcinogenic due to the formation of octocrylene into benzophenone.
The so-called blue light or high energy visible light, also known as screen light or blue light, plays a little-known but important role in the development of skin damage. This radiation is less dangerous than UV radiation, but is also an enemy of our skin health.
This blue light radiation penetrates deeply into our skin unnoticed every day and leads to oxidative stress through the development of free radicals. The face, particularly the chin and cheek area, is especially affected by the blue light radiation from computers and mobile phones.
For daily facial care, my recommendation would be to use a product with a new, environmentally friendly blue light filter or with broadband protection.
Specialty in Dermato-Oncology: Dr. Annette Zimpfer-Keese (left) and Dr. Christine Zimpfer
© Freepik
"My recommendation is always to avoid sunburn and skin redness," said Dr. Annette Zimpfer-Keese.
