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Früherkennung von Hautkrebs und Screeninguntersuchungen

Early detection of skin cancer and skin cancer screening examinations

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Von 1970 bis 2010 ist nach Registerdaten des Saarlands die Inzidenz des Melanoms um das 7‑Fache und die Inzidenz des epithelialen Hautkrebses, der heute die mit weitem Abstand häufigste Krebserkrankung darstellt, um das 13-Fache angestiegen. Ursächlich ist der starke Anstieg der UV-Exposition aufgrund veränderter Urlaubs- und Freizeitgewohnheiten. Die erhebliche Zunahme von Hautkrebs steigert die Anforderungen an die chirurgische Versorgung sowie an klinische Nachsorgeuntersuchungen stark und führte auch zu einer deutlichen Zunahme der Melanommortalität. Die Früherkennung kann einer Abnahme des Versorgungsaufwands und langfristig auch der Mortalität dienen. Sie ist prinzipiell einfach, da die Mehrzahl der verdächtigen Tumoren ohne apparativen Aufwand erkennbar sind.

Ziel

Die Möglichkeiten der klinischen Hautkrebsdiagnose mit diagnostischen Algorithmen werden vorgestellt und die Verbesserung der diagnostischen Treffsicherheit durch Dermatoskopie sowie der bisherige Beitrag der gesetzlichen Hautkrebsvorsorge untersucht.

Methode

Die Daten wurden einer selektiven Literaturrecherche in der Datenbank PubMed entnommen.

Ergebnisse und Diskussion

Die Hautkrebsfrüherkennung ist mithilfe Inspektion und Dermatoskopie in bis zu 90 % der Fälle möglich. Besondere Aufmerksamkeit sollte der Wahrnehmung auffälliger Tumoren durch die Patienten gezollt werden. Es gibt bisher keine Daten, ob neue diagnostische Verfahren die Treffsicherheit weiter erhöhen. Im Juli 2008 wurde das gesetzliche, 2‑jährliche Hautkrebsscreening für Personen ab 35 Jahren mit Kostenerstattung deutschlandweit eingeführt, an dem bisher mehr als 30 % der Bevölkerung teilnahmen. Eine vom Gemeinsamen Bundesausschuss durchgeführte Begleituntersuchung erhob Daten vom Garbage-in-garbage-out-Typ, entsprechend bleiben Fragen zum Nutzen des Hautkrebsscreenings bisher unbeantwortet.

Abstract

Background

From 1970 to 2010, the incidence of melanoma rose 7‑fold and the incidence of epithelial skin cancer, which is by far the most common form of cancer, 13-fold, according to the Saarland cancer registry data. This was due to the steep increase in UV exposure because of changes in holiday and leisure habits. The significant rise in skin cancers has greatly increased the demand for surgical care and for clinical follow-up examinations, and has also led to a significant increase in melanoma mortality. Early detection can be conducive to a decrease in care expenditure and long-term mortality. It is in principle simple, because the majority of suspected tumors are recognizable without expenditure on equipment.

Aim

The possibilities of the clinical diagnosis of skin cancers will be presented, together with diagnostic algorithms, and improvement of diagnostic accuracy by applying dermoscopy is discussed, along with the current contribution of statutory skin cancer screening tests.

Method

Data were extracted from a selective literature search in the PubMed database.

Results and discussion

Early detection of skin cancer is possible in up to 90 % of cases with the aid of testing and dermatoscopy. Particular attention should be paid to suspected skin tumors of which the patient is aware. There are no data on whether new diagnostic methods increase diagnostic accuracy further. In July 2008, statutory skin cancer screening with reimbursement was introduced throughout Germany for individuals from the age of 35 years every 2 years, in which more than 30 % of the population participated. A survey conducted by the Federal Joint Committee accompanying the clinical screening examinations collected data of the garbage in, garbage out type; accordingly, questions about the benefit of the skin cancer screenings remain unanswered.

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Notes

  1. Garbe’s rule: „If a patient is worried about a single skin lesion, do not ignore their suspicion and have a low threshold for performing a biopsy“ [42].

Literatur

  1. Leiter U, Eigentler T, Garbe C (2014) Epidemiology of skin cancer. Adv Exp Med Biol 810:120–140

    PubMed  Google Scholar 

  2. Lucas RM, McMichael AJ, Armstrong BK, Smith WT (2008) Estimating the global disease burden due to ultraviolet radiation exposure. Int J Epidemiol 37:654–667

    Article  PubMed  Google Scholar 

  3. Petersen B, Thieden E, Philipsen PA, Heydenreich J, Young AR, Wulf HC (2013) A sun holiday is a sunburn holiday. Photodermatol Photoimmunol Photomed 29:221–224

    Article  PubMed  Google Scholar 

  4. Garbe C, Leiter U (2009) Melanoma epidemiology and trends. Clin Dermatol 27:3–9

    Article  PubMed  Google Scholar 

  5. Breitbart EW, Choudhury K, Anders MP, Volkmer B, Greinert R, Katalinic A, Tacke J, Keilholz U (2014) Benefits and risks of skin cancer screening. Oncol Res Treat 37(Suppl 3):38–47

    Article  PubMed  Google Scholar 

  6. Garbe C, Peris K, Hauschild A, Saiag P, Middleton M, Spatz A, Grob JJ, Malvehy J, Newton-Bishop J, Stratigos A, Pehamberger H, Eggermont AM (2012) Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline – Update 2012. Eur J Cancer 48:2375–2390

    Article  PubMed  Google Scholar 

  7. Kittler H, Pehamberger H, Wolff K, Binder M (2002) Diagnostic accuracy of dermoscopy. Lancet Oncol 3:159–165

    Article  CAS  PubMed  Google Scholar 

  8. McGovern VJ, Mihm MC Jr., Bailly C, Booth JC, Clark WH Jr., Cochran AJ, Hardy EG, Hicks JD, Levene A, Lewis MG, Little JH, Milton GW (1973) The classification of malignant melanoma and its histologic reporting. Cancer 32:1446–1457

    Article  CAS  PubMed  Google Scholar 

  9. Mihm MC Jr., Clark WH Jr., From L (1971) The clinical diagnosis, classification and histogenetic concepts of the early stages of cutaneous malignant melanomas. N Engl J Med 284:1078–1082

    Article  PubMed  Google Scholar 

  10. Breslow A (1970) Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg 172:902–908

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Breslow A (1977) Problems in the measurement of tumor thickness and level of invasion in cutaneous melanoma. Hum Pathol 8:1–2

    Article  CAS  PubMed  Google Scholar 

  12. Hazen BP, Bhatia AC, Zaim T, Brodell RT (1999) The clinical diagnosis of early malignant melanoma: expansion of the ABCD criteria to improve diagnostic sensitivity. Dermatol Online J 5:3

    CAS  PubMed  Google Scholar 

  13. Rigel DS, Russak J, Friedman R (2010) The evolution of melanoma diagnosis: 25 years beyond the ABCDs. CA Cancer J Clin 60:301–316

    Article  PubMed  Google Scholar 

  14. Grob JJ, Bonerandi JJ (1998) The ‘ugly duckling’ sign: identification of the common characteristics of nevi in an individual as a basis for melanoma screening. Arch Dermatol 134:103–104

    Article  CAS  PubMed  Google Scholar 

  15. Wazaefi Y, Gaudy-Marqueste C, Avril MF, Malvehy J, Pellacani G, Thomas L, Triller R, Bruneu Y, Monestier S, Richard MA, Fertil B, Grob JJ (2013) Evidence of a limited intra-individual diversity of nevi: intuitive perception of dominant clusters is a crucial step in the analysis of nevi by dermatologists. J Invest Dermatol 133:2355–2361

    Article  CAS  PubMed  Google Scholar 

  16. Garbe C, McLeod GR, Buettner PG (2000) Time trends of cutaneous melanoma in Queensland, Australia and Central Europe. Cancer 89:1269–1278

    Article  CAS  PubMed  Google Scholar 

  17. Forsea AM, Marmol V del, Vries E de, Bailey EE, Geller AC (2012) Melanoma incidence and mortality in Europe: new estimates, persistent disparities. Br J Dermatol 167:1124–1130

    Article  CAS  PubMed  Google Scholar 

  18. Forsea AM, Del Marmol V, Stratigos A, Geller AC (2014) Melanoma prognosis in Europe: far from equal. Br J Dermatol 171:179–182

    Article  CAS  PubMed  Google Scholar 

  19. Rudolph C, Schnoor M, Eisemann N, Katalinic A (2015) Incidence trends of nonmelanoma skin cancer in Germany from 1998 to 2010. J Dtsch Dermatol Ges 13:788–797

    PubMed  Google Scholar 

  20. Stang A, Stegmaier C, Jockel KH (2003) Nonmelanoma skin cancer in the Federal State of Saarland, Germany, 1995–1999. Br J Cancer 89:1205–1208

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Hauschild A, Breuninger H, Kaufmann R, Kortmann RD, Klein M, Werner J, Reifenberger J, Dirschka T, Garbe C (2013) Brief S2k guidelines – basal cell carcinoma of the skin. J Dtsch Dermatol Ges 11(Suppl 3):10–15

    Article  PubMed  Google Scholar 

  22. Breuninger H, Eigentler T, Bootz F, Hauschild A, Kortmann RD, Wolff K, Stockfleth E, Szeimies RM, Rompel R, Garbe C, Grabbe S (2013) Brief S2k guidelines – cutaneous squamous cell carcinoma. J Dtsch Dermatol Ges 11(Suppl 3):37–45

    Article  PubMed  Google Scholar 

  23. Stratigos A, Garbe C, Lebbe C, Malvehy J, Marmol V del, Pehamberger H, Peris K, Becker JC, Zalaudek I, Saiag P, Middleton MR, Bastholt L, Testori A, Grob JJ (2015) Diagnosis and treatment of invasive squamous cell carcinoma of the skin: European consensus-based interdisciplinary guideline. Eur J Cancer 51:1989–2007

    Article  PubMed  Google Scholar 

  24. Argenziano G, Albertini G, Castagnetti F, Pace B de, Lernia V di, Longo C, Pellacani G, Piana S, Ricci C, Zalaudek I (2012) Early diagnosis of melanoma: what is the impact of dermoscopy? Dermatol Ther 25:403–409

    Article  PubMed  Google Scholar 

  25. Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F, Binder M, Cerroni L, Rosa G de, Ferrara G, Hofmann-Wellenhof R, Landthaler M, Menzies SW, Pehamberger H, Piccolo D, Rabinovitz HS, Schiffner R, Staibano S, Stolz W, Bartenjev I, Blum A, Braun R, Cabo H, Carli P, Giorgi V de, Fleming MG, Grichnik JM, Grin CM, Halpern AC, Johr R, Katz B, Kenet RO, Kittler H, Kreusch J, Malvehy J, Mazzocchetti G, Oliviero M, Ozdemir F, Peris K, Perotti R, Perusquia A, Pizzichetta MA, Puig S, Rao B, Rubegni P, Saida T, Scalvenzi M, Seidenari S, Stanganelli I, Tanaka M, Westerhoff K, Wolf IH, Braun-Falco O, Kerl H, Nishikawa T, Wolff K, Kopf AW (2003) Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol 48:679–693

    Article  PubMed  Google Scholar 

  26. Malvehy J, Puig S (2002) Follow-up of melanocytic skin lesions with digital total-body photography and digital dermoscopy: a two-step method. Clin Dermatol 20:297–304

    Article  PubMed  Google Scholar 

  27. Haenssle HA, Krueger U, Vente C, Thoms KM, Bertsch HP, Zutt M, Rosenberger A, Neumann C, Emmert S (2006) Results from an observational trial: digital epiluminescence microscopy follow-up of atypical nevi increases the sensitivity and the chance of success of conventional dermoscopy in detecting melanoma. J Invest Dermatol 126:980–985

    Article  CAS  PubMed  Google Scholar 

  28. Bauer J, Blum A, Strohhacker U, Garbe C (2005) Surveillance of patients at high risk for cutaneous malignant melanoma using digital dermoscopy. Br J Dermatol 152:87–92

    Article  CAS  PubMed  Google Scholar 

  29. Stevenson AD, Mickan S, Mallett S, Ayya M (2013) Systematic review of diagnostic accuracy of reflectance confocal microscopy for melanoma diagnosis in patients with clinically equivocal skin lesions. Dermatol Pract Concept 3:19–27

    Article  PubMed  PubMed Central  Google Scholar 

  30. Pellacani G, Guitera P, Longo C, Avramidis M, Seidenari S, Menzies S (2007) The impact of in vivo reflectance confocal microscopy for the diagnostic accuracy of melanoma and equivocal melanocytic lesions. J Invest Dermatol 127:2759–2765

    Article  CAS  PubMed  Google Scholar 

  31. Lallas A, Argenziano G, Zendri E, Moscarella E, Longo C, Grenzi L, Pellacani G, Zalaudek I (2013) Update on non-melanoma skin cancer and the value of dermoscopy in its diagnosis and treatment monitoring. Expert Rev Anticancer Ther 13:541–558

    Article  CAS  PubMed  Google Scholar 

  32. Alarcon I, Carrera C, Turegano P, Malvehy J, Puig S (2014) Basal cell carcinoma with spontaneous regression: added value of reflectance confocal microscopy when the dermoscopic diagnosis is uncertain. J Am Acad Dermatol 71:e7–e9

    Article  PubMed  Google Scholar 

  33. Manfredini M, Arginelli F, Dunsby C, French P, Talbot C, Konig K, Pellacani G, Ponti G, Seidenari S (2013) High-resolution imaging of basal cell carcinoma: a comparison between multiphoton microscopy with fluorescence lifetime imaging and reflectance confocal microscopy. Skin Res Technol 19:e433–e443

    Article  PubMed  Google Scholar 

  34. Breitbart EW, Waldmann A, Nolte S, Capellaro M, Greinert R, Volkmer B, Katalinic A (2012) Systematic skin cancer screening in Northern Germany. J Am Acad Dermatol 66:201–211

    Article  PubMed  Google Scholar 

  35. Eisemann N, Waldmann A, Geller AC, Weinstock MA, Volkmer B, Greinert R, Breitbart EW, Katalinic A (2014) Non-melanoma skin cancer incidence and impact of skin cancer screening on incidence. J Invest Dermatol 134:43–50

    Article  CAS  PubMed  Google Scholar 

  36. Katalinic A, Waldmann A, Weinstock MA, Geller AC, Eisemann N, Greinert R, Volkmer B, Breitbart E (2012) Does skin cancer screening save lives?: an observational study comparing trends in melanoma mortality in regions with and without screening. Cancer 118:5395–5402

    Article  PubMed  Google Scholar 

  37. Stang A, Jockel KH (2015) Does skin cancer screening save lives? A detailed analysis of mortality time trends in Schleswig-Holstein and Germany. Cancer

  38. Bundesausschuss G (2008) Hautkrebsscreening. https://www.g-ba.de/informationen/abschlussberichte/580/

    Google Scholar 

  39. Veit C, Lueken F, Melsheimer O (2015) Evaluation der Screeninguntersuchungen auf Hautkrebs gemäß Krebsfrüherkennungs-Richtlinie des Gemeinsamen Bundesausschusses. https://www.g-ba.de/downloads/17-98-3907/2015-03-11_BQS_HKS-Abschlussbericht-2009-2010.pdf

    Google Scholar 

  40. Augustin M, Stadler R, Reusch M, Schafer I, Kornek T, Luger T (2012) Skin cancer screening in Germany – perception by the public. J Dtsch Dermatol Ges 10:42–49

    PubMed  Google Scholar 

  41. Kornek T, Schafer I, Reusch M, Blome C, Herberger K, Beikert FC, Augustin M (2012) Routine skin cancer screening in Germany: four years of experience from the dermatologists’ perspective. Dermatology (Basel) 225:289–293

    Article  Google Scholar 

  42. Bolognia JL, Jorizzo JL, Schaffer JV (2012) Dermatology, textbook, 3. Aufl. Bd. 2. Elsevier, Amsterdam

    Google Scholar 

  43. Solschenizyn A (1971) Krebsstation – Roman in zwei Büchern. Band I und Band II. Rowohlt Taschenbuch Verlag

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  1. Sektion für Dermatoonkologie, Universitäts-Hautklinik, Liebermeisterstr. 25, 72074, Tübingen, Deutschland

    C. Garbe

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Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Garbe, C. Früherkennung von Hautkrebs und Screeninguntersuchungen. Onkologe 22, 537–549 (2016). https://doi.org/10.1007/s00761-016-0065-x

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