Skin Cancer Treatment in Germany

Besides excessive sun exposure, which is the main risk factor for skin cancer, there are others:

• skin phototype I: fair skin with freckles, red or blond hair, light-coloured eyes;

• age > 50 years;

• living in an area with high levels of solar radiation;

• sunburn in the past;

• precancerous skin conditions (actinic keratosis);

• a history of skin cancer;

• skin cancer in close relatives.

In recent decades a steady rise has been recorded worldwide in the incidence of non-melanoma skin cancers, which include basal cell and squamous cell carcinoma. Actinic keratosis is biologically regarded as a “precancerous condition” and, on histological examination, may prove to be an early squamous cell carcinoma.

Routine screening for skin cancer is carried out by the patient through self-examination of the skin in a mirror, by the doctor during an examination, or by both.

Since many forms of skin cancer appear to be linked to ultraviolet (UV) exposure, a number of measures are recommended to reduce the harmful effect of the sun on the skin. You should:

• avoid sun exposure: stay in the shade, keep outdoor activity to a minimum between 10 a.m. and 4 p.m. (when the sun's rays are strongest), and avoid sunbathing and the use of tanning beds;

• wear protective clothing (long-sleeved shirts, trousers and wide-brimmed hats);

• use sunscreens with a sun protection factor (SPF) of 30 or higher and broad-spectrum UVA/UVB protection, and apply them as instructed (that is, reapply every 2 hours or after swimming or sweating);

• sunscreens must not be used as a way of prolonging time spent in the sun.

The data currently available are insufficient to assess the effect of these measures on the incidence of and mortality from melanoma; in non-melanoma skin cancers (basal cell carcinoma and squamous cell carcinoma) sun protection measures do reduce the number of new cases.

The treatment of actinic keratosis and “non-melanoma” skin cancer is a highly topical issue: incidence is high, the disease tends to recur, lesions are frequently located on exposed areas of skin and especially on the face, existing treatments are not effective enough, and they leave significant cosmetic defects. One of the most effective and gentlest treatments for “non-melanoma” skin cancer is photodynamic therapy.

Photodynamic therapy (PDT) is an effective non-invasive treatment for skin cancer, based on the selective accumulation of a photosensitising agent in tumour cells and their subsequent photodynamic destruction through chemical reactions triggered by light of a particular spectrum.

The key component of this reaction is the photosensitiser (PS) - a substance that increases the sensitivity of diseased tissue to light: the tumour or affected tissue is destroyed when it is irradiated with low-intensity light. Using a photosensitiser rules out the risk of uncontrolled thermal damage to tissues and organs and effectively destroys the altered areas of skin while preserving the surrounding healthy tissue as far as possible.

For photodynamic therapy, Metvix® cream is used as the topical photosensitiser, together with the unique Aktilite® photodynamic lamp. The lamp emits cold visible light in the red part of the spectrum. Applying Metvix® cream leads to a selective increase in the porphyrin content of tumour cells. These photoactive particles make the tumour cells sensitive to light. In healthy cells the porphyrin content is very low. Once the cell membranes and altered tissues have been activated by the photosensitiser, they are bombarded with light particles and completely destroyed. The replacement of the dead tumour cells by healthy ones gives an excellent cosmetic result. Photodynamic therapy with Metvix® is therefore a world-leading option for the treatment and long-term management of patients with “non-melanoma” types of skin cancer and actinic keratosis.

Indications for photodynamic therapy with Metvix®

• actinic keratosis of the face and scalp;

• superficial and/or nodular basal cell skin cancer (cutaneous basalioma);

• squamous cell carcinoma of the skin in situ (Bowen's disease).

Contraindications to photodynamic therapy

• hypersensitivity to the components of the preparation;

• morphoeaform basal cell skin cancer;

• porphyria;

• allergic reactions to peanut oil;

• pregnancy.

The photodynamic therapy procedure with Metvix® cream is carried out in 3 stages

• preparation stage: anaesthesia, mechanical cleansing of the lesion, removal of scales and crusts;

• application of Metvix cream; the treated area is covered with an occlusive dressing for 3 hours;

• light exposure: irradiation lasts 7-10 minutes.

The effect of treatment should be assessed 3 months after the procedure.

Actinic keratosis is treated with a single session of photodynamic therapy. Three months later the result of treatment is assessed and, if necessary, a second session is carried out.

Basalioma and Bowen's disease require two sessions with an interval of 7 days between them.

Photodynamic therapy is a unique method of treating skin cancer that has a great many advantages:

• non-invasive treatment of the tumour-affected area of skin only;

• treatment of skin cancer in areas that are difficult to reach surgically (the nose, the ears);

• photodynamic therapy (PDT) can be repeated many times;

• treatment is possible for elderly patients and for patients with severe comorbidities;

• treatment can be given on an outpatient basis;

• several lesions can be treated in a single session.

Its selective anti-tumour action sets photodynamic therapy (PDT) apart from the conventional treatments used in cancer patients.

Photodynamic anti-tumour therapy (PDT) compares favourably with conventional treatments because of its selective action. It is a local chemotherapy that is activated by light. The mechanism of PDT is that the light-sensitive substance accumulates specifically in cancer cells and, under light quanta of a particular wavelength, photochemical reactions take place that lead to the death of the tumour cells

In the treatment of disseminated melanoma and basal cell carcinoma, PDT has proved excellent thanks to its ability to destroy the tumour completely with minimal damage to the surrounding healthy tissue, the preservation of organ function, the option of repeat sessions and good cosmetic results.

It may be indicated for tumours in awkward locations (the corner of the eye, the ear, the ala of the nose, the nasolabial fold and so on), as well as for tumours that are resistant to conventional treatment.

• urgent arrangement of an appointment with leading German oncology experts;

• diagnosis and treatment exclusively at certified university cancer centres;

• innovative diagnostic techniques;

• accurate pathological diagnosis at certified institutes of pathology;

• treatment starting without delay once the work-up is complete;

• selection of the optimal individual therapy by a multidisciplinary tumour board (surgeons, dermatologists, radiologists, haematologists, chemotherapists, pathologists and nuclear medicine specialists);

• adherence to international treatment protocols;

• innovative methods of treating cancer;

• non-invasive treatment of the tumour-affected area of skin only;

• the use of minimally invasive surgical techniques wherever possible;

• implantation of a port system for chemotherapy to avoid damage to the peripheral veins;

• the use of photodynamic therapy in “non-melanoma” skin cancer (the topical photosensitiser Metvix® cream and the unique Aktilite® photodynamic lamp);

• continuous monitoring of the tumour's response to the drugs, allowing oncologists to change the regimen in good time and select more effective agents, which ensures a high survival rate for cancer patients even at an advanced stage;

• supportive therapy to minimise the side effects of chemotherapy;

• treatment with genuine, latest-generation cytostatic drugs;

• an individually tailored radiotherapy plan.