There are various kinds of skin cancer. Basal cell carcinoma and squamous cell carcinoma are the most common and frequently appear on parts of the body which are exposed to the sun for example, the head, face, nose, shoulders and the back of hands. Melanoma is a skin cancer that can appear anywhere on the body and is a very aggressive. Since skin cancer rarely shows symptoms, early detection by a dermatologist is the best prerequisite for a full recovery. An existing skin cancer can usually, but not always, be treated with various therapies. Once the skin cancer has healed, patients should have regular checkups with a dermatologist.


1. What is skin cancer?

Generally, skin lesions (growths on the surface or beneath the skin) can be harmless but, they can also be dangerous and life threatening.

Dangerous skin lesions are categorized as skin cancer and primarily refer to malignant melanomas. Depending on the degenerative cell type, dermatologists can differentiate between the cancer types.

Diagnosed cases of skin cancer are continuously increasing. In fact, Switzerland has the highest rate in comparison to other countries in Europe.

The indications of the individual types of cancer are very different as is their appearance.

Harmless skin lesions, for example birthmarks (pigmented connective tissue) or age warts (seborrheic keratoses) can be left alone or removed with a laser.

2. How can you recognize skin cancer?

Usually the patient themselves or family relation notices a change in the skin or a change in a birthmark. Skin cancer rarely shows symptoms. Noticeable large skin defects, sores and spontaneous bleeding first occur in the advanced stages. Dermatologist use a dermatoscope to examine suspicious skin lesions.

This is a special illuminated microscope that dermatologists use to examine the skin’s surface.

Skin cancer - birthmark control - skin check

Dermatoscope for examining suspicious skin lesions

The dermatologist uses this to identify skin cancer on the basis of certain criteria and assign the lesion to the various types of skin cancer.

3. What kinds of skin cancer are there?

3.1. Non-melanoma: skin cancer of the top skin layer.

Non-melanoma skin cancer is primarily caused by UV-light, respectively sunlight. Most commonly it appears on older people and primarily on body regions which were in the course of life exposed to the sun’s rays. This is usually the head, face, especially the lips and nose, shoulders, chest, forearms and the back of hands.

There are two main types of non-melanoma skin cancer:

Basal Cell Carcinoma

Basal cell carcinoma or basalioma, starts in the basal cell layer (lower layer) of the epidermis. It is considered to be a semi-malignant skin cancer because it very rarely metastasizes or spreads. Basal cell carcinomas are frequently detected on the face, particularly the nose, forehead and cheeks.


nodular basal cell carcinoma on cheek

Squamous cell carcinoma

Squamous cell carcinomas or prickle cell carcinomas begin in the squamous cells found in the stratum spinosum layer of the epidermis. In advanced stages they can metastasize. Squamous cell carcinomas are also frequently found on the face and can also appear on the lips, particularly the lower lip.

Hautkrebs - Spianliom

Squamous cell carcinoma on the forearm ©Inge

Both types destroy the skin and surrounding tissue. For the most part, they cause only minor symptoms such as itching or some discomfort. They can however, especially basal cell carcinomas, spontaneously bleed without any injury to the skin. These skin cancers mostly develop from pre-cancerous skin lesions, actinic keratosis and Bowen’s disease. These pre-cancers also rarely show any symptoms, possibly slight itchiness or a stinging at most.

3.2. Melanoma Skin Cancer from pigment forming cells

Melanoma skin cancer is a malignant cancer.It develops in degenerative pigment building skin cells called melanocytes. This most commonly occurs in birthmarks. When birthmarks become irregular and start to change in appearance, typically melanoma skin cancer has developed.

It is a very aggressive cancer!

Malignant melanomas are responsible for most skin cancer related deaths.


Melanom an der Schulter

Melanomas can grow quickly and spread (metastasize) to other sites on the body through the lymphatic system to lymph nodes, internal organs and underlying subcutaneous tissue. The metastases spread further through the lymphatic system. When the secondary malignant growths spread to internal organs, the organs can no longer function properly. Patients suffer from intensive pain and eventually die from organ failure. In particular, when melanoma is detected in late stages, they are usually deadly and also responsible for most deaths related to skin cancer.

3.3. Rare forms of skin cancer

Skin lymphoma or Cutaneous Lymphoma are lesions which develop from the skin’s immune cells, the lymphocytes. This condition may resemble eczema and is very rare.

There are rare skin cancers which develop in other skin cells for example, Merkel cell carcinoma.

Verschiede Hautkrebsarten in der Haut

Various types of skin cancer ©logo3in1

4. What is skin cancer screening?

For skin cancer examinations otherwise known as a skin cancer screening, the dermatologist examines the patient’s entire skin surface including the scalp and outer soft tissue. Here at the derma competence center this is done using a modern cold light microscopy illuminator which allows for computerized analysis (assessment of danger) and the possibility to generate digital photographs of suspicious birthmarks or skin lesions for monitoring at follow-up screenings.

Facts on Skin Cancer Screening:

  • A skin cancer screening makes a lot of sense because early detection of skin cancer makes it easier to treat and mostly results in a full recovery.
  • The examination takes about 15 to 30 minutes depending on the amount of skin changes or birthmarks.
  • The screening is covered by health insurance or and insurance supplements.
  • Once a year dermatologist Dr. Schnitzler in Zurich Enge, participates on National Skin Cancer Day and offers free examinations and diagnosis. (Link to News Skin Cancer Day)

5. What is skin cancer aftercare?

After having had skin cancer, patients are advised to have the entire skin examined at regular intervals (based on the type of cancer). If necessary, a control of the lymph nodes, tumor markers and internal organs is organized.

Birth Control Skin Cancer Skin Examination - Dr. Schnitzler Zurich-Enge

Dr. Schnitzler examines a suspicious birthmark for analysis.

Skin Cancer Aftercare Facts:

  • The examination is similar to the initial skin cancer screening with the use of the cold light microscopy illuminator. Digital photographs and computer analyses are compared to precisely determine any changes in the skin lesions.
  • The derma competence center works closely together with general practitioners, specialists, hospitals and university clinics.
  • For the skin cancer aftercare, the latest guidelines and quality regulations are strictly followed.

6. How is skin cancer treated?

Skin cancer is very treatable when diagnosed in the early stages. Early detection is the crucial. Then, the dermatologist can initiate the suitable therapy. These treatments are covered by health insurance and in most cases can be carried out on an out-patient basis.

6.1. Skin surgery, removal by excision

Skin surgery or derma surgery refers to the surgical excision of dangerous skin growths which mostly appear on the top skin layer. Disturbing benign lesions can also be removed by means of derma surgery.

Procedure for surgical removal of skin cancer:

  • An in depth, comprehensive consultation reviewing the intervention with the patient is first conducted before the surgical procedure. In addition, the detailed procedures concerning wound care are discussed with the patient in advance.
  • The surgical removal of the skin lesion takes place at the derma competence center in the designated intervention room.
  • Another photograph of the cancerous tumor is taken before the intervention begins.
  • The operative removal is carried out under local anesthetic.
  • Depending on the indication, various OP-techniques are used on the skin and mucous membrane, for example shave excision or local flap techniques. The option used depends of course on the nature of the structure to be removed.
  • The removed skin cancer, basal cell, squamous cell or melanoma is sent for laboratory testing at the University Hospital in Zürich.
  • The removed skin cancer, basal cell, squamous cell or melanoma is sent for laboratory testing at the University Hospital in Zürich.
  • Dr. Schnitzler immediately informs his patients as soon as the exact range of the tissue examination is available.

Important to observe after an OP!

After a skin cancer operation use of saunas, sports and other demanding activities should be temporarily avoided.

Skin surgery - skin cancer removal - skin surgery birthmark removal

Operative Removal of a Skin Cancer

6.2. Photo Dynamic Therapy (PDT)

Certain types of cancer respectfully, basal cell carcinoma and its pre-stages: actinic keratoses and Bowen’s disease, can be gently treated with the use of photo dynamic therapy. This gentle means of treatment is recognized by health insurance.

What happens during photodynamic therapy (PDT)?

  • A light-sensitive medicated cream is applied to the affected area of skin.
  • The area is covered with a light and airtight bandage for approx. 3 hours, giving the cream time to absorb.
  • Afterwards, the area is treated with a red light at a specified wavelength for several minutes.
  • The PDT light may feel slightly uncomfortable to some patients but is not considered painful.
  • The treated diseased cells are destroyed without damage to the surrounding healthy tissue. The diseased cells are naturally expelled in the following days.
  • There is no scarring after the treated area has healed.
Skin cancer treatment - photodynamic therapy

After PDT treatment with the use of red light, direct exposure to UV-rays is to be avoided to approximately 10 days!

Daylight-PDT is another form of photodynamic therapy whereby the artificial irradiation with red light is eliminated. During suitable weather conditions, a photosensitizing cream is applied to the area that need to be treated. Afterwards, the patient must simple keep the treated area exposed to daylight for 2 hours. Although this method is even more gentle, it is not as effective as standard PDT.

6.3. Cryotherapy or Cold Therapy

Cryotherapy has long since been used in dermatology for successful treatments of basal cell carcinoma and actinic keratoses. This therapy however can also be used to treat benign skin lesions for example, warts and hemangiomas (strawberry nevus). Usually only on session is needed though in certain cases, several treatments may be required. The related side effects and pain are very slight and well tolerated by patients. The drawback to this therapy is that it is difficult to determine if all the diseased cells get treated. Cryotherapy is also recognized and covered by health insurance.

What happens during Cryotherapy?

  • If necessary, after application of a topical cold anesthetic, the surface of the lesion is gently scrapped away.
  • Liquid nitrogen is then applied directly to the skin with an applicator or by spray. This freezes the suspicious lesion or defect.
  • Typically, there is a slight burning sensation.
  • Scabbing or blistering may occur on the treated area.
  • With the suitable subsequent wound care, the treated area heals.
  • Scarring is very seldom.

Cryotherapy does not guarantee that all of the cancerous tissue has been destroyed!

Vereisung eines Hautumors.

Use of Cryotherapy on a skin lesion.

warts freezing - Icing - Discontinue cryo treatment

Detail der Apllikation der Vereisungsbehandlung im Kontaktverfahren.

6.4. Skin cancer creams

Superficial skin cancers and their pre-cancer stages can be treated with different creams. These creams are either topical chemotherapy or immune response modifiers.

The use of topical cancer treatments is limited to particular types of cancer and only recommended when chances of spreading are unlikely.

Also, the duration of use varies significantly from days to weeks depending on the prescribed preparation.

What these creams have in common is that they do cause skin sensitivity and irritation. These side effects go away when the therapy is completed. Scarring is very rare.

Skin cancer creams are not the most reliable treatment method to cure cancer. However, for certain stages of skin cancer, they are highly recommended. Due to the length of the application period and skin irritations, some patients find this therapy to be cumbersome.

Not all skin cancers are suitable for topical therapies!

What happened during topical treatment for skin cancer?

  • Depending on the cancer type, the dermatologist prescribes the suitable cream.
  • Depending on the cancer type, the dermatologist prescribes the suitable cream.
  • Depending on the kind of cream used, at some point skin irritations of varying degrees will develop. The cancerous cells are destroyed.
  • After discontinuing use of the cream, the irritations heal.
  • After consultation with your dermatologist, this process may be repeated if the cancer has not completely healed.
  • The length of this therapy may vary from days to weeks.

6.5. Additional Therapy Possibilities

There are instances when the therapies mentioned above are not effective enough to successfully treat the skin cancer. It is also possible that due to the location of the lesion, for example, on the nose or eye, these forms of treatment cannot be used. In such cases, Dr. Schnitzler refers the patient to the Zurich University Hospital for radiation therapy or infusion therapy (Chemotherapy).

7. Overview of different kinds of skin cancer

Early detection of skin cancer significantly increases the successful treatment. Early detection is key. A dermatologist can perform the suitable therapy. These therapies are covered by health insurance and can usually be conducted on an out-patients basis.

skin cancer compact

In short, even for the smallest suspicion of skin cancer, it is very important to refer to a dermatologist. This is very important! They can detect skin cancer in its early stages, make the diagnosis and prescribe the corresponding therapy. Theses therapies are conducted on an out-patient basis and covered by health insurance.

Autor - Dr. med. Hero P. D. Schnitzler

I am Dr. Hero P. D. Schnitzler and founded the derma competence center in Zurich Enge in 2015, which I have been managing with heart, soul and professional competence ever since.

I am a member of various Swiss and international professional societies and a long-time lecturer for aesthetic laser medicine (D.A.L.M.) at the University of Greifswald, and for the Swiss skills program FMCH laser treatments of the skin.

Picture credits: ©logo3in1, ©Inge, ©Jaojormami, ©Henk Vrieselaar –