Our services at a glance:
Treatment for skin cancer: surgical treatment of skin cancers, drug-based treatment of skin cancers
Surgical treatment for skin cancers
Squamous cell carcinomas, basal cell carcinomas and malignant melanomas are the most common types of skin cancer. Approximately 130,000 new cases are being recorded every year, with cases increasing at a rate of 7 % per year.
Increasing exposure to UV radiation is the main reason for this increase, with increased exposure being due, in part, to the depletion of the ozone layer but also due to an increase in outdoor leisure time activities, including holidaying in countries with high solar UV radiation. As far as the risk factors for malignant melanoma are concerned, there is no clear association with total UV exposure. Instead, the disease appears to be linked to severe and frequent sunburns suffered as a child or teenager. A high number of moles on the body is another risk factor.
Malignant melanomas do not merely develop on skin that is exposed to the sun, but also on the back, stomach and limbs. Very rarely, malignant melanomas may also develop in locations that are difficult to see, such as under a nail, between the toes or on the mucous membranes.
Surgical treatment for skin cancers is performed in the Dermatology unit's surgical unit (Prof. Dr. E. Dippel), which comprises three operating theatres. The surgical removal of skin cancers is performed in accordance with the guidelines of the German Society of Dermatology (Deutsche Gesellschaft für Dermatologie) and includes the safety margins stipulated therein. The term "microscopically controlled surgery" refers to the systematic histological search for tumour involvement along the margin of the excision site, which is performed to ensure that all tumour tissue has been removed. The excision site is then closed in a reconstructive plastic surgery procedure aimed at ensuring optimal visual appearance of the skin.
Sentinel lymph node biospy
Sentinel lymph node removal is performed in the Dermatology Clinic's surgical unit, in collaboration with the Nuclear Medicine unit. The procedure involves injecting radioactive material into the area around the skin tumour in order to simulate the process of how tumour cells would be removed via the lymphatic system. This process identifies the sentinel lymph node, i.e. the first lymph node the cancer may drain into. This procedure is followed by gamma probe-guided surgery for exact sentinel lymph node localisation. Histological and immunohistological analyses of the lymph node will then determine whether tumour cells are already present inside the first lymph node. This is an important step in determining the spread of the cancer and where necessary can help decide on an appropriate course of treatment.
Drug-based treatment for skin cancers
Topical chemotherapy treatment
Superficial basal cell carcinomas and squamous cell carcinomas can be treated with topical chemotherapy ointments. This gentle, non-invasive procedure can also be used in the treatment of extensive areas of precancerous tissue and is commonly used to avoid a surgical intervention.
Topical treatment with interferon and other cytokines
Skin metastases originating from primary skin cancers can also be treated with interferon and other cytokines. This option is available when surgical removal is unrealistic as an option due to the number of tumours or when a tumour cannot be removed completely.
Adjuvant therapy refers to additional, precautionary therapy in cancers that are at an increased risk of metastasising. Adjuvant therapy commonly involves the use of interferon to delay or even prevent the reoccurrence of metastases.
In the Dermatology Clinic, we also perform microscopic analyses of tissue samples and surgical specimens.
Specimens have to be fixed in formalin prior to undergoing further analysis in the laboratory: Specimens have to be dehydrated, stabilised and sectioned before they can be subjected to analysis under the microscope.
Microscope diagnostics are used in inflammatory skin disorders, disorders affecting the mucous membranes, as well as benign and malignant skin cancers.
Where applicable, our laboratory offers a number of staining techniques, which can improve the diagnostic process. For example, special staining techniques allow the identification of fungal pathogens and allow the more accurate classification of certain types of skin cancer.
In cases of malignant disease, the aim of surgery is the complete removal of cancerous tissue. This minimises the risk of any recurrence of the cancer, or of any metastases forming from small amounts of remaining cancerous tissue. Although scarring cannot be prevented, the cosmetic impact of scarring is minimised by the use of surgical techniques that involve intraoperative testing of tissue samples around the excision site, in order to preserve as much healthy tissue as possible.
This allows the surgeon to keep the safety margin around the tumour as narrow as possible whilst ensuring complete removal of cancerous tissue. At the end of the procedure, the wound is not sutured, but covered with a special dressing. The sample is then marked to allow the histologist to accurately localise any area affected by incomplete tissue removal. This ensures that any surgery to remove remaining tissue can focus in on the exact area where cancerous tissue was identified.
Our histology laboratory also offers direct and indirect immunofluorescence for the diagnosis of autoimmune disorders such as lupus erythematosus and blistering skin disorders. Direct immunofluorescence requires a biopsy to be taken, while indirect immunofluorescence involves taking a sample of the patient's blood. Both techniques involve the addition of fluorescent dyes, which allow visualisation under the microscope of particular antibodies and other factors that might indicate a specific diagnosis.
We continue to work closely with PD Dr. Mindaugas Andrulis and the Pathology Institute which is located in the same building. The Pathology Institute is responsible for the analysis of all surgical samples, with results being discussed at regular interdisciplinary meetings.
For years, occupational skin diseases have accounted for the majority of all reported occupational diseases. 90 % of all cases relate to occupational dermatitis, presenting with multicausal aetiology and a complex clinical picture. Initially, treatment for established cases of occupational dermatitis involves the topical application of medications. Where required, additional systemic treatment may be instigated, appropriate to the exact stage or extent of the disease and in accordance with professional guidelines. In addition, we focus our efforts on the prevention of disease and appropriate skin care to restore the skin barrier.
- Detailed medical history and examination
- Allergy diagnosis (skin tests, laboratory tests)
- Occupational dermatitis consultations offering treatment and support that is appropriate to the extent and severity of disease
- Advice on skin protection and preventative measures
- Dermatologist's assessments and reports, expert assessments and advice
Eczema and dermatitis
Atopic eczema (atopic dermatitis)
Psoriasis is the commonest skin disorder across the Western industrialised nations. Estimates in Germany are that up to 2.4 million people are affected by psoriasis, with up to 30 % of cases relating to moderate to severe psoriasis, which is often chronic. The impact of psoriasis on a patient's quality of life is comparable to that of severe or chronic diseases such as type 2 diabetes, coronary heart disease and cancer.
Initial occurrence of the disease has been linked to a number of triggers, including infections (especially streptococcal infections), stress or medications (e.g. beta blockers, lithium and chloroquine).
Psoriasis is a chronic inflammatory autoimmune disease with a genetic component. The disease has been linked to systemic inflammation and is associated with a significantly increased risk of coronary heart disease, heart attack and stroke.
Effective treatments are available for the early stage of the disease as well as long-term treatment. The exact treatment approach will depend on the severity of the disease and may include a combination of general skin care measures and topical treatment, phototherapy and specific systemic therapies.
Our interdisciplinary approach to treatment offers our patients access to additional support from experts in other specialities, such as rheumatology (for joint pain) as well as specialist treatment for specific comorbidities. In addition, our patients have the opportunity of taking part in treatment trials.
Current treatment trials
Effects of different biological therapies in psoriasis vulgaris and psoriasis arthropatica: Humira® (adalimumab) and Enbrel® (etanercept)
Treatment trial on the effectiveness of the medical product "Protosaal“ as part of photodynamic therapy treatment for psoriatic arthritis.
Study on the quality of life of patients with psoriasis vulgaris undergoing systemic treatment
Fungal infections: mycology laboratory
The process of identifying the fungal species involved in infections of the skin, hair, nails and mucous membranes, starts with the taking of samples, which are then processed and cultured in our mycology laboratory. This is followed by microscopic and cultural analysis to identify the exact species involved.
Samples or swabs may be taken from skin scrapings, mucous membranes, nail clippings, stools, urine and other body fluids.
- Microscopic analysis of the uncultured sample
- Use of colouring agents and specialist dye-based techniques
- Culturing of fungal pathogens, including specialist culturing techniques
- Resistance testing
Autoimmune disorders of the skin
Phlebology - venous leg ulcers (ulcus cruris) and venous disease
The main focus is the diagnosis and treatment of venous disorders of the lower limb, in particular varicose veins and chronic venous insufficiency and its associated complications, e.g. ulcus cruris (venous leg ulcer).
Depending on the diagnosis, we offer the following procedures and techniques:
- Doppler sonography
- Colour-coded duplex sonography
- Mini phlebectomy of branch veins (surgical removal of small veins)
- Wound management (conservative and surgical treatments)
- Manual and intermittent compression therapy
- Negative pressure wound therapy
- Drug-based therapy (improving blood circulation)
Sexually transmitted diseases
Phototherapy and photodiagnostics
A large number of skin disorders can be treated with UV light alone, or with UV in combination with topical ointments or systemic drugs.
- Psoriasis vulgaris
- Atopic eczema
- Exzema and dermatitis, e.g. chronic cases involving the hands and feet
- Cutaneous lymphoma
- Sclerosing skin disorders, e.g. scleroderma, lichen sclerosus
- Lichen ruber
- Polymorphic light eruption
The phototherapy equipment used for this type of therapy is subject to regular quality control measures in order to minimise any long-term side effects associated with UV exposure.
Our phototherapy unit offers the following diagnostic and treatment techniques:
- UVA -1 therapy (cold light phototherapy)
- UVB - 311 therapy
- Light stick, UV comb UVB - 311 therapy
- CUP cube
- PUVA therapy: Topical PUVA, shower or bath PUVA therapy or systemic PUVA
- MED (minimal erythema dose) and MPD (minimal phototoxic dose) testing
- Photo provocation test for the diagnosis of photo dermatitis
- Photo patch testing for the diagnosis of photoallergy
Photodynamic diagnosis and therapy
Photodynamic therapy (PDT) refers to a technique which is used to treat cancer and other tissue changes with a combination of light, a light-sensitive substance (photosensitising agent) and oxygen present in the treated tissue. The procedure involves the administration of a photosensitising agent or a precursor, which preferentially accumulates within the tumour tissue. After a certain amount of time the tumour and the healthy tissue surrounding it are exposed to an appropriate wavelength of light. The photodynamic processes involved result in toxic substances being formed, which, due to the fact that the tumour tissue selectively accumulates the photosensitising agent, affect mainly the tumour.