White skin cancer – how dangerous is it really?

In addition to altered liver spots, which show up in the clinical picture of black skin cancer, there is also white skin cancer, which is far more common and can present itself with very different symptoms, for example, small skin nodules. How to recognize and treat white cancer and how dangerous it can be, you will learn in this article.

What is white skin cancer?

Two different types of cancer are summarized under the term “white skin cancer”: basal cell carcinoma and squamous cell carcinoma :

• Basal cell carcinoma (basalioma)  is one of the most common types of skin cancer in Central Europe. Men and women are equally affected.
• Squamous cell carcinoma (squamous cell carcinoma)  is more common in men than in women and primarily affects people over the age of 50.

White skin cancer must be differentiated from black skin cancer, usually dark brown or black spots. For example, an existing birthmark can change and look darker, more significant or different, which can indicate a tumour. Itching and bleeding from the tumour can lead to a doctor’s visit. Black skin cancer has a worse prognosis than white skin cancer. Detailed information on “black skin cancer” can be found in this article.

 

What does white skin cancer look like in the early stages?

The appearance of white skin cancer in the early stages differs depending on the type of cancer:

• Basal cell carcinoma usually appears as a small, skin-coloured nodule in the early stages. No precursor occurs before cancer.
• Squamous cell carcinoma, on the other hand, has a preliminary stage (precancerous condition): actinic keratosis. This can present as a rough, scaly patch or nodule in the early stages. The colour varies from skin-coloured to reddish-brown. The size also varies significantly from millimetre-sized changes to those with a diameter of two to three centimetres. Actinic keratosis is not a malignant disease, but it can degenerate into squamous cell carcinoma and should be treated. More information about actinic keratosis can be found here.

How is white skin cancer manifested?

Depending on the form of white skin cancer, different symptoms can occur.

Both types of cancer usually show no symptoms for a long time. However, the skin on the affected area may itch or bleed. Pain can occur wildly when penetrating deeper into the tissue layers. 

 

Symptoms of basal cell carcinoma

The basal cell carcinoma can occur in very different forms. The following signs and symptoms can be recognized as white skin cancer: 

• The basalioma nodules already mentioned grow slowly and necrotize in the central area. This means that the cells in the middle of the small skin nodules die off due to a pathological process. As a result, the surface of the nodule sinks in over time.
• A hollow with a wall-like edge is formed by sinking in the middle. Small vessels often shine through on the surface of the rim.
• A crust often forms, which can bleed.
• Most basaliomas are on the head.
• The basal cell carcinoma can also appear as red spots or scarring changes.

Spinalioma symptoms

Spinalioma often shows the appearance of an actinic keratosis in the early stages. However, this does not necessarily occur before cancer develops. The following signs also indicate squamous cell carcinoma:

• In this course, cornifications develop that stick so firmly that they cannot be removed with a finger. When trying to detach them, vulnerable tumours can cause bleeding.
• Spinalioma also appears mainly on the face.

Where does white skin cancer occur?

Like basalioma, spinalioma and its precursors mainly appear on skin areas heavily exposed to the sun, such as the forehead, nose, temples, lower lip, and the back of the hand. The scalp and, more rarely, the back, arms and legs can also be affected.

 

How fast does white skin cancer grow?

Basalioma is a prolonged growing cancer. It is particularly typical of this type of cancer that it grows over several months to years.

Spinalioma, on the other hand, increases within a few months.

What is the cause of white skin cancer?

Intense sun exposure is the leading cause of basalioma and spinalioma. For this reason, the disease mainly affects areas such as the face that are heavily exposed to the sun.

People with a weakened immune system are also particularly at risk, for example, as a result of taking medication after transplantations, with chronic inflammatory bowel diseases or with HIV. 

Other risk factors  for basal cell carcinoma also include the following features:

• A light skin type.
• The male sex is affected more often.
• Already existing basalioma. The risk of further basal cell carcinomas occurring is increased in such cases.

Spinaliomas often develop from a preliminary stage, i.e. on skin that has already been damaged by light. Sunlight is, therefore, also a risk factor for squamous cell carcinoma. More rarely, they can arise from burn scars, chronic wounds or other skin diseases. 

How is white skin cancer treated?

Most often, treatment requires surgery to remove the white skin cancer. In the case of squamous cell carcinoma, if there is a higher risk (compared to basal cell carcinoma) of further tumour deposits (metastases), additional removal of the adjacent lymph nodes may also be necessary.

However, there are also alternative methods to classic tumour removal. One is photodynamic therapy,  which is used for smaller, superficial tumours. Here, with the help of light and a special ointment, the cancer cells are killed while the healthy cells are spared. It is also used effectively in the preliminary stage of spinalioma, actinic keratosis.

Cold therapy  (cryotherapy), laser therapy,  therapy with X-ray radiation and treatment with a special cream containing the active ingredient imiquimod are also used. Imiquimod stimulates the immune response and thus fights the cancer cells. However, with these nonsurgical procedures, the risk of the cancer coming back is higher than with surgical removal. 

Chemotherapy may be necessary for squamous cell carcinomas with tumour deposits in the lymph nodes and organs forming metastases.

 

How dangerous is white skin cancer?

Basal cell carcinomas rarely form metastases in other organs. However, they can grow into deeper layers and damage bones and cartilage.

Squamous cell carcinomas can also form metastases in lymph nodes or other organs. Compared to basal cell carcinoma, they form metastases more frequently, but overall, they rarely develop. The final stage of the disease with metastases in organs can be fatal. 

As a rule, however, both forms of white skin cancer can be treated well and have a good chance of recovery. 

What happens if you don’t treat white skin cancer?

If white skin cancer is not treated, there is a risk that secondary tumours will develop, which can damage other organs. Cancer therapy is, therefore, essential. 

How to prevent white skin cancer?

Regular skin check-ups can enable early detection of white skin cancer and, thus, early treatment with higher chances of success. From age 35, those with statutory health insurance are entitled to a preventive check-up every two years free of charge. This can be done by a dermatologist (dermatologist) or a family doctor trained for this purpose. 

Sufficient sun protection is also essential in preventing white and black skin cancer since the sun is the leading risk factor for its development.