Skin cancer prevention

An early detection examination primarily aims to do one thing: to catch an illness in a healthy individual before symptoms arise. These individuals are considered healthy at the time of the examination. If an illness is detected early, they will be treated faster and get the intervention they need. As soon as you notice an abnormality, such as changes in your skin, or your doctor suspects that something requires more investigation, the examination is no longer about early detection. The corresponding necessary examinations for investigating the suspicious change in your skin are then considered treatment and become a service covered by your health insurance.

Solar radiation is the main cause of skin cancer. Therefore, individuals with light skin or lots of moles primarily have an increased risk. That’s why it is important to protect yourself from the sun: apply sun cream when you spend time in the sun. Avoid the intense midday sun. Stay in the shade and wear clothing that covers your skin where possible. Avoid tanning salons, as even this type of radiation causes skin damage.

Almost everyone has moles. Most of these brown spots are completely harmless. But sometimes they change shape, colour or size, or new, unusual looking marks appear. Visit a doctor if this happens to you. 

Check your own skin regularly, ideally once a month, and systematically to catch any potential changes. 

When you check your skin, look out for the ABCDEs:

• A is for asymmetry: the two halves of the mole do not match. 

• B is for border: suspicious moles may have uneven borders, with scalloped or notched edges and a rough surface. Benign moles are generally round or oval-shaped.

• C is for colour: melanomas are typically irregular and non-uniform in colour.

• D is for diameter and dynamics: changes in the skin are suspicious when they exceed a certain size (2–6 mm) and change in colour, size or shape at a certain rate.

• E is for elevation: a raised mole (>1 mm) and a rough, scaly surface are suspicious.

Your doctor can identify any moles that look suspicious and that may potentially lead to cancer. This way skin cancer can be caught as early as possible – always with the aim of treating it quickly. The types of skin cancer that are the main focus here are basal cell carcinoma and squamous cell carcinoma (both non-melanoma skin cancer), as well as malignant melanoma.

Studies show that skin cancer is being caught more frequently thanks to early detection. Nevertheless, early detection has not been proven to slow the rate of diagnosis of basal cell carcinoma, squamous cell carcinoma or a malignant melanoma, nor has it been proven to improve the rate of survival. The benefit of screening also depends on your individual skin cancer risk.

Individuals with a very light complexion, those who often spend time in the sun and older people have an increased risk of skin cancer. Women generally have a lower risk than men. Men aged 65 and older have the highest risk.

Early detection means that the severity of the disease can be reduced. Skin cancer screening can provide information at the time of the examination as to whether the skin has changed or whether there are signs of skin cancer. But screening cannot predict or prevent skin cancer. Its sole purpose is early detection.

Skin cancer screening is not invasive. Your doctor only examines the skin’s surface. However, one downside may be that a mole is determined to be suspicious. This can cause uncertainty and mental stress and may lead to further examinations. Often the suspicious mole turns out to be harmless. If your doctor identifies a change in your skin that appears to be malignant but ultimately never becomes harmful, this is called an overdiagnosis. This means that it would not become necessary to clarify the situation. How often a ‘false positive’ occurs in not clear yet. But it may also be the case that skin cancer is not identified and therefore goes untreated, even though treatment would be a good idea.

First your doctor takes your medical history. How often have you spent time in the sun or in a tanning salon? How often have you had sunburn? Do you have relatives who have had skin cancer? Your doctor then systematically examines your entire body for any noteworthy changes in your skin, including on your head and your nose and mouth. His eyes are trained to find noteworthy changes. Noteworthy changes especially include spots that have become dark and moles that have changed edges or are of a certain size. After examining your skin, the doctor will discuss the result of the screening with you and advise you on recommended courses of action, such as spending time in the sun in moderation.

The skin examination is not painful. But some patients do find it unpleasant to have to fully undress for the screening.  

The early detection screening by a doctor is recommended for individuals aged 35 and older. The examination should be conducted every two years. This is a statutory service offered every two years for all insurants aged 35 and older. Example: if a person has a skin cancer screening in July 2015, they will have the option of having another early detection examination from January 2017. All you need to do is present your SBK healthcare card. If you yourself discover a suspicious spot or mole on your skin, you can have it examined by your GP at any time as a treatment service. Here, too, you just need to present your SBK health care card.

You can get a skin cancer screening from a GP specialist, dermatologist, venereologist or internist. There is one condition, however: your doctor must be certified to conduct a skin cancer screening. This is necessary in order for the examination to be charged as a statutory health service. Ask your doctor ahead of time whether they can charge for the service through the health care card.

Yes. SBK covers the cost of skin cancer screenings up to a maximum of 25 euros every day for insurants who are under the age of 35. Screening can be carried out by approved GPs. In Bavaria and Lower Saxony, the costs are only covered for participating practitioners. Your personal consultant will gladly provide you with information on participating practitioners.

In Bavaria, Lower Saxony and Bremen, screening is covered by the health care card. In other federal states, you will receive a private invoice. Send the invoice to SBK by post to SBK, 80227 Munich, Germany, or through your personal consultant. 

From the age of 35, skin cancer screening every two years is a statutory service and is charged through the health care card.

In addition to skin cancer screening for individuals aged 35 and older, which is a statutory health service, there are also personalised health care services for early detection of skin cancer. These include, for example, reflected light microscopy and video dermoscopy. They are not recommended by the Federal Joint Committee (G-BA) as screening for early detection in healthy individuals and are therefore services that insurants must pay for themselves.

With reflected light microscopy, the dermatologist uses a dermoscope (reflected light microscope) to shine additional light onto the skin. This method should in theory allow for better evaluation of spots and moles compared to just assessing the skin with the naked eye. The benefits of this method, however, have not yet been proven.

As yet there is no proven advantage of reflected light microscopy as an early detection examination method over the standard examination with the naked eye. For this reason, reflected light microscopy is still a personalised health care service.

With video dermoscopy, the images of individual pigmented moles are stored on a computer. They are primarily used to check and monitor the progression of spots and moles on the skin. They serve as documentation of how the skin has changed. 

The Federal Joint Committee has not included video dermoscopy in the catalogue of statutory services because as yet there is no proven advantage of video dermoscopy over the standard examination. For this reason, it is still a personalised health care service.