February 25, 2025, 3:47 pm | Read time: 6 minutes

White skin cancer is a danger that is often overlooked. It occurs ten times more frequently than malignant melanoma and increasingly affects young people. White skin cancer grows on the surface and also into the skin, which sometimes means that a lot of tissue has to be cut out. The rarer form, known as squamous cell carcinoma, is more difficult to detect than the darker basal cell carcinoma. FITBOOK tells you which skin changes urgently require a visit to the dermatologist.

How Basal Cell Carcinoma and Squamous Cell Carcinoma Develop

Basal cell carcinoma originates from the basal cells, a special cell layer in the skin. Squamous cell carcinoma originates from the so-called spindle cells, which are also found in the skin. In the event of damaging sunburn, the cells in the skin set repair mechanisms in motion, and it is precisely this process that can lead to malfunctions — we then speak of “degenerated cells:” cancer.

This Is How Many People Develop White Skin Cancer Every Year

The biggest driver of both forms of white skin cancer is regular sun exposure over the course of a lifetime. Accordingly, the average risk of developing the disease is 70 years. The incidence – i.e., the number of new cases within a year, averages 200 per 100,000 inhabitants in the USA. By comparison, “only” 20 per 100,000 inhabitants develop malignant melanoma.¹ These figures come from the USA. Oncologist Dr. Rainer Lipp considers them to be much more reliable than “our” figures: “Germany cannot present such incidences because we don’t have a proper tumor database,” the Managing Director of the German Oncology Foundation tells us. For Germany, he estimates the number of new cases of white skin cancer per year to be slightly lower, as we have fewer hours of sunshine overall (1716 hours vs. 2628 hours).²

Why More and More Young People Are Affected

According to Lipp, more and more younger people are developing white skin cancer today. According to the expert, the figures were driven by tanning beds — a trend over the last few decades that has now “fortunately” declined sharply.

In Lipp’s opinion, however, new cases of basal cell carcinoma and squamous cell carcinoma have not quite reached their peak: “We are now also dealing with the effects of a sun protection policy from the 1970s, 1980s, and 1990s, which many people from today’s perspective are fatally lax about,” says Lipp. Just think of the idea of applying coconut oil for tanning (which offers zero sun protection) or applying sun cream with a sun protection factor of 2, 4, or 8.

Fortunately, things are different today, where we have the choice between 30 and 50 sun protection, and hardly anyone (still) uses anything less. Moreover, the “toaster” has also slowly become obsolete: the use of sunbeds has fallen by a good 85 percent since the turn of the millennium, from an average of 11 percent to 1.6 percent in 2015.³

White Skin Cancer — Differences and Similarities Between Basal Cell Carcinoma and Squamous Cell Carcinoma

Back to white skin cancer and its forms: Basal cell carcinoma is far more common than squamous cell carcinoma: 80 vs. 20 percent of cases. What both types of skin cancer have in common is that …

• they grow steadily — growth can also be very slow
• they grow locally (along the surface and also into the skin)

What distinguishes squamous cell carcinoma and basal cell carcinoma beyond their frequency and initial cells is their appearance:

• Squamous cell carcinomas result in a yellowish, scaly change in the skin
• Basal cell carcinomas are somewhat darker (not black!), also yellowish-greyish, and therefore easier to recognize

Squamous cell carcinomas cannot be scratched away with a finger and start to bleed if you try. Sometimes, rosettes also form around them.

What Makes It Difficult to Detect the Extent of the Disease

“White skin cancer generally rarely spreads to other tissues and can be tackled locally,” explains Lipp. However, what makes it difficult to detect its extent is the fact that the carcinomas can not only grow to the surface but also “into the skin.” If the local growth is very advanced, very deep surgery is required; in other words, a lot has to be cut out. This is why it is important not to wait forever to have a check-up if suspicious skin changes have been discovered on the face (especially the lip or nose) or neck — basal cell carcinoma and squamous cell carcinoma dominate here.

Crux of the Operation and Likelihood of Relapse

Early surgical removal ensures an extremely high chance of recovery. The frequency of recurrence of white skin cancer after successful treatment (ointments are used in addition to surgery) is less than three percent. This means that in 97 percent of cases, white skin cancer does not return within five years “if the operation is done well and everything has really been cut out,” adds the oncologist. This is often not the case and the reason for relapses.

Crucial points during surgery: “Surgeons must plan for a sufficient resection margin.” This means that slightly more than the diseased area is cut out — a kind of safety margin. The oncologist shares that there are now surgical procedures that can also visualize the extension into the skin. However, not every dermatologist has this option, which is why the expert advises having such operations performed in a derma center (which can be found in every large city).

In terms of figures, more people die from white skin cancer than from black skin cancer — but this is due to the number of cases, which is much higher (200 vs. 20 per 100,000 inhabitants). The chances of curing white skin cancer — whether basal cell carcinoma or squamous cell carcinoma — are very good due to local growth.

When Does Skin Cancer Become Malignant?

A cancer is malignant when it grows beyond its borders, invasively, or metastasizes, i.e., it grows into other tissues. Both basal cell carcinoma and squamous cell carcinoma can, therefore, be or become malignant. Squamous cell carcinoma has many benign precursors, such as the so-called actinic keratoses. Once it has progressed, it becomes malignant. Lipp advises: “If you suspect it, have a dermatologist take a close look at it.” Because at some point, the local growth is so strong that very deep surgery is required. Which can sometimes be disfiguring.

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Cervical Carcinoma Causes, Symptoms and Treatment of Cervical Cancer

Skin Health Sunny Days in March — Do I Need UV Protection Now?

Everyone Should Do This As a Preventative Measure

It can’t be said often enough: sun cream with a high SPF, sun cream with a high SPF, sun cream with a high SPF! “Unfortunately, it’s still a very common myth that you can’t get a tan with a sun protection factor of 50,” says Lipp. All it means is that you are 50 times better protected from the sun. So: “Don’t sizzle in the sun from morning to night and avoid sunburns.” This is the best way to prevent the development of white skin cancer.