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Therapie von Hautmetastasen beim malignen Melanom

Therapy of cutaneous metastases of malignent melanoma

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Zusammenfassung

Das maligne Melanom stellt aufgrund der hohen und weiter steigenden Inzidenz und der schlechten Prognose von Patienten mit dickem Primärtumor (T3, T4) eine besondere Herausforderung für Dermatologen und Onkologen dar. Bei fortgeschrittenem Tumorleiden kommt den kutanen und subkutanen Melanommetastasen besondere Bedeutung zu, da sie die betroffenen Patienten stark beeinträchtigen und zu einer Einschränkung der Lebensqualität führen können. Hier besteht die Möglichkeit zur topischen Therapie, zu der es allerdings nur wenige klinische Studien gibt. Bei der Therapieentscheidung müssen Lokalisation, Anzahl, Größe und Verteilung der Hautmetastasen, Beteiligung innerer Organe, Alter sowie Allgemeinzustand des Patienten berücksichtigt werden. Insbesondere bei solitären, gut zugänglichen Hautmetastasen stellt die chirurgische Exzision die Therapie der Wahl dar. Alternativ ist die Metastasenentfernung mittels CO2-Laser möglich. Bei ausgedehnter Metastasierung im Bereich einer Extremität ist die Durchführung einer isolierten Extremitätenperfusion mit Melphalan sowie bei multiplen kleineren Hautmetastasen eine Bestrahlung indiziert. Weiterhin gibt der Beitrag eine Übersicht über derzeit überwiegend im „Off-label-Bereich“ topisch, peri- und intraläsional eingesetzte Chemotherapeutika und Immunmodulatoren.

Abstract

Malignant melanoma represents a particular challenge for dermatologists and oncologists because of its high and increasing incidence and the poor prognosis of patients with thick primary tumors (T3, T4). In advanced stages of melanoma, cutaneous and subcutaneous metastases have a special significance, as they markedly affect the patient and may lead to a limitation in quality of life. While topical therapy is possible, there are only limited clinical studies. The location, number, size and distribution of skin metastases, involvement of internal organs, age and general condition should be considered in assessing therapeutic options. Especially with solitary, easily accessible metastases, surgical excision represents the therapy of choice. Ablation using CO2 laser is an alternative. With extensive metastases in just one extremity, isolated limb perfusion (ILP) with melphalan is an option, while multiple, smaller metastases can be irradiated. Further, several chemotherapeutic agents and immune modulators can be used topically, peri- and intralesionally.

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Literatur

  1. Balch CM, Soong SJ, Gershenwald JE et al. (2001) Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol 19: 3622–3634

    PubMed  Google Scholar 

  2. Bong AB, Bonnekoh B, Franke I et al. (2002) Imiquimod, a topical immune response modifier, in the treatment of cutaneous metastases of malignant melanoma. Dermatol 205: 135–138

    Article  Google Scholar 

  3. Burke K, David M, Junge K, Sindermann H (1994) Overview on the clinical development of miltefosine solution (Miltex(r)) for the treatment of cutaneous breast cancer. Drugs today 30 [Suppl B]: 59–72

  4. Burris HA, Vogel CL, Castro D et al. (1998) Intratumoral cisplatin/epinephrine-injectable gel as a palliative treatment for accessible solid tumors: a multicenter pilot study. Otolaryngol Head Neck Surg 118: 496–503

    Article  PubMed  Google Scholar 

  5. Cascinelli N, Clemente C, Bufalino R et al. (1993) Perinodular injection of thymopentin (TP 5) in cutaneous and subcutaneous metastases of melanoma. Mel Res 3: 471–476

    Google Scholar 

  6. Clark J, Grabs AJ, Parsons PG et al. (1994) Melphalan uptake, hyperthermic synergism and drug resistance in a human cell culture model for the isolated limb perfusion of melanoma. Melanoma Res 4: 365–370

    Article  PubMed  Google Scholar 

  7. Creech O Jr, Krementz E (1966) Techniques of regional perfusion. Surgery 60: 938–947

    PubMed  Google Scholar 

  8. Fenig E, Eidelevich E, Njuguna E et al. (1999) Role of radiation therapy in the management of cutaneous malignant melanoma. Am J Clin Oncol 22: 184–186

    Article  PubMed  Google Scholar 

  9. Fierlbeck G, d’Hoedt B, Stroebel W et al. (1992) Intraläsionale Therapie von Melanommetastasen mit rekombinantem Interferon-β. Hautarzt 43: 16–21

    PubMed  Google Scholar 

  10. Fraker DL (1999) Hyperthermic regional perfusion for melanoma and sarcoma of the lims. Curr Probl Surg 36: 841–907

    PubMed  Google Scholar 

  11. Garbe C, Hauschild A, Volkenandt M et al. (2005) Deutsche Leitlinie: Malignes Melanom, In: Garbe C (Hrsg) Interdisziplinäre Leitlinien zur Diagnostik und Behandlung von Hauttumoren. Thieme, Stuttgart, S 23–55

  12. Gibson SC, Byrne DS, McKay AJ (2004) Ten-year experience of carbon dioxide laser ablation as treatment for cutaneous recurrence of malignant melanoma. Br J Surg 91(7): 893–895

    Article  PubMed  Google Scholar 

  13. Grünhagen DJ, de Wilt JH, van Geel AN, Eggermont AM (2006) Isolated limb perfusion for melanoma patients – a review of its indications and the role of tumor necrosis factor-α. Eur J Surg Oncol 32: 371–380

    Google Scholar 

  14. Hoeller C, Jansen B, Heere-Ress E et al. (2001) Perilesional injection of r-GM-CSF in patients with cutaneous melanoma metastases. J Invest Dermatol 117: 371–374

    Article  PubMed  Google Scholar 

  15. Illig L, Paul E (1976) Unspezifische epifokale Immuntherapie des malignen Melanoms der Haut mit DNCB nach Malek-Mansour. Hautarzt 27: 579–587

    PubMed  Google Scholar 

  16. Kaplan I, Ger R, Sharon U (1973) The carbon dioxide laser in plastic surgery. Br J Plast Surg 26: 359–362

    PubMed  Google Scholar 

  17. Karrer S, Szeimies RM, Hohenleutner U, Landthaler M (2001) Role of lasers and photodynamic therapy in the treatment of cutaneous malignancy. Am J Clin Dermatol 2(4): 229–237

    Article  PubMed  Google Scholar 

  18. Katalinic A, Kunze U, Schafer T (2003) Epidemiology of cutaneous melanoma and non-melanoma skin cancer in Schleswig-Holstein, Germany: incidence, clinical subtypes, tumour stages and localization (epidemiology of skin cancer). Br J Dermatol 149(6): 1200–1206

    Article  PubMed  Google Scholar 

  19. Kozlov AP, Moskalik KG (1980) Pulsed laser radiation therapy of skin tumors. Cancer 46: 2172–2178

    Article  PubMed  Google Scholar 

  20. Lindner P, Doubrovsky A, Kam PC, Thompson JF (2002) Prognostic factors after isolated limb perfusion with cytotoxic agents for melanoma. Ann Surg Oncol 9: 127–136

    Google Scholar 

  21. Lingam MK, McKay AJ (1995) Carbon dioxide laser ablation as an alternative treatment for cutaneous metastases from malignant melanoma. Br J Surg 82(10): 1346–1348

    PubMed  Google Scholar 

  22. Loquai C, Nashan D, Metze D et al. (2004) Imiquimod, pegyliertes Interferon-α-2b und Interleukin-2 in der Behandlung kutaner Melanommetastasen. Hautarzt 55:176–181

    Article  PubMed  Google Scholar 

  23. Malek-Mansour S (1973) Remission of melanoma with DNCB treatment. Lancet 2: 503–504

    Article  PubMed  Google Scholar 

  24. Meier F, Will S, Ellwanger U et al. (2002) Metastatic pathways and time courses in the orderly progression of cutaneous melanoma. Br J Dermatol 147(1): 62–70

    Article  PubMed  Google Scholar 

  25. Oratz R, Hauschild A, Sebastian G et al. (2003) Intratumoral cisplatin/adrenaline injectable gel for the treatment of patients with cutaneous and soft tissue metastases of malignant melanoma. Mel Res 13(1): 59–66

    Article  Google Scholar 

  26. Overgaard J, Gonzalez Gonzales D, Hulshof MC et al. (1995) Randomised trial of hyperthermia as adjuvant to radiotherapy for recurrent or metastatic malignant melanoma. European society for hyperthermic oncology. Lancet 345: 540–543

    Article  PubMed  Google Scholar 

  27. Radny P, Caroli UM, Bauer J et al. (2003) Phase II trial of intralesional therapy with interleukin-2 in soft-tissue melanoma metastases. Br J Canc 89: 1620–1626

    Article  Google Scholar 

  28. Ragnarsson-Olding B, Djureen-Martensson E, Mansson-Brahme E, Hansson (2005) Loco-regional control of cutaneous metastases of malignant melanoma by treatment with miltefosine (Miltex). Acta Oncol 44(7): 773–777

    Google Scholar 

  29. Rajpar SF, Marsden JR (2006) Imiquimod in the treatment of lentigo maligna. Br J Dermatol 155(4): 653–656

    Article  PubMed  Google Scholar 

  30. Rapprich H, Hagedorn M (2006) Intraläsionäre Behandlung mit Interferon-β beim metastasierten Melanom. JDDG 4: 743–746

    Article  PubMed  Google Scholar 

  31. Ridolfi L, Ridolfi R, Ascari-Raccagni A et al. (2001) Intralesional granulocyte-monocyte colony-stimulating factor followed by subcutaneous interleukin-2 in metastatic melanoma: a pilot study in elderly patients. J Eur Acad Dermatol Venereol 15: 218–223

    Article  PubMed  Google Scholar 

  32. Rosenberg SA, Yang JC, White DE et al. (1998) Durability of complete responses in patients with metastatic cancer treated with high-dose interleukin-2. Ann Surg 228: 307–319

    Article  PubMed  Google Scholar 

  33. Rossi CR, Foletto M, Mocellin S et al. (2004) Hyperthermic isolated limb perfusion with low-dose tumor necrosis factor-α and melphalan fur bulky in-transit melanoma metastases. Ann Surg Oncol 11(2): 173–177

    Google Scholar 

  34. Sauze WT (1991) Fraction size in external beam radiation therapy in the treatment of melanoma. Int J Radiat Oncol Bil Phys 20: 419–432

    Google Scholar 

  35. Schraffordt Koops H, Vaglini M, Suciv S et al.(1998) Prophylactic isolated limb perfusion for localized, high-risk limb melanoma: results of a multicenter randomized phase III trial. J Clin Oncol 16: 2906–2912

    Google Scholar 

  36. Sebastian G, Stein A (2006) Das maligne Melanom der Haut. Uni-Med Science, Bremen, S 99

  37. Stanley MA (2002) Imiquimod and the imidazoquinolones: mechanism of action and therapeutic potential. Clin Exp Dermatol 27: 571–577

    Article  PubMed  Google Scholar 

  38. Stevens G, McKay MJ (2006) Dispelling the myths surrounding radiotherapy for treatment of cutaneous melanoma. Lancet Oncol 7(7): 575–583

    Article  PubMed  Google Scholar 

  39. Strobbe LJ, Hart AA, Rümke P et al. (1997) Topical dinitrochlorobenzene combined with systemic dacarbazine in the treatment of recurrent melanoma. Mel Res 7: 507–512

    Article  Google Scholar 

  40. Strobbe LJ, Nieweg OE, Kroon BB (1997) Carbon dioxide laser for cutaneous melanoma metastases: indications and limitations. Eur J Surg Oncol 23(5): 435–438

    Article  PubMed  Google Scholar 

  41. Thompson JF, Gianoutsos MP (1992) Isolated limb perfusion for melanoma: effectiveness and toxicity of cisplatin compared with that of melphalan and other drugs. World J Surg 16: 227–233

    Article  PubMed  Google Scholar 

  42. Thompson JF, Scolyer RA, Kefford RF (2005) Cutaneous Melanoma. Lancet 365: 687–701

    PubMed  Google Scholar 

  43. Vrouenraets BC, Nieweg OE, Kroon BB (1996) Thirty-five years of isolated limb perfusion for melanoma: indications and results. Br J Surg 83: 1319–1328

    PubMed  Google Scholar 

  44. Wieberdink J, Benck Huysen C, Braat RP et al. (1982) Dosimetry in isolation perfusion of the limbs by assessment of perfused tissue volume and grading of toxic tissue reactions. Eur J Cancer Clin Oncol 18: 905–910

    Article  PubMed  Google Scholar 

  45. Wolf IH, Smolle J, Binder B et al. (2003) Topical imiquimod in the treatment of metastatic melanoma to skin. Arch Dermatol 139: 273–276

    Article  PubMed  Google Scholar 

  46. Wolf P, Rieger E, Kerl H (1993) Topical photodynamic therapy with endogenous porphyrins after application of 5-aminolevulinic acid. An alternative treatment modality for solar keratoses, superficial squamous cell carcinomas, and basal cell carcinomas? J Am Acad Dermatol 28(1): 17–21. Erratum in: J Am Acad Dermatol 29(1): 41

    Google Scholar 

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  1. Klinik und Poliklinik für Dermatologie am Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307 , Dresden, Deutschland

    P. Rehberger, S. Eppinger, A. Stein & J. Schmitt

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  1. P. Rehberger
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  2. S. Eppinger
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  3. A. Stein
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Correspondence to P. Rehberger.

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Rehberger, P., Eppinger, S., Stein, A. et al. Therapie von Hautmetastasen beim malignen Melanom. Hautarzt 57, 1143–1153 (2006). https://doi.org/10.1007/s00105-006-1253-1

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