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Malignen Melanoms

Operative Therapie des Primärtumors

Malignant melanoma

Surgical treatment of primary tumors

  • Leitthema: Melanom
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Die vollständige Exzision des malignen Melanoms stellt die Therapie der ersten Wahl bei Primärtumoren dar. Die Bestimmung des geeigneten Sicherheitsabstands um den Primärtumor war fast 70 Jahre lang von anekdotischen Fallberichten und Dogmen geprägt, die erst durch Ergebnisse kontrollierter klinischer (prospektiv-randomisierter) Studien reduziert wurden. Die Entscheidung für oder gegen ein weniger radikales Operationsregime beeinflusst neben der Morbidität der Patienten nachweislich auch das Ausmaß der Behandlungskosten. So konnte gezeigt werden, dass mit einem risikoadaptierten Vorgehen bei der Wahl des Sicherheitsabstands ein Teil von stationären Behandlungen vermieden oder die Dauer des stationären Aufenthalts signifikant verkürzt werden kann.

Die Sentinel-node-Biopsie für Melanome ab einer Tumordicke von 1,0 mm ist neu in die Leitlinien zur Behandlung des malignen Melanoms aufgenommen worden. Der Sentinel-node-Status ist ein ausgezeichneter Prognoseparameter und könnte in Zukunft für die Auswahl der geeigneten Therapie entscheidend werden.

Abstract

Complete excision of primary melanoma tumors is the treatment of choice. Anecdotal case reports and dogmas characterized the discussion of adequate safety margins for almost 70 years. Later on, prospective randomized clinical trials introduced risk-adapted safety margins for melanoma. The decision for and against radical surgical approaches affects the morbidity of patients as well as cost efficacy significantly. Risk-adapted safety margins will reduce the number of hospitalization days in the future.

Sentinel node biopsy for melanomas with a tumor thickness of at least 1.0 mm has recently been implemented into the guidelines of malignant melanoma. The sentinel node status is an excellent prognostic factor and might be of great relevance for adequate adjuvant therapies in high-risk melanoma patients in the future.

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Authors and Affiliations

  1. Klinik für Dermatologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel

    A. Hauschild, S. Lischner & K. Kähler

  2. Klinik für Dermatologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstraße 7, 24105, Kiel

    A. Hauschild

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  1. A. Hauschild
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  2. S. Lischner
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  3. K. Kähler
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Correspondence to A. Hauschild.

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Hauschild, A., Lischner, S. & Kähler, K. Malignen Melanoms. Onkologe 10, 701–709 (2004). https://doi.org/10.1007/s00761-004-0722-3

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  • DOI: https://doi.org/10.1007/s00761-004-0722-3

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