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Epidemiologie und Risikofaktoren des malignen Melanoms

Epidemiology and risk factors for malignant melanoma

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Zusammenfassung

Das maligne Melanom zeigt weltweit eine deutlich steigende Inzidenz. In Deutschland werden 12–14 neue Melanome pro 100.000 Einwohner und Jahr diagnostiziert; in Australien sind es mehr als 50. Am malignen Melanom versterben weit mehr Menschen als an allen anderen Hauttumoren zusammen. Bei den Männern waren es zu Beginn der 90er Jahre in Deutschland ca. 2,6 Fälle pro 100.000 Einwohner und Jahr und bei Frauen 1,7 Fälle. Der wichtigste prognostische Faktor ist die Tumordicke. Somit kann die Früherkennung zur Senkung der Mortalität beitragen. Bei 40% der Patienten werden Melanome vor dem 50. Lebensjahr diagnostiziert. 40% aller Melanome treten bei Frauen an den unteren Extremitäten und bei Männern am oberen Stamm auf.

Anhand der Gesamtzahl melanozytärer Nävi, der Zahl atypischer Nävi und der Eigen- und Familienanamnese bezüglich des Melanoms lassen sich Risikogruppen definieren. Risikopatienten sollten sich regelmäßig vom Hautfacharzt im Rahmen einer Ganzkörperinspektion untersuchen lassen. Eine anamnestische Veränderung eines solitären pigmentierten oder nichtpigmentierten Hauttumors sollte zur Exzision mit histologischer Untersuchung führen. Bei Patienten mit einer besonders hohen Zahl atypischer Nävi sollten diese dokumentiert werden (z. B. Computerdermatokopie, Speicherung digitaler Bilder). Hinweise zum Vorgehen bei Risikopatienten werden gegeben.

Die Prävention kann langfristig die Inzidenz des Melanoms senken. Gerade im Kindesalter spielt dies eine bedeutende Rolle, da zu diesem Zeitpunkt ein Großteil der Nävi als spätere Risikofaktoren für Melanome erworben wird. Adäquate Kleidung und gesundheitsbewusstes Verhalten schützen vor Nävi und Melanomen; für Sonnencreme alleine ist ein protektiver Effekt nicht bewiesen.

Abstract

The incidence of cutaneous melanoma is increasing worldwide. In Germany an incidence of 12–14 cases per 100,000 inhabitants and year is registered; in Australia the incidence exceeds 50 cases. Mortality due to cutaneous melanoma is higher than for all other nonmelanoma skin cancers together. At the beginning of the 1990s, mortality in Germany reached 2.6 cases per 100,000 inhabitants and year for males and 1.7 cases for females. The most important prognostic factor in melanoma is Breslow’s tumor thickness. Therefore, early detection significantly contributes toward lowering mortality. In 40% of patients melanoma already occurs before the age of 50 years. In 40% of females melanoma develops on the lower extremity and in the same percentage of males melanoma occurs on the upper trunk.

Risk groups for melanoma development can be defined based on the total number of acquired melanocytic nevi, the number of atypical melanocytic nevi, and the previous occurrence of cutaneous melanoma in the patient or his family. Persons at elevated risk should be regularly screened by a dermatologist. In cases of significant change or growth of nevi in adults, the lesion should be excised and examined by histopathology. In patients with high numbers of atypical nevi, these should be documented by computed dermoscopy and the images stored. Recommendations for screening of persons at elevated risk are outlined.

Primary preventive measures may help to lower the incidence of melanoma over a longer time. Particularly prevention of sun exposure in childhood may be suitable to prevent nevus development and thereby lower the risk of later melanoma development. Sun protective clothing and sun protective behavior are required to inhibit nevus and melanoma development; use of sunscreens alone does not seem to be suitable for melanoma prevention.

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  1. Universitäts-Hautklinik Tübingen

    A. Blum, C. Garbe & J. Bauer

  2. Universitäts-Hautklinik Tübingen, Liebermeisterstraße 25, 72076 , Tübingen

    A. Blum

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Correspondence to A. Blum.

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Blum, A., Garbe, C. & Bauer, J. Epidemiologie und Risikofaktoren des malignen Melanoms. Onkologe 10, 688–700 (2004). https://doi.org/10.1007/s00761-004-0723-2

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