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Malignes Melanom − Früherkennung, Diagnostik und Nachsorge

Malignant melanoma—early recognition, diagnostics and aftercare

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Das maligne Melanom ist eine häufige Hautkrebsart mit einer sehr hohen Mortalität. In Europa versterben jährlich etwa 22.000 Menschen daran, davon etwa 2700 Patienten alleine in Deutschland. Die Inzidenz zeigt seit Jahren eine steigende Tendenz. Bedeutende Risikofaktoren für die Entstehung eines malignen Melanoms sind die Anzahl der melanozytären Nävi am Körper, eine positive Familienanamnese für Melanom und genetische Prädisposition.

Ziel

In dieser Arbeit soll auch dem Nichtdermatoonkologen eine Übersicht über die Diagnostik, Behandlung, Stadieneinteilung und Nachsorge des malignen Melanoms vermittelt werden.

Material und Methoden

Es wurde eine selektive Literaturrecherche in Medline über Pubmed erstellt und mit eigenen Erfahrungen der Autoren ergänzt.

Ergebnisse

Es werden 4 klinische Formen des Melanoms unterschieden: superfiziell spreitende Melanome (SSM), Lentigo-maligna-Melanome (LMM), akral-lentiginöse Melanome (ALM) und noduläre Melanome (NM). Diese unterscheiden sich sowohl in ihrem klinischen Erscheinungsbild, ihrer Lokalisation und Entwicklung und letztlich auch ihrer Prognose, die für das ALM und NM am ungünstigsten ist. Zur Diagnosesicherung und zur klinischen und pathologischen Stadieneinteilung ist eine operative Erstversorgung von kutanen Melanomen unerlässlich. Ab einer Tumordicke nach Breslow über 1 mm wird die diagnostische Exzision des Wächterlymphknotens (WLK) empfohlen. Bei Befall des WLK sollte zunächst eine Ausbreitungsdiagnostik mittels Schnittbildgebung erfolgen. Ist eine Exzision und Nachexzision und ggf. die WLK-Biopsie erfolgt, wird eine stadiengerechte Ausbreitungsdiagnostik empfohlen. Die empfohlene Nachsorge des malignen Melanoms gestaltet sich stadienadaptiert und entsprechend der aktuellen Leitlinie.

Abstract

Background

Malignant melanoma is a frequent form of skin cancer with a very high mortality. In Europe approximately 22,000 people die each year due to melanoma, of which 2700 patients in Germany alone. The incidence has shown an increasing tendency for years. Significant risk factors for the emergence of a malignant melanoma are the number of melanocytic naevi on the body, a positive family history for melanomas and a genetic predisposition.

Objective

The aim of this article is to give an overview for non-dermatologists on the diagnostics, treatment, stage classification and aftercare of malignant melanoma.

Material and methods

A selective literature search was carried out in Medline via PubMed and supplemented by personal experiences of the authors.

Results

A differentiation can be made between four clinical types of melanoma: superficial spreading melanoma (SSM), lentigo maligna melanoma (LMM), acral lentiginous melanoma (ALM) and nodular melanoma (NM). These types can be differentiated by the clinical phenotype, the localization and development of primaries and finally in the prognosis, which is most unfavorable for ALM and NM. For confirmation of the diagnosis and for clinical and pathological stage classification, an initial operative treatment of cutaneous melanomas is essential. The diagnostic excision of sentinal lymph nodes is recommended for a tumor thickness according to Breslow over 1 mm. In cases of involvement of the sentinel lymph nodes spread diagnostics with sectional imaging should first be carried out. When an excision and follow-up excision and if necessary a sentinal lymph node biopsy have been carried out, stage-conform distribution diagnostics are recommended. The recommended aftercare of malignant melanoma is stage adapted and conforms to the current guidelines.

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Authors and Affiliations

  1. HTCC – Hauttumorzentrum Charité, Klinik für Dermatologie, Venerologie und Allergologie, Charité – Universitätsmedizin Berlin, Luisenstr. 2, 10117, Berlin, Deutschland

    Gabor Dobos, Kimberley Farmer, Felix Kiecker &  Claas Ulrich

  2. HTZH Haut-Tumor-Zentrum Hannover, Medizinische Hochschule Hannover, Hannover, Deutschland

    Ralf Gutzmer

Authors
  1. Gabor Dobos
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  2. Kimberley Farmer
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  3. Ralf Gutzmer
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  4. Felix Kiecker
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  5. Claas Ulrich
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Corresponding author

Correspondence to Claas Ulrich.

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Interessenkonflikt

G. Dobos, K. Farmer, R. Gutzmer, F. Kiecker und C. Ulrich geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Dobos, G., Farmer, K., Gutzmer, R. et al. Malignes Melanom − Früherkennung, Diagnostik und Nachsorge. Onkologe 24, 453–463 (2018). https://doi.org/10.1007/s00761-018-0379-y

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