Skip to main content
SpringerLink
Log in

Aktueller Stand der Therapie des malignen Melanoms

  • Conference paper
Fortschritte der praktischen Dermatologie und Venerologie

Part of the book series: Fortschritte der praktischen Dermatologie und Venerologie ((DERMATOLOGIE,volume 15))

Zusammenfassung

Die therapeutischen Konzepte zur Behandlung maligner Melanome der Haut waren in den letzten 20 Jahren aufgrund verbesserter epidemiologischer Erfassung, retro- und prospektiver klinischer Studien und konsequenter Nachsorgeprogramme einem stetigen Wandel unterworfen. Die wichtigste Erkenntnis für die Therapieplanung war, daß die Prognose maligner Melanome in direkter Abhängigkeit zur Tiefe der Tumorinvasion steht [69]. Die Einteilung der malignen Melanome in Tumoren mit niedrigem, mittlerem und hohem Metastasierungsrisiko hat die Behandlungsstrategie neu definiert [53]. Die heute aktuellen therapeutischen Maßnahmen müssen vornehmlich unter dem Gesichtspunkt der Qualitätskontrolle und Qualitätssicherung gesehen werden. Entsprechende Richtlinien sind erstellt und werden augenblicklich diskutiert [21]. Die Ziele der Melanomtherapie sind in Abhängigkeit vom klinischen Tumorstadium kurativ, adjuvant und palliativ. Dementsprechend lassen sich die therapeutischen Möglichkeiten in drei Gruppen unterteilen [60]:

  • Standardtherapie bei malignen Melanomen im klinischen Stadium I

  • Therapiekonzepte unter Studienbedingungen bei metastasierenden Melanomen

  • Behandlungsprinzipien unter experimentellen Bedingungen bei ausgewählten Tumorkonstellationen

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 44.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 59.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  • Ackerman AB (1996) Letter to the Editor. J Am Acad Dermatol 35: 279

    Article  CAS  PubMed  Google Scholar 

  • Alex JC, Krag DN (1993) Gammaprobe guided localization of lymph nodes. Surg Oncol 2: 137–143

    Article  CAS  PubMed  Google Scholar 

  • Baas PC, Koops HS, Hoekstra HJ (1992) Groin dissection in the treatment of lower extremity melanoma: short and long term morbidity. Arch Surg 127: 281–286

    Article  CAS  PubMed  Google Scholar 

  • Bachter D, Balda BR, Vogt H, Büchels H (1996) Die „sentinel“ Lymphnodektomie mittels Szintillationsdetektor. Hautarzt 47: 754–758

    Article  CAS  PubMed  Google Scholar 

  • Balch CM, Murad TM, Soong SJ, Milton GW (1978) A multifactorial analysis of melanoma: prognostic histopathological features comparing Clark’s and Breslow’s staging methods. Ann Surg 188: 732–742

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Balch CM, Soong SJ, Milton GW, Shaw HM, McGovern VJ, Murad TM (1982) A comparison of prognostic factors and surgical results in 1786 patients with localized (stage I) melanoma treated in Alabama, USA and South Wales, Australia. Ann Surg 196: 677–684

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Balch CM, Smith TJ, Jewell WR, Raymond B (1993) Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm). Ann Surg 218: 262–269

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Bowsher WG, Taylor BA, Hughes LA (1986) Morbidity, mortality and local recurrence following regional node dissection for melanoma. Br J Surg 73: 906–908

    Article  CAS  PubMed  Google Scholar 

  • Breslow A, Macht SD (1977) Optimal size of resection margin for thin cutaneous melanoma. Surg Gynecol Obstet 145: 691–692

    CAS  PubMed  Google Scholar 

  • Breuninger H, Adis S (1991) Quantitative Darstellung lokaler Mikrosatelliten. In: Meigel W, Lengen W, Schwenzer G (Hrsg) Diagnostik und Therapie maligner Melanome. Diesbach, Berlin, S 252–254

    Google Scholar 

  • Brown C, Zitelli J (1995) The prognosis and treatment of true local cutaneous recurrent malignant melanoma. Dermatol Surg 21: 285–290

    CAS  PubMed  Google Scholar 

  • Cady B (1988) Prophylactic lymph node dissection in melanoma: does it help? J Clin Oncol 6: 2–4

    CAS  PubMed  Google Scholar 

  • Cochran AJ (1971) Studies of the melanocytes of the epidermis adjacent to tumors. J Invest Dermatol 57: 38–43

    Article  CAS  PubMed  Google Scholar 

  • Cosimi AB, Sober AJ, Mihm MC Jr (1984) Conservative surgical management of superficially invasive cutaneous melanoma. Cancer 53: 1256–1269

    Article  CAS  PubMed  Google Scholar 

  • Day CL Jr, Harrist TJ, Gorstein F, Mihm MC (1981) Malignant melanoma: prognostic significance of „microscopic satellites“ in the reticular dermis and subcutaneous fat. Ann Surg 194: 108–112

    Article  PubMed Central  PubMed  Google Scholar 

  • Drepper H, Köhler CD, Bastian B, Breuninger H, Brökker EB, Gohl J, Groth W, Hermanek P (1994) Prognosevorteil für definierte Risikogruppen durch die Lymphknotendissektion. Hautarzt 45: 615–622

    Article  CAS  PubMed  Google Scholar 

  • Elder DE, Guerry D, van Horn, Hurwitz S, Zehngebot L, Goldmann L (1985) The role of lymph node dissection for clinical stage I malignant melanoma of intermediate thickness (1.51–3.99 mm). Cancer 56: 413–418

    Article  CAS  PubMed  Google Scholar 

  • Elder DE, Guerry D, Heiberger RM (1983) Optimal resection margin for cutaneous malignant melanoma. Plast Reconstr Surg 71: 66–72

    Article  CAS  PubMed  Google Scholar 

  • van der Esch EP, Cascinelli M, Preda F, Morabito A (1981) Stage I melanoma of the skin: evaluation of prognosis according to histologic characteristics. Cancer 48: 1668–1673

    Article  Google Scholar 

  • Garbe C, Büttner P, Ellwanger U (1995) Das Zentralregister malignes Melanom der Deutschen Dermatologischen Gesellschaft in den Jahren 1983–1993. Hautarzt 46: 683–692

    Article  CAS  PubMed  Google Scholar 

  • Garbe C (1996) Entwurf zu den Leitlinien zur Qualitätssicherung in der Dermatologischen Onkologie. Omnimed, derm 2, S 17–22

    Google Scholar 

  • Glas FL, Fenske NA, Messina JL, Cruse CW, Rapaport DP (1995) The role of selective lymphadenectomy in the management of patients with malignant melanoma. Dermatol Surg 21: 979–983

    Google Scholar 

  • Goldman LI, Byrd R (1988) Narrowing resection margins for patients with low risk melanoma. Am J Surg 155: 242–244

    Article  CAS  PubMed  Google Scholar 

  • Handley WS (1907) The pathology of melanotic growths in relation to their operative treatment. Lancet 1: 927–933,996–1003

    Google Scholar 

  • Hauschild A (1996) Protokoll zur Therapieoptimierung beim malignen Melanom im Stadium der Fernmetastasierung der Arbeitsgemeinschaft Dermatologische Onkologie. Hautarzt 47: 67–68

    Article  CAS  PubMed  Google Scholar 

  • Heenan PJ, English DR, Holman CD, Armstrong BK (1992) The effects of surgical treatment on survival and local recurrence of cutaneous malignant melanoma. Cancer 69: 421–426

    Article  CAS  PubMed  Google Scholar 

  • Heenan PJ (1996) „Local recurrences“’ of completely excised melanomas are metastases to the primary surgical site. Abstract: 17th Colloquium of the International Society of Dermatopathology, Zürich, p 66

    Google Scholar 

  • Hölzel D, Klannert A, Schmidt M (1996) Krebs: Häufigkeit, Befunde und Behandlungsergebnisse. Zuck schwerdt, München, Bern, Wien, New York, S 281–295

    Google Scholar 

  • Holmstrom H (1992) Surgical management of primary melanoma. Semin Surg Oncol 8: 366–369

    Article  CAS  PubMed  Google Scholar 

  • Ho VC, Sober AJ (1990) Therapy for cutaneous melanoma: an update. J Am Acad Dermatol 22: 159–176

    Article  CAS  Google Scholar 

  • Johnson TM, Sondak VK (1995) Centimeter here, a centimeter there: does it matter? J Am Acad Dermatol 33: 532–534

    Article  CAS  PubMed  Google Scholar 

  • Karg DN, Meijer SJ, Weaver DL (1995) Minimal-access surgery for staging of malignant melanoma. Arch Surg 130: 654–658

    Article  Google Scholar 

  • Kaufmann R (1996) Operative Therapie des primären Melanoms. Onkologie 2: 449–452

    Article  Google Scholar 

  • Kelly JW, Sagebiel RW, Calderon W, Murillo L, Dakin R, Blois M (1984) The frequency of local recurrence and microsatellites as a guide to reexcision margins for cutaneous malignant melanoma. Ann Surg 20: 759–763

    Google Scholar 

  • Kenady DK, Brown BW, McBride CM (1982) Exzision of underlying fascia with a primary malignant melanoma: effect on recurrence and survival rates. Surgery 92: 615–618

    CAS  PubMed  Google Scholar 

  • Kirkwood JM, Hunt M, Ernstoff MS, Smith TJ, Borden C, Blum R (1996) Interferon-alpha-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Coopereative Oncology Groups Trial EST 1684. J Clin Oncol 14: 7–17

    CAS  PubMed  Google Scholar 

  • Kleeberg UR, Tilgen W (1996) Palliative und supportive Therapie bei Melanompatienten — das Primat des nihil nocere. Onkologe 2: 465–472

    Article  Google Scholar 

  • Koh HK, Sober AJ, Day CL Jr (1986) Prognosis of clinical stage I melanoma patients with positive elective regional node dissection. J Clin Oncol 4: 1238–1244

    CAS  PubMed  Google Scholar 

  • Koller J, Rettenbacher L, Dietze O (1996) „Sentinel lymph node detection“ in der Primärtherapie des malignen Melanoms. Zbl Haut 168: 26

    Google Scholar 

  • Konz B (1979) Melanomtherapie: Zwischenbilanz 1979. In: Braun-Falco O, Wolff HH (Hrsg) Fortschritte der praktischen Dermatologie und Venerologie, Bd 9. Springer, Berlin, S 21–30

    Google Scholar 

  • Lakhani S, Selby P, Bliss JM, Peeren TJ, Gore ME, McElwain TJ (1990) Chemotherapy for malignant melanoma: combinations and high doses produce more responses without survival benefit. Br J Cancer 61: 330–334

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Landthaler M (1993) Radikalität in der Behandlung maligner Melanome. In: Braun-Falco O, Ring J (Hrsg) Fortschritte der praktischen Dermatologie und Venerologie, Bd 13. Springer, Berlin, S 155–160

    Chapter  Google Scholar 

  • Lewis MG (1978) Möglichkeiten der Immuntherapie bei malignen Melanomen. Hautarzt 29: 619–624

    CAS  PubMed  Google Scholar 

  • McCarthy WH, Shaw HM, Milton GW (1985) Efficacy of elective lymph node dissection in 2347 patients with clinical stage I malignant melanoma. Surg Gynecol Obstet 161: 575–580

    CAS  PubMed  Google Scholar 

  • Morton DL, Wen DR, Cochran A (1992) Management of early-stage melanoma by intraoperative lymphatic mapping and selective lymphadenectomy. Surg Oncol Clin North Am 1: 247–259

    Google Scholar 

  • Morton DL, Wen DR, Wong JH et al. (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 127.392–399

    Article  CAS  PubMed  Google Scholar 

  • Olsen G (1969) Removal of fascia — cause of more frequent metastases of malignant melanomas of the skin to regional lymph nodes. Cancer 17: 1159–1164

    Article  Google Scholar 

  • Petres J, Rompel R. Büttner P, Teichelmann K, Garbe C (1996) Elektive Lymphknotendissektion bei primärem malignem Melanom. Hautarzt 47: 29–34

    Article  CAS  PubMed  Google Scholar 

  • Reintgen DS, Cox EB, McCarthy KS, Vollmer R (1983) Efficacy of elective lymph node dissection in patients with intermediate thickness primary melanoma. Ann Surg 198: 379–385

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Reintgen DS, Vollmer R, Tso CY, Seigier HF (1987) Prognosis for recurrent stage I malignant melanoma. Arch Surg 122: 1338–1342

    Article  CAS  PubMed  Google Scholar 

  • Roses DF, Harris MM, Rigel Ds, Carey Z, Friedman R, Kopf AW (1983) Local and in-transit metastases following definitive excision for primary cutaneous malignant melanoma. Ann Surg 198: 65–69

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Schadendorf D (1996) Stellungnahme zur Arbeit Petres: Elektive Lymphknotendissekion bei primärem malignen Melanom. Hautarzt 47: 722–723

    Article  CAS  PubMed  Google Scholar 

  • Schmoeckel C, Bockelbrink A, Bockelbrink H, Kistler H, Braun-Falco O (1983) Low- and high-risk malignant melanoma- — III. Prognostic significance of the resection margin. Eur J Cancer Clin Oncol 19: 245–249

    Article  CAS  PubMed  Google Scholar 

  • Seebacher C, Heubaum F, Kuster P, Steinert W, Koch R (1990) Vergleichende Analyse in Narkose und Lokalanästhesie operierter maligner Melanome der Haut. Hautarzt 41:137–141

    CAS  PubMed  Google Scholar 

  • Seigier HF, Lucas VS, Pickett RN, Huang T (1980) DTIC, CCNU, bleomycin and vincristine (BOLD) in metastatic melanoma. Cancer 46: 2346–2348

    Article  Google Scholar 

  • Silbermann AW (1987) Malignant melanoma: practical consideration concerning prophylactic lymph node dissection. Ann Surg 206: 206–209

    Article  Google Scholar 

  • Sim FH, Taylor WF, Pritchard DJ, Soule EH (1986) Lymphadenectomy in management of stage I malignant melanoma: a prospective study. Mayo Clin Proc 61: 697–705

    Article  CAS  PubMed  Google Scholar 

  • Slingluff CL, Stidham KR, Ricci WM, Stanley WE, Seigler KR (1994) Surgical management of regional lymph nodes in patients with melanoma. Ann Surg 219: 120–130

    Article  PubMed Central  PubMed  Google Scholar 

  • Tilgen W (1994) Adjuvante und palliative Therapie des Melanoms. Chirurg 65: 153–13

    CAS  PubMed  Google Scholar 

  • Tilgen W (1994) Therapie des malignen Melanoms: Derzeitiger Stand und Perspektive. In: Macher E, Kolde G, Bröcker EB (Hrsg) Jahrbuch der Dermatologie 1994/ 95: Tumoren und Haut. Biermann, Zülpich, S 123–150

    Google Scholar 

  • Urist MM, Balch CM, Soong SJ, Shaw H, Milton G, Maddox W (1985) The influence of surgical margins and prognostic factors predicting the risk of local recurrence in 3445 patients with primary cutaneous melanoma. Cancer 55: 1398–1403

    Article  CAS  PubMed  Google Scholar 

  • Urist MM, Maddox WA, Kennedy JE, Balch CM (1983) Patient risk factors and surgical morbidity after regional lymphadenectomy in 204 melanoma patients. Cancer 51: 2152–2156

    Article  CAS  PubMed  Google Scholar 

  • Van der Veen H, Hoekstra OS, Paul MA. Cuesta MA, Meijer S (1994) Gamma probe-guided sentinel node biosy to select patients with melanoma for lymphadenectomy. Brit J Surg 81: 1769–1770

    Article  PubMed  Google Scholar 

  • Veronesi U, Adamus J, Bandiera DC, Brennhovd ID, Caceres E, Cascinelli N (1982) Delayed regional lymph node dissection in stage I melanomas of the skin of the lower extremities. Cancer 49: 2420–2430

    Article  CAS  PubMed  Google Scholar 

  • Veronesi U, Adamus J, Aubert C, Bajetta E, Beretta G, Bonadona G (1982) A randomized trial of adjuvant chemotherapy and immunotherapy in cutaneous melanoma. N Engl J Med 307: 913–916

    Article  CAS  PubMed  Google Scholar 

  • Veronesi U, Cascinelli M, Adamus J, Balch C, Bandiera D, Barchuk A (1988) Thin stage I primary cutaneous malignant melanoma: comparison of excision with margins of 1 or 3 cm. N Engl J Med 318: 1159–1162

    Article  CAS  PubMed  Google Scholar 

  • Veronesi U, Cascinelli M (1991) Narrow excision (l-cm margin). A safe procedure for thin cutaneous melanoma. Arch Surg 126: 438–441

    Article  CAS  PubMed  Google Scholar 

  • Weidner F, Hornstein 0 (1972) Das Problem der regionalen Lymphknoten-Metastasierung beim malignen Melanom. Arch Dermatol Forsch 245: 50–62

    Article  CAS  PubMed  Google Scholar 

  • Wanebo HJ, Fortner JG, Woodruff J, McLean B, Binkowski E (1975) Selection of the optimum surgical treatment of stage I melanoma by depth of microinva- sion. Ann Surg 182: 302–315

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Wong CK (1970) A study of melanocytes in the normal skin sourrounding malignant melanomata. Dermatologica 141: 215–225

    Article  CAS  PubMed  Google Scholar 

  • Zeitels J, La Rossa D, Hamilton R, Synnestvedt M, Schultz D (1988) A comparison of local recurrence and resection margins for stage I primary cutaneous malignant melanomas. Plast Reconstr Surg 81: 688–693

    Article  CAS  PubMed  Google Scholar 

Download references

Authors
  1. Birger Konz
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Dermatologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Frauenlobstraße 9-11, D-80337, München, Germany

    Gerd Plewig (Direktor) (Direktor)

  2. Dermatologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Frauenlobstraße 9-11, D-80337, München, Germany

    Bernhard Przybilla

Rights and permissions

Reprints and permissions

Copyright information

© 1997 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Konz, B. (1997). Aktueller Stand der Therapie des malignen Melanoms. In: Plewig, G., Przybilla, B. (eds) Fortschritte der praktischen Dermatologie und Venerologie. Fortschritte der praktischen Dermatologie und Venerologie, vol 15. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-60534-5_40

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-60534-5_40

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-64448-1

  • Online ISBN: 978-3-642-60534-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation