Zusammenfassung
Die prognostische Aussagekraft verschiedener Klassifikationssysteme für das maligne Melanom wird an einem Kollektiv von 2495 langfristig beobachteten Patienten untersucht.
Die TUmordicke nach Breslow erweist sich beim primären Melanom als stärkster Prädiktor für das Überleben der Patienten, während dem Invasionslevel nach Clark in multivariater Analyse erst nach der Lokalisation des Primärtumors und dem Geschlecht des Patienten Bedeutung zukommt. Eine stetig indirekt — proportionale Beziehung zwischen Tumordicke und Überleben ermöglicht die Neufestsetzung von Dickegruppen. Intervallgrenzen bei 1, 2 und 4 Millimetern ohne Berücksichtigung der Invasionstiefe führen hierbei zu einer — nach prognostischen Kriterien — besonders günstigen Einteilung.
In fortgeschrittenen Krankheitsstadien kann zwischen lokoregionärer und Fernmetastasierung unterschieden werden, wobei im ersteren Fall in-transit und Satellitenmetastasen von regionärem Lymphknotenbefall signifikant abzugrenzen sind.
Isolierte juxtaregionäre Lymphknotenmetastasen traten primär oder im Verlauf der Beobachtung bei lediglich 19 Patienten unserer Untersuchungsgruppe auf und boten im Vergleich zu viszeraler Metastasierung einen nur unwesentlichen prognostischen Vorteil. Die Zuordnung zu einem gemeinsamen Stadium erscheint daher sinnvoll.
Summary
The prognostic value of various classification systems for malignant melanoma was investigated in a population of 2495 patients who were observed long term. In the case of primary melanoma, Breslow’s tumor thickness proved to be the most powerful predictor of patient survival, while in multivariate analysis, the significance of Clark’s level ranged after that of both localization of the primary tumor and the sex of the patient. A continuous indirectly proportional relationship between tumor thickness and survival makes it possible to regrade thickness groups. Grading cutoffs at 1, 2 and 4 mm, with no account taken of depth of invasion, result in a particularly favorable classification in terms of prognostic criteria. In advanced stages of the disease, differentiation can be made between locoregional and distant metastases; in the former case, intransit and satellite metastases differ significantly from regional lymph node involvement.
Isolated juxtaregional lymph node metastases occurred primarily or during the course of the observation period in only 19 patients in our group and, in comparison with visceral metastases, have only an insignificantly better prognosis. For this reason, it would appear meaningful to assign them to a common stage.
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Häffner, A.C., Garbe, C., Burg, G., Orfanos, C.E., Rassner, G. (1992). Zur Klassifizierung maligner Melanome nach prognostischen Kriterien. In: Burg, G., Hartmann, A.A., Konz, B. (eds) Onkologische Dermatologie. Fortschritte der operativen und onkologischen Dermatologie, vol 7. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-77690-8_20
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