[Prognosis-oriented therapy of malignant melanoma. New concepts]

Similar to other countries, the incidence of malignant melanoma (MM) is significantly increasing in the Federal Republic of Germany. In established MM, curative therapeutic measures are limited. Current worldwide effort is therefore being directed toward its early recognition and the immediate surgical removement of the primary tumor, with a safety margin of at least 3 cm from the edge of the tumor in all cases. General anesthesia seems preferable and is used in most German university departments of dermatology. Another essential requirement is to subdivide clinical stage I into several risk groups since the 5-year survival rate of each individual case included in this stage may vary from greater than 90% to less than 50%; this can be accomplished by analyzing two main prognostic criteria that will largely determine the final outcome: tumor thickness, and tumor localization. Sex may also play a role in some cases. Other prognostic factors should also be considered. The selection of postoperative therapeutic measures (including prophylactic immunotherapy, prophylactic chemotherapy, and prophylactic regional lymphadenectomy) will then depend on the prognostic risk expected for each patient. This approach means that all of the main individual parameters must be carefully evaluated, and this is time-consuming, but it seems to be more appropriate than any other method for achieving optimal therapeutic results. When MM are in the late metastasizing clinical stages only palliative measures are currently possible, and there is little hope, if any, for a final cure.