[Continuity dissection in malignant melanoma of the skin]

The dissection incontinuity is indicated for the treatment of malignant melanomas of the skin with high risk and favourable anatomic positions of the lesions. The performance of the incontinuity operation means to remove the primary site, intervening lymphatics and regional lymph nodes en bloc. Intransit- and micrometastases can be excised in addition to the tumor in stadium I of the disease. Melanomas with high risk are all nodular types as well as all other types of the levels IV and V. In level III the selection was made more appropriate to the addition of thickness measurements (greater than 1.5 mm). There were no operative mortalities in this series of 36 cases with high risk melanomas. The morbidity in the postoperative period with ileus, pulmonary embolism and hemorrhage in three patients could be controlled with appropriate measures. The large operation wounds measuring to 60 cm in length and 12 cm in width were closed by dermanaplasties and skin grafting. In two cases only necrosis of the wound edges impaired the healing somewhat; five patients developed edema. In 12 cases the dissection incontinuity was combined with an elective lymphadenectomy of the axillary and in 26 cases of the inguinal groups. Micrometastases in one node were found in three patients; four patients developed metastases. The after-care period with 19 month is still to short for final evaluations. Since the potential for nodal metastases can be reasonably predicted, the performance of dissection incontinuity with elective regional lymphadenectomy continues outweigh any hypothetical disadvantage.