Operative Therapie des malignen Melanoms

Zusammenfassung

Die operative Therapie ist maßgeblich im Behandlungskonzept des malignen Melanoms. Sie ist essentieller Bestandteil der Diagnosesicherung, des Stagings und der Therapie in allen Stadien der Erkrankung. Die optimale Planung und Durchführung der Primärexzision, der Sentinel-Lymphknoten-Biopsie und der Nachexzision mit Sicherheitsabstand legen den Grundstein einer erfolgreichen Behandlung, die neben oder auch in Kombination mit einer modernen Systemtherapie die Metastasen-Chirurgie miteinschließt.

Abstract

Surgical therapy is an important part of the treatment concept for malignant melanoma. It is an essential component of confirming the diagnosis, staging and therapy in all stages of the disease. Optimal planning and execution of the primary excision, sentinel lymph node biopsy and postexcision with a safety margin lay the foundation for successful treatment, which includes metastatic surgery in addition to or in combination with systemic therapy.

• Literatur

• 1 Tronnier M, Garbe C, Bröcker EB. et al. Standards in histopathologic diagnosis of malignant melanomas. Recommendations of the Working Group of the Central Malignant Melanoma Registry of the German Dermatologic Society. Hautarzt 1997; 48: 720-729
• 2 Tran KT, Wright NA, Cockerell CJ. Biopsy of the pigmented lesion – when and how. J Am Acad Dermatol 2008; 59: 852-871
• 3 Martin RCG, Scoggins CR, Ross MI. et al. Is incisional biopsy of melanoma harmful?. Am J Surg 2005; 190: 913-917
• 4 Pflugfelder A, Weide B, Eigentler TK. et al. Incisional biopsy and melanoma prognosis: Facts and controversies. Clin Dermatol 2010; 28: 316-318
• 5 Stell VH, Norton HJ, Smith KS. et al. Method of biopsy and incidence of positive margins in primary melanoma. Ann Surg Oncol 2007; 14: 893-898
• 6 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): Diagnostik, Therapie und Nachsorge des Melanoms, Langversion 3.3, 2020, AWMF-Register-Nr.: 032/024OL. http://www.leitlinienprogrammonkologie.de/leitlinien/melanom/
• 7 Sladden MJ, Balch C, Barzilai DA. et al. Surgical excision margins for primary cutaneous melanoma. Cochrane Database Syst Rev 2009; (04) CD004835DOI: 10
• 8 Kenady DE, Brown BW, McBride CM. Excision of underlying fascia with a primary malignant melanoma: effect on recurrence and survival rates. Surgery 1982; 92: 615-618
• 9 Wheatley K, Wilson JS, Gaunt P. et al. Surgical excision margins in primary cutaneous melanoma: A meta-analysis and Bayesian probability evaluation. Cancer Treat Rev 2016; 42: 73-81
• 10 Veronesi U, Cascinelli N. Narrow excision (1-cm margin). A safe procedure for thin cutaneous melanoma. Arch Surg 1991; 126: 438-441
• 11 McLeod M, Choudhary S, Giannakakis G. et al. Surgical treatments for lentigo maligna: a review. Dermatol Surg 2011; 37: 1210-1228
• 12 Mohrle M, Schippert W, Garbe C. et al. Prognostic parameters and surgical strategies for facial melanomas. J Dtsch Dermatol Ges 2003; 1: 457-463
• 13 Stevenson O, Ahmed I. Lentigo maligna: prognosis and treatment options. Am J Clin Dermatol 2005; 6: 151-164
• 14 Kunte C, Geimer T, Baumert J. et al. Prognostic factors associated with sentinel lymph node positivity and effect of sentinel status on survival: an analysis of 1049 patients with cutaneous melanoma. Melanoma Res 2010; 20: 330-337
• 15 Mays MP, Martin RCG, Burton A. et al. Should all patients with melanoma between 1 and 2 mm Breslow thickness undergo sentinel lymph node biopsy?. Cancer 2010; 116: 1535-1544
• 16 McMasters KM, Wong SL, Edwards MJ. et al. Factors that predict the presence of sentinel lymph node metastasis in patients with melanoma. Surgery 2001; 130: 151-156
• 17 Kretschmer L, Thoms KM, Peeters S. et al. Postoperative morbidity of lymph node excision for cutaneous melanomasentinel lymphonodectomy versus complete regional lymph node dissection. Melanoma Res 2008; 18: 16-21
• 18 Morton DL, Cochran AJ, Thompson JF. et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg 2005; 242: 302-313
• 19 Warycha M, Polsky D, Osman I. et al. Metaanalysis of sentinel lymph node positivity in thin melanoma (≤ 1 mm). JAAD 2009; 60: AB10
• 20 Nguyen CL, McClay EF, Cole DJ. et al. Melanoma thickness and histology predict sentinel lymph node status. Am J Surg 2001; 181: 8-11
• 21 Gutzmer R, Satzger I, Thoms KM. et al. Sentinel lymph node status is the most important prognostic factor for thick (> or = 4 mm) melanomas. J Dtsch Dermatol Ges 2008; 6: 198-203
• 22 Scoggins CR, Bowen AL, Martin RC. et al. Prognostic information from sentinel lymph node biopsy in patients with thick melanoma. Arch Surg 2010; 145: 622-627
• 23 Paek SC, Griffith KA, Johnson TM. et al. The impact of factors beyond Breslow depth on predicting sentinel lymph node positivity in melanoma. Cancer 2007; 109: 100-108
• 24 Puleo CA, Messina JL, Riker AI. et al. Sentinel node biopsy for thin melanomas: which patients should be considered?. Cancer Control 2005; 12: 230-235
• 25 Socrier Y, Lauwers-Cances V, Lamant L. et al. Histological regression in primary melanoma: not a predictor of sentinel lymph node metastasis in a cohort of 397 patients. Br J Dermatol 2010; 162: 830-834
• 26 Morton DL, Wen DR, Wong JH. et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992; 127: 392-399
• 27 Bostick P, Essner R, Glass E. et al. Comparison of blue dye and probeassisted intraoperative lymphatic mapping in melanoma to identify sentinel nodes in 100 lymphatic basins. Arch Surg 1999; 134: 43-49
• 28 Kretschmer L, Peeters S, Beckmann I. et al. Intraoperative detection of sentinel lymph nodes in cutaneous malignant melanoma – blue dye alone versus blue dye plus gamma detection. J Dtsch Dermatol Ges 2005; 3: 615-622
• 29 Lens MB, Dawes M, Goodacre T. et al. Elective lymph node dissection in patients with melanoma: systematic review and meta-analysis of randomized controlled trials. Arch Surg 2002; 137: 458-461
• 30 Starritt EC, Uren RF, Scolyer RA. et al. Ultrasound examination of sentinel nodes in the initial assessment of patients with primary cutaneous melanoma. Ann Surg Oncol 2005; 12: 18-23
• 31 Koers K, Francken AB, Haanen BAG. et al. Vemurafenib as neoadjuvant treatment for unresectable regional metastatic melanoma. J Clin Oncol 2013; 31: e251-e253
• 32 der Ploeg APT, van Akkooi ACJ, Rutkowski P. et al. Prognosis in patients with sentinel node-positive melanoma without immediate completion lymph node dissection. Br J Surg 2012; 99: 1396-1405
• 33 Meier F, Will S, Ellwanger U. et al. Metastatic pathways and time courses in the orderly progression of cutaneous melanoma. Br J Dermatol 2002; 147: 62-70
• 34 Kretschmer L, Beckmann I, Thoms KM. et al. Factors predicting the risk of in-transit recurrence after sentinel lymphonodectomy in patients with cutaneous malignant melanoma. Ann Surg Oncol 2006; 13: 1105-1112
• 35 Brand CU, Ellwanger U, Stroebel W. et al. Prolonged survival of 2 years or longer for patients with disseminated melanoma. An analysis of related prognostic factors. Cancer 1997; 79: 2345-2353
• 36 Sanki A, Scolyer RA, Thompson JF. Surgery for melanoma metastases of the gastrointestinal tract: indications and results. Eur J Surg Oncol 2009; 35: 313-319
• 37 Delaunay MM, Amici JM, Avril MF. et al. Surgery of pulmonary metastasis from malignant melanoma. Results and criteria of surgical excision. Ann Dermatol Venereol 1991; 118: 287-295
• 38 Petersen RP, Hanish SI, Haney JC. et al. Improved survival with pulmonary metastasectomy: an analysis of 1720 patients with pulmonary metastatic melanoma. J Thorac Cardiovasc Surg 2007; 133: 104-110
• 39 Roaten JB, Pearlman N, Gonzalez R. et al. Identifying risk factors for complications following sentinel lymph node biopsy for melanoma. Arch Surg 2005; 140: 85-89
• 40 Even-Sapir E, Lerman H, Lievshitz G. et al. Lymphoscintigraphy for sentinel node mapping using a hybrid SPECT/CT system. J Nucl Med 2003; 44: 1413-1420
• 41 Mar MV, Miller SA, Kim EE. et al. Evaluation and localization of lymphatic drainage and sentinel lymph nodes in patients with head and neck melanomas by hybrid SPECT/CT lymphoscintigraphic imaging. J Nucl Med Technol 2007; 35: 10-20