Operative Therapie des malignen Melanoms

The right operative therapy plays a key role in the management of malignant melanoma. If the diagnosis of melanoma is likely, an excision biopsy of the entire pigmented lesion is strongly recommended. After the diagnosis has been confirmed by histology, a safety margin should be excised in accordance with the tumor thickness (a 1-cm safety margin in tumors up to 2 mm in thickness and 2 cm in tumors thicker than 2 mm). In melanoma of the face or genital region, the safety margins can be reduced if the tumors are excised under micrographic control. In patients with a vertical tumor thickness of 1 mm or more, it is recommended to obtain a sentinel lymph node biopsy (SLNB). In the case of unfavorable prognostic factors such as ulceration or regression of the primary tumor or Clark level IV or V, a SLNB is recommended even in primary tumors of less than 1 mm thickness. A radical regional lymphadenectomy is recommended in cases of lymph node metastases. Distant metastases involving only one organ should be excised if possible. If the patient has multiple skin metastases (in-transit or satellite metastases) in only one extremity, isolated limb perfusion (melphalan with or without TNF-α) is an effective treatment combining surgical and oncologic strategies.