Therapie und Nachsorge des kutanen Melanoms

Surgical treatment of primary cutaneous melanoma has significantly changed in the last decades. Tumors are excised with lateral margins of 1-2 cm depending on the depth of tumor infiltration, and reconstructive procedures for defect closure are rarely necessary. Elective lymph node dissection has been replaced by the sentinel lymph node procedure and radical lymph node dissection is restricted to patients with positive lymph nodes. Follow-up of melanoma has been adapted to the individual risk profile of the patient. In early stage melanoma only clinical follow-up examinations are warranted. Ultrasound investigations of the regional lymph nodes is recommended for patients with locally advanced melanoma and with lymph nodes metastases. CT-scans, MRI and PET/CT are recommended only for stage III patients and it has to be taken into account that these evaluations may have only limited value regarding the prognosis of the patients. In stage IV melanoma, the follow-up scheme should be adapted to the individual needs of the patient.