Evidence and interdisciplinary consensus-based German guidelines: surgical treatment and radiotherapy of melanoma

Authors:
  • AHAxel Hauschild
    Axel Hauschild
  • MVMatthias Volkenandt
    Matthias Volkenandt
  • DSDirk Schadendorf
    Dirk Schadendorf
  • WSWilhelm Stolz
    Wilhelm Stolz
  • URUwe Reinhold
    Uwe Reinhold
  • RKRolf-Dieter Kortmann
    Rolf-Dieter Kortmann
  • CKChristoph Kettelhack
    Christoph Kettelhack
  • BFBernhard Frerich
    Bernhard Frerich
  • UKUlrich Keilholz
    Ulrich Keilholz
  • RDReinhard Dummer
    Reinhard Dummer
  • GSGünther Sebastian
    Günther Sebastian
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Abstract
The primary treatment of a melanoma is surgical excision. An excisional biopsy is preferred, and safety margins of 1 cm for tumor thickness up to 2 mm and 2 cm for higher tumor thickness should be applied either at primary excision or in a two-step procedure. When dealing with facial, acral or anogenital melanomas, micrographic control of the surgical margins may be preferable to allow reduced safety margins and conservation of tissue. The sentinel lymph node biopsy should be performed in patients whose primary melanoma is thicker than 1.0 mm and this operation should be performed in centers where both the operative and nuclear medicine teams are experienced. In clinically identified lymph node metastases, radical lymph node dissection is considered standard therapy. If distant metastases involve just one internal organ and operative removal is feasible, then surgery should be seen as therapy of choice. Radiation therapy for the primary treatment of melanoma is indicated only in those cases in which surgery is impossible or not reasonable. In regional lymph nodes, radiation therapy is usually recommended when excision is not complete (R1 resection) or if the nodes are inoperable. In distant metastases, radiation therapy is particularly indicated in bone metastases, brain metastases and soft tissue metastases.

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