Waltraud Stroebel

Prospective Evaluation of a Follow-Up Schedule in Cutaneous Melanoma Patients: Recommendations for an Effective Follow-Up Strategy

PURPOSE To prospectively examine and evaluate the results of follow-up procedures in a large cohort of cutaneous melanoma patients. PATIENTS AND METHODS This was a prospective study in 2,008 consecutive patients with stage I to IV cutaneous melanoma from 1996 to 1998 on the yield of stage-appropriate follow-up examinations according to the German guidelines. Documentation of patient and follow-up data comprised patient demography, primary tumor specifics, and any clinical and technical examinations performed. The detection of metastasis was classified as early or late, and the means of their detection and the resulting overall survival probabilities were examined. RESULTS A total of 3,800 clinical examinations and 12,398 imaging techniques were documented. Sixty-two second primary melanomas in 46 patients and 233 disease recurrences in 112 patients were detected during this time. In stage I to III disease, physical examination was responsible for the discovery of 50% of all recurrences. In the primary tumor stages, 21% of all recurrences were discovered by lymph node sonography, with the majority being classified as early detection. Forty-eight percent of the recurrences were classified as early detection, and these patients had a significant benefit of overall survival probability. CONCLUSION The results of our study suggest that an elaborated follow-up schedule in cutaneous melanoma is suitable for the early detection of second primary melanomas and early recurrences. The intensity of clinical and technical examinations can be reduced during follow-up of patients in the primary tumor stages and may be intensified in locoregional disease. Recommendations for an effective follow-up strategy are outlined.

Primary cutaneous melanoma. Prognostic classification of anatomic location

Background. Anatomic location has been identified by several investigators as a significant prognostic factor for patients with primary cutaneous melanoma (CM). However, the best determination of higher and lower risk sites is still controversial, and the biologic significance of tumor site in the course of primary CM is unknown. The aim of the present study was to identify higher and lower risk sites based on multivariate analysis.

Ultrasound examination of regional lymph nodes significantly improves early detection of locoregional metastases during the follow-up of patients with cutaneous melanoma

In regional lymph node metastasis of cutaneous melanoma, the number and volume of involved lymph nodes are the most important prognostic factors. Several studies have revealed that palpation of the lymphatic drainage area(s) and regional lymph nodes has a high rate of false‐negative results during follow‐up. The aim of the current study was to assess the sensitivity and specificity of ultrasound versus clinical diagnosis in the detection of subcutaneous and regional metastases.

Prolonged survival of 2 years or longer for patients with disseminated melanoma

Once melanoma has metastasized to distant sites, the prognosis is usually poor, showing an overall median survival of 6‐8 months. Long term survival is extremely rare, and there is still controversy concerning the prognostic significance of therapeutic modalities. The aim of the current study was to identify important prognostic factors associated with Stage IV melanoma.

Patterns of local horizontal spread of melanomas: consequences for surgery and histopathologic investigation.

Understanding local spreading patterns of melanomas is a precondition for the localized surgical treatment and histopathologic investigation. We used hematoxylin and eosin-stained paraffin sections for a two-phase, cellular and microscopic study of patterns of lateral spread in superficial spreading melanomas (SSMs), nodular melanomas (NMs), lentigo maligna melanomas (LMMs), and acral lentiginous melanomas (ALMs). Complete histologic examination of vertical excisional margins was carried out with paraffin sections 5 mm beyond the clinical tumor border of 1395 SSMs, 376 NMs, 179 LMMs, 46 ALMs, and 37 acrally located SSMs or NMs. Further sections of embedded material were analyzed when tumor-positive margins were found. In case of continuous tumor spread, reoperations were continued until the tissue was free of tumor cells. In case of noncontinuity, a final excision was made to a minimum safety margin of 10 to 20 mm. Concentrically consecutive, 5-microm thick hematoxylin and eosin-stained sections were taken from the outside of a 10-mm safety margin inward to the clinical borders of 34 SSMs, five NMs, 10 LMMs, and five ALMs. Noncontinuous subclinical spread was found in all SSMs and NMs in the form of few isolated cell nests at the epidermis-dermis junction. Ninety-two percent of these were located within 6 mm of the central tumor. All LMMs and ALMs showed a clearly demonstrable, uninterrupted spread into the periphery at the epidermis-dermis junction, too, usually in groups of outgrowths. The probability of finding these outgrowths 5 mm beyond the clinical tumor border was 54% in LMM and ALM. Complete histologic examination of vertical excisional margins (micrographic surgery) is therefore the therapy of choice only for LMM and ALM and is inefficient for SSM and NM.

Metastatic melanoma of unknown primary origin shows prognostic similarities to regional metastatic melanoma

Metastatic melanoma of unknown primary origin accounts for approximately 2‐6% of all melanoma cases. The prognostic significance of this diagnosis is still controversial.

Melanomnachsorge: Integriertes Nachsorgekonzept der Tübinger Hautklinik sowie Ergebnisse einer Umfrage zur Melanomnachsorge an deutschen Hautkliniken

Bei standig steigender Melanomhaufigkeit gewinnt auch die Melanomnachsorge eine zunehmende Bedeutung. In diesem Beitrag wird zunachst uber ein integriertes Nachsorgekonzept berichtet, welches kooperativ von Klinik und niedergelassenen Arzten getragen wird. Weiterhin werden die Ergebnisse einer aktuellen Umfrage an deutschen Hautkliniken uber die durchgefuhrte Melanomnachsorge berichtet.

Nachsorge bei Melanompatienten

Sich sorgen um Patienten nach einer Melanomopera ration ist notwendig. Wenn bei Patienten eine lokoregionare Metastasierung eintritt, so haben sie eine Zehnjahresuberlebensrate von 20–40%, so das eine klinische und apparative Diagnostik (v.a. Lymphknotensonographie) im Rahmen der Nachsorge sinnvoll erscheint. Allerdings stirbt nach wie vor jeder 3. bis 4. Patient an den Folgen seines Melanoms.

Red circumscribed tumor on the foot

Ein 42-Jahre alter Patient berichtete von einem seit der Kindheit bestehenden rötlichen Tumor an seinem rechten Fuß. In den letzten 8 Monaten bemerkte er eine Größenzunahme ohne Farbveränderung. Der Patient war sonst gesund, hatte keine Erkrankungen und nahm keine Medikamente ein. In der Kindheit und Adoleszenz hatte er wiederholt Sonnenbrände. Die Eigenund Familienanamnese bezüglich maligner Hauttumoren war unauffällig.

Rtlicher umschriebener Tumor am Fu@@@Red circumscribed tumor on the foot

Ein 42-Jahre alter Patient berichtete von einem seit der Kindheit bestehenden rötlichen Tumor an seinem rechten Fuß. In den letzten 8 Monaten bemerkte er eine Größenzunahme ohne Farbveränderung. Der Patient war sonst gesund, hatte keine Erkrankungen und nahm keine Medikamente ein. In der Kindheit und Adoleszenz hatte er wiederholt Sonnenbrände. Die Eigenund Familienanamnese bezüglich maligner Hauttumoren war unauffällig.