Malignant melanoma—early recognition, diagnostics and aftercare

Background: Malignant melanoma is a frequent form of skin cancer with a very high mortality. In Europe approximately 22,000 people die each year due to melanoma, of which 2700 patients in Germany alone. The incidence has shown an increasing tendency for years. Significant risk factors for the emergence of a malignant melanoma are the number of melanocytic naevi on the body, a positive family history for melanomas and a genetic predisposition. Objective: The aim of this article is to give an overview for non-dermatologists on the diagnostics, treatment, stage classification and aftercare of malignant melanoma. Material and methods: A selective literature search was carried out in Medline via PubMed and supplemented by personal experiences of the authors. Results: A differentiation can be made between four clinical types of melanoma: superficial spreading melanoma (SSM), lentigo maligna melanoma (LMM), acral lentiginous melanoma (ALM) and nodular melanoma (NM). These types can be differentiated by the clinical phenotype, the localization and development of primaries and finally in the prognosis, which is most unfavorable for ALM and NM. For confirmation of the diagnosis and for clinical and pathological stage classification, an initial operative treatment of cutaneous melanomas is essential. The diagnostic excision of sentinal lymph nodes is recommended for a tumor thickness according to Breslow over 1 mm. In cases of involvement of the sentinel lymph nodes spread diagnostics with sectional imaging should first be carried out. When an excision and follow-up excision and if necessary a sentinal lymph node biopsy have been carried out, stage-conform distribution diagnostics are recommended. The recommended aftercare of malignant melanoma is stage adapted and conforms to the current guidelines.