Diagnostik und adjuvante therapie des malignen melanoms

Background: The incidence of malignant melanoma has tripled in the last 20 years. More than 90% of all melanomas are diagnosed as primary tumor without metastases, today. Diagnosis: A significant improvement in the staging of melanoma patients is the introduction of the sentinel node biopsy in recent years. It is performed in melanomas of more than 1 mm Breslow's thickness. Treatment with Interferon alpha: High-risk melanomas of more than 1.5 mm thickness (Stage II), exulceration, special localization (like the anal canal) or lymph node metastases (Stage III), are an indication for adjuvant therapy. Of all substances used, only interferon α has been shown to significantly increase disease-free and overall survival. In order to achieve these effects, interferon α has to be applied in high-dosage regimens. Low-dose regimens used in Stage II disease, have so far only led to an increase of the disease-free survival without effect on overall survival. Of the known effects of interferon α, the immune modulatory seems to be less important than the antiangiogenic and antiproliferative effects. Therefore, today interferon α is tested in large randomized trials over longer periods (5 years). Further Therapeutic Perspectives: Adjuvant vaccination strategies with tumor cell lysates or with specific tumor antigens, as well as antiangiogenic substances are promising and currently under clinical investigation, while older strategies like the use of BCG have not shown significant effects.