Melanoma: Hauschild A

Dummer R, Hauschild A, Jost L, Anonymous00147. · Department of Dermatology, University of Kiel, Kiel, Germany. · Ann Oncol. · Pubmed #18456782 links to  free full text

This publication has no abstract.

Garbe C, Hauschild A, Volkenandt M, Schadendorf D, Stolz W, Reinhold U, Kortmann RD, Kettelhack C, Frerich B, Keilholz U, Dummer R, Sebastian G, Tilgen W, Schuler G, Mackensen A, Kaufmann R. · University Department of Dermatology, Tübingen, Germany. · Melanoma Res. · Pubmed #18337653 No free full text.

Abstract: Systemic medical treatment of melanoma is administered in the adjuvant and palliative setting. Adjuvant therapy may be considered in patients with primary melanoma with more than 1.5 mm tumor thickness and with regional node metastasis. Presently no indication for systemic adjuvant chemotherapy or for adjuvant therapy with nonspecific immune-stimulatory agents outside controlled studies is seen. Interferon-alpha is the first substance in the adjuvant therapy of melanoma, which has shown to present a significant advantage to the patients in some prospective randomized studies. Good arguments for using adjuvant interferon-alpha therapy in high-risk melanoma patients exist. Both high-dose and low-dose interferon-alpha show promise. The major indications for systemic chemotherapy and chemoimmunotherapy are inoperable recurrent tumors, inoperable regional metastases and distant metastases (stage IV). As treatment in such situations is primarily palliative, the effect of any regimen on the quality of life must be carefully weighed. As a first line treatment, single agent therapy is recommended, as polychemotherapy or biochemotherapy did not show significant advantages for prolongation of survival; hence they are more toxic. An urgent need for development of new treatment modalities is necessary and general principles of experimental immunotherapy are outlined.

Garbe C, Hauschild A, Volkenandt M, Schadendorf D, Stolz W, Reinhold U, Kortmann RD, Kettelhack C, Frerich B, Keilholz U, Dummer R, Sebastian G, Tilgen W, Schuler G, Mackensen A, Kaufmann R. · University Department of Dermatology, Tübingen, Germany. · Melanoma Res. · Pubmed #18227710 No free full text.

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.

Terheyden P, Tilgen W, Hauschild A. · Department of Dermatology, University Clinic of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany. · J Dtsch Dermatol Ges. · Pubmed #18992025 No free full text.

Abstract: Recent developments in the epidemiology, diagnosis and therapy of malignant melanoma are reviewed, with particular attention paid to established standards of care. When melanoma metastases are inoperable, they respond poorly to the various chemotherapy strategies, so that additional improvements are critically needed. Cytotoxic T-lymphocyte antigen-4 antibodies, multikinase inhibitors, anti-apoptotic strategies and several other approaches are in progress in Phase III trials both as monotherapy as well as in combination with standard chemotherapy.

Schrama D, Hauschild A, Becker JC. · Klinik für Dermatologie, Allergologie und Venerologie, Universitätshautklinik Würzburg, Josef-Schneider-Strasse 2, 97080, Würzburg, Deutschland. · Hautarzt. · Pubmed #18777167 No free full text.

Abstract: Since the efficacy of conventional therapeutic approaches is limited in patients with solid tumors, especially melanoma, there is a need for alternatives. Because of the immunogenicity of melanoma, immunotherapeutic approaches have been widely tested. Among others, therapeutic antibodies have been used. These can be distinguished by their modus operandi, e.g. induction of cellular or complement-dependent cytotoxicity against tumor cells, or modification of immune responses. The latter can be achieved by blockage of inhibitory signal pathways or stimulation of excitatory signal pathways of immune response. We discuss the immunomodulatory antibodies which are currently in clinical testing.

Egberts F, Kahler KC, Livingstone E, Hauschild A. · Department of Dermatology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany. · Onkologie. · Pubmed #18596389 No free full text.

Abstract: In advanced metastatic melanoma (AJCC stage IV), the prognosis is still poor, and views differ on the appropriate systemic treatment for these patients. Therefore, new approaches in therapeutic regimens are mandatory. Sorafenib is an oral multikinase inhibitor that targets 2 classes of kinases which are known to be involved in both tumor proliferation and angiogenesis. These kinases include Raf kinases and the vascular endothelial growth factor (VEGF) receptor. Sorafenib has been evaluated as a single therapy agent as well as in combination with various chemotherapeutical drugs in a number of clinical trials. The vast majority of clinical data exists for patients with advanced renal cell cancer for which sorafenib has been approved by the FDA and EMEA. Very recently, sorafenib was approved for advanced hepatocellular cancers due to its overall survival improvement. Since B-raf gene mutations have been found in 69% of melanoma cell lines, sorafenib was brought into various phase I/II and phase III trials in metastatic melanoma. However, as a single-agent therapy, sorafenib seems to be of limited use. Also, the combination of sorafenib with the chemotherapeutic agents carboplatin and paclitaxel has failed to show superiority in progression-free and overall survival compared to the same chemoregimen plus an oral placebo in a phase III trial (PRISM study). More promising data were observed in large-sized phase II studies on dacarbazine (DTIC) plus sorafenib and temozolomide plus sorafenib. However, these data need to be confirmed in prospective randomized phase III trials. Till then, sorafenib remains an interesting but still experimental new agent for melanoma.

Hauschild A, Rass K, Tilgen W. · Schwerpunktbereich Dermato-Onkologie und Operative Dermatologie, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Deutschland. · Hautarzt. · Pubmed #18478195 No free full text.

Abstract: Malignant melanoma is one of the most common cancers accounting for 4-5% of all human malignancies and steadily increasing in incidence. The medical management of melanoma patients in Germany can be regarded as largely standardized based upon interdisciplinary guide lines. The results of adjuvant and especially palliative treatment of melanoma are unsatisfactory. Thus there is an urgent need for controlled clinical trials in order to optimize standard treatment approaches and to evaluate new drugs. The treatment of patients affected with high risk or metastatic melanoma within those clinical trials should be standard of care. This overview delineates the most important clinical trials currently conducted or planned in the adjuvant and palliative setting of melanoma treatment.

Hauschild A, Kähler KC, Schäfer M, Fluck M. · Department of Dermatology, University Clinic Schleswig-Holstein, Campus Kiel, Germany. · J Dtsch Dermatol Ges. · Pubmed #18371051 No free full text.

Abstract: SUMMARY: Adjuvant interferon-alpha (IFN-alpha) therapy in patients with melanoma has been established as standard therapy since more than 10 years.During IFN-alpha therapy, flu-like symptoms, gastrointestinal disorders, arthralgias and neuropsychiatric symptoms are the most common side effects. The management and prophylaxis of these side effects have been improved by a more detailed understanding of pathophysiologic mechanisms and increased clinical experience. New insights in the relevance of detection of autoantibodies and development of autoimmunity have influenced the clinical pathway substantially. This review covers the pathomechanisms, incidence and optimized therapy of IFN-alpha-associated side effects.

Lorigan P, Eisen T, Hauschild A. · CRUK Department of Medical Oncology, Christie Hospital NHS Trust, Wilmslow Road, Manchester, UK. · Exp Dermatol. · Pubmed #18312390 No free full text.

Abstract: The last decade has seen a considerable improvement in the understanding of the biology of melanoma. Advances have come in the understanding of the importance of critical oncogenes and tumour suppressor genes, epigenetic phenomena, signalling pathways, drug resistance mechanisms, the pivotal role of the local immune system, and the importance of cell-cell and cell-matrix interactions. Many of these pathways and interactions include potentially 'drugable' targets. These developments have allowed the identification and/or design of a range of new, targeted therapies. Evaluation of these new drugs has brought a whole new series of challenges. These include identification of appropriate pre-clinical models, overcoming the redundancy in-built in complex biological systems, identification of appropriate molecular and clinical endpoints to show that the drug is hitting the target, how to combine treatments, and new toxicities. For the first time, there is the possibility of personalized treatment for melanoma patients, based on individual host and tumour characteristics. This paper discusses the range of new drugs and targets have been identified, the outcome of clinical trials, and the directions for future advances.

Hauschild A, Gogas H, Tarhini A, Middleton MR, Testori A, Dréno B, Kirkwood JM. · Department of Dermatology, University of Kiel, Kiel, Germany. · Cancer. · Pubmed #18236459 links to  free full text

Abstract: Interferon-alpha-2b (IFNalpha2b) is the only effective adjuvant therapy for melanoma patients at high risk of recurrence that has been approved by regulatory authorities worldwide. However, IFN toxicities increase the risk of poor treatment compliance and impair the potential for benefit from this agent. A review of the literature demonstrated little recent attention to supportive care in the management of IFN toxicities. An international group of experts with extensive personal experience in the use of IFNs worked together to develop practical guidelines for the use of IFNs. Practical recommendations were developed for patient education on the use of IFN; initial patient assessment and monitoring, including contraindications to the use of IFN, monitoring and managing adverse events, and IFN dose modification and discontinuation; IFN injection procedures; treatment of elderly patients; and use during pregnancy and nursing. Successful adjuvant therapy of melanoma with high-dose IFN requires close compliance with the treatment regimen. Recommendations for the recognition and management of adverse events are designed to enable more patients to complete the full planned course of treatment.

Krengel S, Breuninger H, Hauschild A, Höger P, Merl V, Hamm H. · Dermatology practice, Lübeck, Germany. · J Dtsch Dermatol Ges. · Pubmed #18021247 No free full text.

Abstract: In 2005, an Internet-based network for the support of patients with congenital melanocytic nevi in German-speaking countries was started (http://www.naevus-netzwerk.de). Along with detailed information for patients and parents, the home-page includes a nevus registry which is based on an electronic questionnaire and which aims at providing data on the long-term course of nevi estimated to reach > 10 cm in largest diameter. In the past, congenital melanocytic nevi have been subject to various mythological interpretations ("Tierfellnävus", lit."animal coat nevus";"Muttermal"). Today an increasing body of reliable scientific data allows a differentiated reflection of the risk of malignant transformation and has led to progress in the diagnostic and therapeutic management. Recent findings from the literature and considerations from scientific meetings are reviewed.

Hauschild A, Schadendorf D, Garbe C, Ugurel S, Kähler KC. · Department of Dermatology, University of Kiel, Kiel, Germany. · Cancer Treat Res. · Pubmed #17953423 No free full text.

This publication has no abstract.

Hauschild A. · Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Keil, Germany. · J Dtsch Dermatol Ges. · Pubmed #17376105 No free full text.

This publication has no abstract.

Becker JC, Kirkwood JM, Agarwala SS, Dummer R, Schrama D, Hauschild A. · Department of Dermatology, Julius Maximilians University, Würzburg, Germany. · Cancer. · Pubmed #17039502 links to  free full text

Abstract: Effective therapy for melanoma remains an unmet goal, with most traditional therapies representing inadequate trade-offs among the several goals of specificity, efficacy, and toxicity. Targeted molecular therapeutics are tailored to genetic abnormalities that are associated with tumor progression. Modulation of aberrant signaling pathways in cancer cells has the potential to provide more effective and potentially nontoxic therapy for a broad range of cancers, including melanoma. Among the possible targets in melanoma are the Ras-MAPK and PI3K/AKT signal transduction pathways, the proteasome, histone deacetylases, methyltransferases, and melanoma-induced angiogenesis.

Egberts F, Lischner S, Russo P, Kampen WU, Hauschild A. · Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany. · J Dtsch Dermatol Ges. · Pubmed #16928239 No free full text.

Abstract: In the treatment of malignant melanoma, various stage-dependent diagnostic and therapeutic procedures are widely accepted.The situation becomes more complicated in pregnant women due to potential hazardous side effects to the fetus. We report on a 36-year-old woman, who was admitted with a high-risk malignant melanoma on the right cheek. Prior to surgery we performed computed tomography (CT)-scans that were unremarkable with the exception of "two small cysts of the uterus" The primary melanoma was excised and a sentinel node biopsy was performed under general anesthesia using radioactive tracers. Afterwards, adjuvant therapy with interferon alpha 2b was initiated. Five weeks later our patient reported that she was pregnant with twins in their eleventh week of gestation, although she previously denied several questions regarding a potential pregnancy. She declined the offer of an abortion and elected to continue with the interferon treatment against our medical advice. In the 36(th) week of gestation, she developed regional lymph node metastases. Consequently, labor was induced, resulting in the delivery of healthy twins. Six months later our patient developed lung metastases. Despite several chemotherapy regimens, she died one year later. An interdisciplinary approach to obtaining informed consent and managing female high risk melanoma patients with potential or present pregnancy is presented.

Hauschild A, Kleeberg UR. · Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstrasse 7, 24105 Kiel. · Hautarzt. · Pubmed #16927109 No free full text.

Abstract: Four decades of clinical and basic research have laid a solid base for clinicians to choose the best possible treatment for patients with melanoma. There has been a relative and absolute decrease in mortality despite increasing incidence. However, this decline in mortality is primarily the result of programs for primary and secondary prevention, not therapeutic advances. Conventional and high-dose immunomodulatory regimens and cytostatic therapy have failed to improve the prognosis. Whether the high-dose interferon-alpha therapy introduced by Kirkwood et al. 2001 can produce sustainable improvement in cure rate is controversial. Further developments such as treatment with recombinant cytokines (especially IL-2 and GM-CSF), specific blockade of neoplastic signal transduction and vaccination are the central issues in current research. In the future the task will be to offer an highly individualized therapy plan, based on specific prognostic and risk criteria defined in molecular genetic parameters. Indiscriminate use of newer therapeutic approaches is simply not affordable in this age of shrinking financial resources for health care.

Krengel S, Hauschild A, Schäfer T. · Department of Dermatology, University of Kiel, Kiel, Germany. · Br J Dermatol. · Pubmed #16792745 No free full text.

Abstract: BACKGROUND: The risk of malignant melanoma in congenital melanocytic naevi (CMN) is a matter of controversial and ongoing debate. OBJECTIVES: The purpose of this systematic review is to provide a careful and detailed summary of the published data, including several recently published studies. METHODS: Articles on CMN (n=1424) were retrieved from Medline, 1966-October 2005. Case reports and studies lacking relevant clinical information were excluded. Only systematic collections of cases were taken into consideration. Series with fewer than 20 patients or studies with a mean follow-up of <3 years were regarded as epidemiologically less significant. RESULTS: Fourteen articles were finally chosen for further analysis. The studies varied significantly with respect to study design (source of cases; retrospective vs. prospective analysis), age of patients, follow-up time, and naevus characteristics. The frequency of melanomas ranged between 0.05% and 10.7% and was significantly higher in smaller studies (P<0.0001). In a total of 6571 patients with CMN who were followed for a mean of 3.4-23.7 years, 46 patients (0.7%) developed 49 melanomas. The mean age at diagnosis of melanoma was 15.5 years (median 7). By comparison with age-adjusted data from the Surveillance, Epidemiology and End Results database, we calculated that patients with CMN carry an approximately 465-fold increased relative risk of developing melanoma during childhood and adolescence. Primary melanomas arose inside the naevi in 33 of 49 cases (67%). In seven cases (14%), metastatic melanoma with unknown primary was encountered; in four cases (8%) the melanoma developed at an extracutaneous site. The risk of developing melanoma and the rate of fatal courses were by far highest in CMN>or=40 cm in diameter. CONCLUSIONS: The overall risk of melanoma of 0.7% in all 14 studies was lower than expected. The higher incidence of melanomas in smaller studies indicates selection bias. The melanoma risk strongly depends on the size of CMN and is highest in those naevi traditionally designated as garment naevi. The median age of 7 years at diagnosis of melanoma points to a risk maximum in childhood and adolescence. Future studies on CMN should report: (i) diameter, percentage of body surface, and localization of the CMN; (ii) percentage of naevus area removed by excision or subject to dermabrasion or other superficial treatments; (iii) mean and median age at entry into the study; (iv) mean and median follow-up time; (v) details on each melanoma case; (vi) standardized morbidity ratio of melanoma; and (vii) percentage of neurocutaneous melanosis.

Hauschild A, Egberts F, Russo P, Kähler KC. · Department of Dermatology, University of Kiel, Kiel, Germany. · Cancer Metastasis Rev. · Pubmed #16770537 No free full text.

Abstract: Approximately 20 to 25% of patients with malignant melanoma will die of metastatic disease. The current standards of care for advanced metastatic melanoma (stage IV, AJCC classification) are poor. To date, randomized trials have failed to demonstrate that one regimen is better than another. It is therefore crucial that patients with disseminated malignant melanoma be recruited into clinical trials. In recent years, there have been impressive advances in our knowledge of the biology and nature of cancer development and the growth and progression to metastasis. The approach "from bench to bedside" is current reality in the treatment of several solid tumors and hematologic malignancies. The identification of new targets to facilitate individualized melanoma treatment is now an important issue. This article will give an overview of recent developments in clinical trials of targeted therapies in metastatic melanoma patients.

Garbe C, Hauschild A, Volkenandt M, Schadendorf D, Stolz W, Kortmann RD, Kettelhack C, Frerich B, Keilholz U, Dummer R, Sebastian G, Tilgen W, Schuler G, Mackensen A, Kaufmann R. · Universitäts-Hautklinik Tübingen. · J Dtsch Dermatol Ges. · Pubmed #16638065 No free full text.

This publication has no abstract.

Thoelke A, Willrodt S, Hauschild A, Schadendorf D. · Skin Cancer Unit (German Cancer Research Center) and Department of Dermatology, University Hospital, Mannheim, Germany. · Onkologie. · Pubmed #15585982 No free full text.

Abstract: Extracutaneous malignant melanomas (EMM) require special consideration in the field of oncology due to their rareness and--depending on the localization--the frequency of late diagnosis with consecutive poor prognosis. Only 4-5% of all primary melanomas do not arise from the skin. Most frequently they originate from the mucous membranes lining the respiratory, digestive, and genitourinary tracts or in the eyes as well as in the cerebral meninges. Extracutaneous melanomas are considered to be biologically more aggressive than cutaneous melanomas. The Clark level and Breslow index used for evaluation of cutaneous melanomas are not applicable to EMM and, at present, there are no consistent, internationally accepted therapy standards for this form of the disease. For this reason, this review focuses primarily on the literature pertaining to therapeutic strategies as well as epidemiologic, biological, and diagnostic aspects of this disease.

Mohr P, Weichenthal M, Hauschild A. · Department of Dermatology, Elbeklinikum Buxtehude, Germany. · Onkologie. · Pubmed #12845206 No free full text.

Abstract: Despite intensive research and numerous clinical trials on the adjuvant treatment of patients with high-risk cutaneous melanoma, the issue is still controversial. Early positive results from studies on adjuvant chemo- and immunotherapy were based on historical controls and could not be confirmed by prospective randomized trials. The effect of interleukin-2 in the adjuvant treatment of malignant melanoma is not yet clearly defined. Combined treatment modalities like bio-chemotherapy are still to be analyzed in controlled clinical trials, and results of new studies with active specific immunization (vaccination) will only be available within the next years. Only interferon alpha (IFN alpha) has shown reproducible superiority over observation for high-risk melanoma patients in large prospective randomized trials with respect to disease-free survival (DFS) and partially for overall survival (OS). These studies resulted in the approval of IFN alpha for the adjuvant treatment of malignant melanoma in many countries. Low-dose IFN has shown significant prolongation of DFS, but so far failed to improve OS. The question whether high-dose IFN has shown enough superiority over observation with respect to OS based on one negative and two positive trials to make it the standard therapy in stage IIb,c and stage III melanoma patients still remains unanswered. Results from intermediate-dose IFN alpha, pegylated IFN alpha, and modified high-dose interferon schedules are pending. In conclusion, interferon is the cornerstone of adjuvant therapy in high-risk melanoma today, but the optimal dosage and duration of treatment are still to be defined. Patients with high-risk malignant melanoma should preferentially be treated in prospective randomized multicenter trials to give more detailed data for treatment recommendations.

Hauschild A, Rosien F, Lischner S. · Department of Dermatology, University of Kiel, Germany. · Onkologie. · Pubmed #12845205 No free full text.

Abstract: Excisional biopsy is recommended as the procedure of choice whenever there is suspicion of malignant melanoma. There are only few indications for incisional biopsies, which--in contrast to former opinions--do not worsen the prognosis. For nearly 70 years the debate about the optimal resection safety margin around the primary tumor was influenced by historical case reports and paradigms. Recently, controlled clinical studies provided new insights. Accumulating evidence over the past two decades showed that narrower surgical margins do not have any influence on the rate of advanced metastatic disease. Local recurrence is rare (approximately 0.1%) when primary tumors are thin and is seen more often (approximately 10%) in primary tumors of greater thickness (>4 mm). Analysis of the overall survival in randomized trials shows equal prognosis for malignant melanoma for narrow and wide resection margins. Due to these findings in-toto excisional biopsy for in-situ melanoma, a resection margin of 1 cm for primary tumors with a tumor thickness up to 2 mm and a resection margin of 2 cm for primary tumors greater than 2 mm appears sufficient. By this procedure primary closure of wounds will be possible in nearly all cases, morbidity and costs of surgical approaches will be reduced. For a long time it has been discussed whether prophylactic removal of lymph nodes ('elective lymph node dissection') is of benefit for melanoma patients. More recently 'selective' lymphadenectomy ('sentinel node biopsy', SNB) has been proposed to evaluate the status of the first draining lymph node ('sentinel node') of the regional basin. Several studies now demonstrate that the sentinel node evaluation for underlying metastatic disease reflects the status of the entire lymph node region and is therefore a useful prognostic factor superior to measurement of tumor thickness in primary melanoma. However, it is unclear whether sentinel node biopsy is of benefit for a better survival in affected patients.

Hauschild A, Eiling S, Lischner S, Haacke TC, Christophers E. · Universitäts-Hautklinik Kiel. · Hautarzt. · Pubmed #11757453 No free full text.

Abstract: Excisional biopsy is recommended as the procedure of choice whenever there is suspicion of malignant melanoma. Incisional biopsies are only rarely indicated. For nearly seventy years the debate about the optimum resection safety margin around the primary tumor was influenced by historical case reports and paradigms. Recently, controlled clinical studies have provided new insights. Accumulating evidence over the last two decades shows that narrower surgical margins influence neither the rate of satellites or in-transit-metastases nor the occurrence of advanced metastatic disease. Local recurrence is rare (approx. 0.1%) when primary tumors are thin and is seen more often (approx. 10%) in primary tumors of greater thickness (> 4 mm). Analysis of the overall survival in randomized trials shows equal prognosis for malignant melanoma for narrow and wide resection margins. Due to these findings in-toto excisional biopsy for in-situ melanoma, a resection margin of 1 cm for thin primary tumors (< 1 cm tumor thickness) and a resection margin of 1 to 2 cm for primary tumors greater than 1 mm appears sufficient. With these recommendations, primary closure of wounds will be possible in nearly all cases, reducing surgical costs and morbidity. This article should serve as a basis of discussion for the proposed revision of the current guidelines of the German Dermatologic Society (DDG) on the primary surgical care of melanoma patients.

Hauschild A, Christophers E. · Department of Dermatology, University of Kiel, Germany. · Virchows Arch. · Pubmed #11253124 No free full text.

Abstract: There has, for a long time, been an ongoing discussion on whether the prophylactic removal of lymph nodes ("elective lymph node dissection") is of benefit for melanoma patients. More recently, "selective" lymphadenectomy ("sentinel node biopsy", SNB) has been proposed to evaluate the status of the first draining lymph node ("sentinel node") of the regional basin. Several studies now demonstrate that the sentinel node evaluation for underlying metastatic disease reflects the status of the entire lymph node region and is therefore a useful prognostic factor. A multi-institutional study highlighted SNB status as the most significant prognostic factor, superior to measurement of tumor thickness in primary melanoma. Different techniques to detect micrometastasis within the lymph node are under current evaluation. Histology and immunohistology using antibodies against melanoma-associated antigens are routinely performed in SNs. The clinical value of reverse-transcriptase polymerase chain reaction (RT-PCR)based search for minimal melanoma disease in lymph nodes remains unclear.

Hauschild A, Volkenandt M, Garbe C. · Klinik für Dermatologie, Venerologie und Allergologie, der Christian-Albrechts-Universität Kiel. · Dtsch Med Wochenschr. · Pubmed #11098240 No free full text.

This publication has no abstract.