MANAGEMENT OF PRIMARY MALIGNANT-MELANOMA IN THE GERMAN-SPEAKING COUNTRIES DURING THE YEARS 1983 TO 1993 - A STUDY OF THE CENTRAL MALIGNANT-MELANOMA REGISTRY OF THE GERMAN DERMATOLOGICAL SOCIETY

During the past decade more than 90% of all melanoma patients in the G erman-speaking countries have been diagnosed with a primary tumour alo ne. Therefore, surgical intervention has been the most important eleme nt in the management of these patients. The present investigation was performed to analyse the different surgical procedures used in the tre atment of primary melanoma during the years 1983-1993. The primary tre atment of 15,054 patients with malignant melanoma and without recogniz able metastasis has been examined. During the time period under invest igation the percentage of cases treated with two-step surgical managem ent increased from 30% to 60%. Primary excision was performed in local anaesthesia in 40% of all patients in 1983, whereas in 1993 surgical intervention under local anaesthesia had increased up to 80%. Over the same time, the average safety margin decreased from 33 mm to 21 mm fo r the final excision of primary melanomas, and this decrease was paral leled by marked decrease in the average thickness of the tumours excis ed from 2.1 to 1.5 mm. Elective node dissection was performed in 5% of all patients in 1983, whereas 9% of patients underwent elective node dissection in 1993. The different centres participating were found to differ noticeably in the therapeutic procedures applied for similar In dications. In conclusion, the management of primary malignant melanoma has changed considerably during the years 1983-1993 in the German spe aking area in favour of a two-step surgical procedure, local anaesthes ia for the excision of the primary tumour and smaller safety margins. It seems that earlier diagnosis of the tumour and also ideas about tre atment design may be responsible for these changes.