Prognostic impact of the type of anaesthesia used during the excision of primary cutaneous melanoma

The prognostic value of the type of anaesthesia used for the excision of ma lignant tumours has been a subject of controversy. Cell mediated as well as humoural immune responses can be compromised after general anaesthesia, an d recurrences may therefore occur more frequently. On the other hand, excis ion of primary tumours under local anaesthesia might also influence the pro gnosis unfavourably. The aim of the present study was to determine the prog nostic impact of general and local anaesthesia for the primary excision of cutaneous melanoma. Follow-up data of 4329 patients on the Central Melanoma Registry of the German Dermatological Society were analysed. Cox proportio nal hazards analysis was performed to evaluate the independent significance of the prognostic factors, and survival probabilities were calculated for matched pairs using Kaplan-Meier estimates. Statistical analysis revealed a n independent significant effect on survival for tumour thickness, ulcerati on, level of invasion, anatomical site and gender. General anaesthesia for primary excision of melanoma was associated with a decrease in the survival rate (relative risk 1.46, P < 0.0001). This study revealed a slight but si gnificantly increased risk of death for patients treated with general anaes thesia for the primary excision of melanoma. Therefore local anaesthesia sh ould be preferred for the treatment of primary melanoma. (C) 2000 Lippincot t Williams & Wilkins.