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KMID : 0363219720100010067
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Korean Journal of Dermatology
1972 Volume.10 No. 1 p.67 ~ p.72
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TREATMENT OF MALIGNANT MELANOMA WITH SPECIAL REGARDS TO RADIATION THERAPY
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Haage, Horst
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Abstract
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Treatment of malignant melanoma has gone different ways some thirty years ago. Since at that time radiotheraphy did not bring acceptable results, surgical treatment widely has been used and developed, especially in the Anglo-American countries. Radiotherapy was performed in cases with metastasis only. In European countries on the other side, particulary in Germany,. Switzerland and in the; Netherlands, irradiation was common, due to the development of shortdistance-irradiation by CHAOUL, which I have to talk about a little later.
I myself learnt as a principle, that malignant melanoma never should be touched and treated surgically without preoperative irradiation. The does given was approximately 6, 000 to 12, 000 rads. But I am a radiologist and was taught as a Radiologist. Surgeons of course have other-conceptions and they prefer to use the scalpell.
Drell, I am talking now to dermatologists and you are the one making the diagnosis, for you will see melanomas most frequently. I have not to explain to you the difficulties in. diagnostic. There should be no doubt, if there exists already a nevus which will be changed in form, colour and so on. Itching of this areas, an inflammatory margin is highly suspicious and there is almost no question any more, if you find enlarged regional lymphnodes. But the change from nevus to malignant melanoma is rare. KORTING and also EKBLAD found a relation of 1 to 1 million of all nevus-cell-nevi. Otherwise 35 to 40% of the melanomas occure on the basis of nevus-cell-nevus. In the senium malignant melanoma will develope more often from the melanosis circumscripta preblastomatosa DUBREUILH. Those are to be said a relatively good prognosis.
The main bad melanomas are: the achromic melanoma, marked by a highly malignant clinical course and early lymphnode metastasis: there are however some unpigmented melanomas occuring on the heel, that may have a favorable clinical course and, although they attain considerable size, metastasize late: the ulcerated melanoma, generally of rapid growth: the tumors with satellite nodules and the very raised tumors, which may occupy a small area of skin, but which tend to metastasize early via the hematogeneous and lymphatic pathways. It should be emphasized, that a very simple, but quite useful rule in prognostic evaluation is the fact, that the more raised the melanomas, the worse the prognosis.
Treatment without any diagnosis should not be allowed, it is said. But what to do with
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