title: Evidence and interdisciplinary consensus-based German guidelines: surgical treatment and radiotherapy of melanoma.
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.
authors.affiliation: University Department of Dermatology, Tübingen, Germany. claus.garbe@med.uni-tuebingen.de
authors.forename: Claus
authors.initials: C
authors.lastname: Garbe
authors.forename: Axel
authors.initials: A
authors.lastname: Hauschild
authors.forename: Matthias
authors.initials: M
authors.lastname: Volkenandt
authors.forename: Dirk
authors.initials: D
authors.lastname: Schadendorf
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Stolz
authors.forename: Uwe
authors.initials: U
authors.lastname: Reinhold
authors.forename: Rolf-Dieter
authors.initials: RD
authors.lastname: Kortmann
authors.forename: Christoph
authors.initials: C
authors.lastname: Kettelhack
authors.forename: Bernhard
authors.initials: B
authors.lastname: Frerich
authors.forename: Ulrich
authors.initials: U
authors.lastname: Keilholz
authors.forename: Reinhard
authors.initials: R
authors.lastname: Dummer
authors.forename: Günther
authors.initials: G
authors.lastname: Sebastian
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Tilgen
authors.forename: Gerold
authors.initials: G
authors.lastname: Schuler
authors.forename: Andreas
authors.initials: A
authors.lastname: Mackensen
authors.forename: Roland
authors.initials: R
authors.lastname: Kaufmann
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D008197:Lymph Node Excision; D008545:Melanoma / Q000532:radiotherapy* / Q000601:surgery*; D012878:Skin Neoplasms / Q000532:radiotherapy* / Q000601:surgery*