title: Management of primary and metastasized melanoma in Germany in the time period 1976-2005: an analysis of the Central Malignant Melanoma Registry of the German Dermatological Society.
abstract: This study analysed the changes of excision margins in correlation with tumour thickness as recorded over the last three decades in Germany. The study also evaluated surgical management in different geographical regions and treatment options for metastasized melanoma. A total of 42 625 patients with invasive primary cutaneous melanoma, recorded by the German Central Malignant Melanoma Registry between 1976 and 2005 were included. Multiple linear regression analysis was used to investigate time trends of excision margins adjusted for tumour thickness. Excision margins of 5.0 cm were widely used in the late 1970s but since then have been replaced by smaller margins that are dependent on tumour thickness. In the case of primary melanoma, one-step surgery dominated until 1985 and was mostly replaced by two-step excisions since the early 1990s. In eastern Germany, one-step management remained common until the late 1990s. During the last three decades loco-regional metastases were predominantly treated by surgery (up to 80%), whereas systemic therapy decreased. The primary treatment of distant metastases has consistently been systemic chemotherapy. This descriptive retrospective study revealed a significant decrease in excision margins to a maximum of 2.00 cm. A significant trend towards two-step excisions in primary cutaneous melanoma was observed throughout Germany. Management of metastasized melanoma showed a tendency towards surgical procedures in limited disease and an ongoing trend to systemic treatment in advanced disease.
authors.affiliation: Department of Dermatology, Skin Cancer Program, Central Malignant Melanoma Registry of the German Dermatological Society, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany.
authors.forename: Silke S
authors.initials: SS
authors.lastname: Schwager
authors.forename: Ulrike
authors.initials: U
authors.lastname: Leiter
authors.forename: Petra G
authors.initials: PG
authors.lastname: Buettner
authors.forename: Christiane
authors.initials: C
authors.lastname: Voit
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Marsch
authors.forename: Ralf
authors.initials: R
authors.lastname: Gutzmer
authors.forename: Helmut
authors.initials: H
authors.lastname: Näher
authors.forename: Harald
authors.initials: H
authors.lastname: Gollnick
authors.forename: Eva Bettina
authors.initials: EB
authors.lastname: Bröcker
authors.forename: Claus
authors.initials: C
authors.lastname: Garbe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D005858:Germany; D006801:Humans; D016014:Linear Models; D008297:Male; D008545:Melanoma / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*