[Malignant melanoma: current survey: classification, prognostic factors, therapy guidelines].

Recent statistical studies have extended our knowledge on the biological behavior of malignant melanoma (MM) and have facilitated its classification in clinical stages (I-IV). According to these results, the clinical course of MM is becoming easier to predict. On the basis of clinical and histological criteria (as there are sex of the patient, localization and thickness of the tumor, its histological type and level, irritation, ulceration as well as inflammatory tissue response) patients with high or low prognostic risk can be recognized. Basically, all MM in clinical stages I and II should be totally removed by scalpel excision as early as possible. The following therapeutic measures, however, should be adjusted to the individual prognostic risk of each patient. Since cytostatic treatment of MM in its late metastasizing stages is disappointing, it seems reasonable to apply preventive immunochemotherapy in earlier phases of the disease, particularly in selected patients showing high prognostic risk (p.e. stages Ib and IIa). At present, careful clinical studies on the combined long-term vaccination with BCG and administration of dacarbazine are underway. Their outcome has to be expected within the next 1-2 years. The preliminary trends are contradictory, ranging from a prolonged free interval to no effect at all. In stages III-IV polychemotherapy is now under clinical evaluation, with little success, if any. Dacarbazine, cisplatinum and vindesine are cytostatic drugs which may have some moderate effect in these late phases of the disease.