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A total of 761 melanocytic lesions were studied to elucidate the usefulness of clinical features for the diagnosis of dysplastic naevi. Characteristics associated with high (irregular border, irregular pigmentation), intermediate (black coloured areas, largest diameter greater than 0.5 cm, change of size, change of colour) and low diagnostic efficiency could be defined. Combinations of criteria had high sensitivities: at least one of the following four criteria was positive in 96% of the dysplastic naevi and in all melanomas with less pronounced clinical characteristics: irregular border, irregular pigmentation, greatest diameter greater than 0.5 cm, black coloured areas. A lesion is therefore unlikely to be a dysplastic naevus or a melanoma if all these criteria are absent. When change of size and change of colour were analysed in addition to the features mentioned above a sensitivity of 0.96 was found for at least two of these six criteria. At least three of these six criteria were observed in all melanomas with less pronounced clinical characteristics. However, a rather low specificity (0.19 for at least one of four positive criteria, 0.20 for at least two of six positive criteria) indicated that dysplastic and non-dysplastic naevi cannot be clinically differentiated with acceptable certainty. With less stringent histological criteria approximately twice as high specificities were found. Specificities were about twice as high in a subgroup of patients with at least one proven dysplastic naevus besides the lesion under diagnostic consideration. This facilitates the identification of individuals at risk of developing a melanoma.
Today's treatment methods have less effect on the prognosis of malignant melanomas in the primary tumor stage, irrespective of their localization, than certain prognostically important factors related to the tumor and the tumor patient. In a validation study the dominating prognostic value of tumor thickness after Breslow (1975) and the patient's gender as two independent factors is confirmed. The retrospective comparative treatment studies on the effects of elective lymph node dissection (ELND) and the extent of excision on prognosis are based on the separate evaluation of male and female patients grouped according to tumor thickness classes (0.76 to 1.5, 1.51 to 3.0 and greater than 3.0 mm). The results confirm what was to be expected according to more recent views on the pathology of melanomas (Balch et al. 1987), i.e. that regionally preventive radical measures, particularly elective lymph node dissection, have a positive effect only in a limited intermediate stage of development. Thus, it was only in a small patient group of men with melanomas of the tumor thickness class 1.5 to 3.0 mm that there was, both in relation to the total number of patients (n = 123) and to the group of head and neck melanomas (n = 30), a prognostic difference of 26% or, respectively, 44% to the favor of lymph node dissection. All other male patients as well as the female patient group exhibited better survival rates after removal of the primary tumor without subsequent elective lymph node dissection. Based on own studies and the critical consideration of published treatment studies, a number of recommendations for differentiated treatment according to acknowledged prognostic criteria (stage-specific therapy!) are given.(ABSTRACT TRUNCATED AT 250 WORDS)