Malignant melanoma: microstages and individualized therapy.

In the prognosis of malignant melanoma the clinical stage and the microstage are the most important factors. According to the microstage, malignant melanomas can be divided into low-risk and high-risk melanomas. The subungual-volar melanoma seems to be an exception. Irrespective of the microstage, the prognosis of this type is probably worse than that of other types of melanoma. In patients with clinical Stage I the therapy should be individualized. In a low-risk melanoma, a wide local excision is sufficient; in a high-risk melanoma an additional regional lymph node dissection appears to be indicated; and if the primary tumour is located on an extremity a hyperthermic perfusion is also called for.