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Introduction: Survival of patients with malignant melanoma primarily depends on tumor stage. Hungarian National Cancer Registry does not specify tumors according to TNM stages., Aim: The authors aimed to survey the stage distribution of melanomas at the Department of Dermatology, Dermatooncology and Venerology, Semmelweis University., Method: 1160 patients (558 males and 602 females, aged 60.5±16 and 57±17 years, respectively) diagnosed with cutaneous melanoma between 2004-2009 were included., Results: In comparison with international studies, the case distribution was favorable in stages IA and IV, i.e. the proportion of early melanomas was relatively high (IA: 43.8%), while the incidence in stage IV was low (0.4%). In stages IB-IIA the incidence was significantly lower, while in IIC, IIIA, IIIB it was higher as compared to published data from Western-Europe, Australia and the United States., Conclusions: The study underlines the necessity of prevention and awareness campaigns that may result in increase of early diagnosis of melanomas.

Pathological classification of malignant melanoma did not change in the past decade, it was just completed with UV-induced skin alterations. A new feature, however, is the establishment of molecular classification of melanoma indicating that beside the most frequent genetic alterations (BRAF, NRAS, CKIT mutations) there is a wide variety of rare molecular subclasses. Unfortunately, none of these genetic alterations can be used to discriminate benign lesions from malignant ones. The frequently used "melanoma" markers are mostly melanosomal markers, therefore they are not helpful for this diagnostic purpose either. More recently, novel FISH kits have been developed analyzing characteristic copy number alterations specific for malignant melanoma. Though melanosomal markers are helpful in differencial diagnostics, the presence of normal melanocytes in various tissues (lymph nodes, intestine or brain) requires application of molecular techniques when melanoma metastasis is in question.

Approximately one third of clinical Stage I melanoma patients will experience disease recurrence. The author reviews the main prognostic factors predicting the outcome of melanoma patients, the incidence, pattern and time of first metastases. Of all recurrences, two third will occur earlier by the lymphatic, and one third later by the hematogenous pathway. 75-80% of recurrences develop in the first 3 years, 3-4% of metastases occur after 10 years of disease-free interval. The data emphasize the value of lifelong follow-up.

14 patients suffering from early stage mycosis fungoides were treated with interferon alpha 2-a and PUVA/1 patient in stage I a, 3 patients in stage I b, 4 patients in stage II a and 6 patients in stage II b/during 3-21 months time course. Interferon alpha 2-a was administered 3 times a week, in escalating dose from 3 MU to 9 MU, determining the individual maximal tolerated dose. All of the patients responded well to the treatment. Partial remission was observed after 4-13 weeks of treatment. Total remission developed in 8 cases, after 8 weeks- 9 months of the treatment. Side effects occurred frequently: weight loss, pain, fever, fatigue, leucopenia, thrombopenia, liver enzyme elevation. Because of the side effects the dose of the interferon was reduced individually, the dose reduction did not cause relapse.

For the evaluation of the prognosis of the melanoma malignum (MM) several markers have been used before but none of them was powerful enough therefore a search for new markers is justified. The authors have studied the expression of three metastasis associated proteins, nm23, CD44v3 and MMP2 collagenase using immunohistochemistry on the paraffin embedded tissue samples of 22 primary skin melanomas. The expression of these markers was independent from the thickness of the tumor or the clinical stage of the disease. Due to the frequent discrepancy between the thickness of the tumor and the actual outcome of the disease, they regrouped the cases according to the biological behaviour of the tumor into non-metastatic, lymph node-metastatic and organ metastatic forms. Based on the MMP2 expression +/- tumors can be found but the expression does not correspond to the biological behaviour of MM while decreased nm23 expression characterized the lymph node metastatic tumors. CD44v3 expression was rare in MM and occurred at low level, however, when expressed it showed significant correlation to the organ metastatic phenotype. The authors concluded that the classic invasion markers in case of MM have a limited potential in the characterisation of the invasive phenotype, therefore more sensitive markers are necessary.