A-11 Anesthesia and recurrence of malignant melanoma

Cutaneous malignant melanoma is a malignant tumor, the incidence of which still increases. There is no doubt that the most effective treatment option is its early wide excision with sufficient resection margins. Surgical procedures are performed under local, regional or general anesthesia with regards to the extent of the procedure and localization of the primary lesion. We came up with a question whether the chosen type of anesthesia could have some effect on the result of therapy and recurrence of the disease. We performed a detailed review of published papers from 1980, which deal with this topic.

It has been shown that most papers disprove the previous myth about contraindication of local anesthesia in malignant melanoma surgery and suggest rather the opposite. According to the review papers concerning the effect of general anesthesia on immune system, it is obvious that standardly used anesthetics and opiates have a negative effect on the most important component of cellular immunity, which contributes on elimination of tumor cells and NK cells and cytotoxic T lymphocytes. These pharmaceuticals negatively influence the overall number and activity of these components of cell immunity and reduce the possibility to eliminate circulating tumor cells, which a healthy immune system is able to eliminate. The presentation dealing with the effect of local anesthesia provides further interesting results in lidocaine, in which is demonstrated in vitro suppression of proliferation of tumor cells and in ropivacaine, where in vitro occurs suppression of cell growth of large bowel carcinoma. The most interesting papers about the effect of anesthesia on the course of malignant melanoma include the study of German authors, who statistically demonstrated a significantly higher 10 year survival in 4329 patients with malignant melanoma operated under local anesthesia (85%) compared with patients operated under general anesthesia (79%).

Our findings have shown that chosen type of anesthesia during the surgical procedure in malignant melanoma could have an effect on recurrence of malignant melanoma, however different to what was previously assumed. It has been shown that usage of local or regional anesthesia could reduce recurrence of malignant melanoma. These results should be however supported with other, preferably prospective studies.