Excerpt

Cutaneous melanoma is increasing in incidence in many of the developed countries as this form of cancer occurs predominantly in pale skinned people who expose themselves to intense sunlight, especially when taking holidays in sunny places. The increased work-load for melanoma services resulting from this increase is furthermore complicated by the fact that the individuals with the most rapid rate of increase in incidence are those over the age of 60 and especially men. Male sex and age are two poor prognostic factors for melanoma and therefore the likelihood is that despite efforts to promote primary and secondary melanoma prevention, melanoma mortality is likely to increase rather than decrease. Although the incidence trends described above are of concern, for the first time in very recent years, the advent of therapies targeted to driver mutations (such as inhibitors of BRAF) and of T cell checkpoint inhibitors which both have efficacy in melanoma is in the process of rapidly changing management of this disease. Use of both classes of drugs has been the subject of NICE technology appraisals in recent years and these have been cross referenced in the text.

As a result of these changes both in incidence and treatment, the development of a NICE Clinical Melanoma Guideline is very opportune. The fact that some of the therapeutic changes are recent however means that important issues such as the approach that can be taken to imaging during follow up, are in a state of evolution and some aspects of the Guideline may need review in the near future.

Contents

• Foreword
• Key priorities for implementation
• Key research recommendations
• Methodology
• Staging system
• Pictorial representation of the guideline recommendations
• 1. Epidemiology
  • 1.1. Introduction
  • 1.2. Epidemiological data (England data only)
  • 1.3. Incidence
  • 1.4. Mortality
  • 1.5. Survival
  • 1.6. Prevalence (survivorship)
  • 1.7. Skin cancer MDT Survey (England and Wales)
  • References
• 2. Communication and support
  • Clinical evidence
  • Cost effectiveness evidence
  • References
• 3. Diagnosing melanoma
  • 3.1. Dermoscopy and other visualisation techniques
  • 3.2. Photography
  • 3.3. Atypical spitzoid lesions
  • 3.4. Tumour samples for genetic testing
  • 3.5. Genetic testing in stage I – III melanoma
  • References
• 4. Staging of melanoma
  • Clinical evidence
  • Cost effectiveness evidence (see also Appendix A)
  • References
• 5. Stage 0-II melanoma
  • 5.1. Surgical management
  • 5.2. The use of imiquimod in stage 0 melanoma and skin metastases
  • References
• 6. Stage III melanoma
  • 6.1. Surgical management
  • 6.2. Adjuvant radiotherapy
  • 6.3. In-transit metastases
  • References
• 7. Stage IV melanoma
  • 7.1. Localised treatments for metastatic stage IV melanoma
  • 7.2. Localised treatment for brain metastases
  • 7.3. The role of systemic anticancer therapy
  • References
• 8. Follow-up
  • 8.1. Method, frequency and duration of follow-up
  • 8.2. Brain imaging
  • References
• 9. Other management issues during follow-up
  • 9.1. Managing suboptimal Vitamin D levels
  • 9.2. Concurrent drug therapies
  • References
• Appendices
  • Appendix A. The cost-effectiveness of sentinel node biopsy alongside wide excision versus wide excision only in patients with clinicopathological stage IA to stage IIC melanoma
  • Appendix B. Cost-effectiveness of different follow-up strategies in high risk cutaneous melanoma
  • Appendix C. Abbreviations
  • Appendix D. Glossary
  • Appendix E. Guideline scope
  • Appendix F. People and organisations involved in production of the guideline
  • Appendix G. Needs assessment
  • Appendices H. Full evidence review

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.