Guidance aims to iron out wide variations in melanoma management

Guidance aims to iron out wide variations in melanoma management

Around 13,500 new cases of melanoma are diagnosed each year in the UK and more than 2,000 people die each year of melanoma—more than all other skin cancers combined. And the numbers of new cases are predicted to increase by 50% in the next 15 years.

The new guideline focuses on diagnosing and managing melanoma, working out how far it has progressed, identifying treatments for each stage of the disease, including when the cancer has spread, and outlining the best follow-up care after treatment.

Professor Mark Baker, Centre for Clinical Practice director at NICE, said: “The number of people being diagnosed with melanoma is rising at a worrying rate – faster than any other cancer. If it is caught early, the melanoma can be removed by surgery. “

But he warned: “If it is not diagnosed until the advanced stages it may have spread, so is harder to treat. However, there are a number of options available to help slow the progress of the disease and improve quality of life.“

He added: “The new draft guideline addresses areas where there is uncertainty or variation in practice, and will help clinicians to provide coherent and consistent care for people with suspected or diagnosed melanoma wherever they live.”

The draft recommendations include the need to assess all pigmented skin lesions that are referred for further assessment, using dermoscopy (the examination of the skin using skin surface microscopy), carried out by healthcare professionals trained in this technique.

The guideline also recommends sentinel lymph node biopsy as a staging rather than a therapeutic procedure for people with stage 1B-2C melanoma with a Breslow thickness of 1 mm or more, and providing them with detailed verbal and written information about the possible advantages and disadvantages.

It suggests completion lymphadenectomy as an option for people with a positive sentinel lymph node biopsy (stage 3A melanoma) provided they are given detailed verbal and written information about the possible pros and cons of the procedure.

After treatment, the guideline suggests surveillance imaging for stage 2C or stage 3 melanoma in patients who would become eligible for systemic therapy as a result of early detection of metastatic disease in certain circumstances.

The draft guidance is now open for consultation, with final guidance expected in July this year.

By Caroline White,

OnMedica, Monday 2 February 2015

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