List of clinical questions
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Clinical practice guidelines for the diagnosis and management of melanoma > List of clinical questions
Identification and management of high-risk individuals
- What are the genetic determinants of high risk for new primary melanomas?
- What validated models integrate genetic and clinical risk factors into an overall measurement of high risk from new primary melanoma?
- What interventions have been shown to provide clinical benefit in those assessed to be at high risk of new primary melanomas?
Diagnosis
- What are the clinical features of melanoma and how do atypical melanomas present?
- Diagnostic aids for melanoma
- What is the role of dermoscopy in melanoma diagnosis?
- What is the role of sequential digital dermoscopy imaging in melanoma diagnosis?
- What is the role of automated instruments in melanoma diagnosis?
- What is the role of confocal microscopy in melanoma diagnosis?
- What is the role of skin surface imaging (total body photography) in the early diagnosis of patients at high risk of developing melanoma?
Biopsy
- What type of biopsy should be performed for a pigmented lesion suspicious for melanoma?
- What clinical information should the clinician give the pathologist to aid diagnosis of melanoma?
Definitive margins for excision of primary melanoma
- What are the recommended safety margins for radical excision of a primary melanoma?
- What are the recommended safety margins for radical excision of invasive melanomas?
- When is a sentinel node biopsy indicated?
- Should patients with a positive sentinel lymph node biopsy have a complete node dissection?
- What are the most effective treatment/management interventions to improve outcomes in patients with lentigo maligna?
- Primary desmoplastic and neurotropic melanomas
Melanoma in children
Management of melanoma in pregnancy
- Does pregnancy following a diagnosis of melanoma affect prognosis?
- What is the optimal management of pregnant women with melanoma?
- Should hormone replacement therapy or oral contraceptive pill be discontinued upon development of melanoma?
Management of melanocytic tumour of unknown malignant potential
- What is the role of sentinel node biopsy in the management of MELTUMPs?
- In patients with MELTUMPs, what excision margins are appropriate?
Investigations and follow-up for melanoma patients
- What investigations should be performed following a diagnosis of primary cutaneous melanoma for asymptomatic stage I and II patients?
- What investigations should be performed when in transit and/or regional node disease (stage III melanoma) is diagnosed?
- What investigations should be performed when stage IV melanoma is diagnosed?
- How should patients at each stage of melanoma be followed up after initial definitive treatment?
- What are the ideal frequency and duration of follow-up for melanoma patients?
Treatment of satellite and in-transit metastases
Treatment of macroscopic nodal metastases
Surgical therapy for patients with distant metastases
Treatment approaches to brain metastases in patients with advanced melanoma
- What is the role of systemic drug therapy in the management of patients with advanced melanoma brain metastases?
- What is the recommended surgical treatment of brain metastases in patients with advanced melanoma?
- When is radiotherapy indicated for patients with distant brain metastases?
- Summary of recommendations and practice points
Systemic therapy for distant metastases
- What is the role of adjuvant systemic therapy in patients with resected stage II and stage III melanoma?
- Does systemic drug therapy improve progression-free and overall survival in unresectable stage IIIC and stage IV melanoma?
Radiotherapy
- For patients with distant metastases (other than brain metastases), when is radiotherapy indicated?
- Is adjuvant radiotherapy of value following resection of involved lymph nodes?
Mucosal melanoma What is the appropriate treatment of mucosal melanoma?
Mucosal melanoma What is the appropriate treatment of ocular melanoma?
Multidisciplinary care Is multidisciplinary care of value in the management of melanoma?