Clinical practice guidelines for the diagnosis and management of melanoma
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Foreword
Summary of recommendations
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 for 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?
Management of primary melanoma and lentigo maligna
- What are the recommended safety margins for radical excision of primary melanoma (in situ)?
- 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?
- Management of primary desmoplastic and neurotropic melanomas
Management of melanoma in children
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?
Management of melanoma in pregnancy
- Does pregnancy following a diagnosis of melanoma affect prognosis?
- What is the optimal management for pregnant women with melanoma?
- Continuation of HRT or oral contraceptive pill
Investigations and follow-up for melanoma 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 for patients with melanoma
- Systemic drug therapy for patients with brain metastases
- Surgical approach to brain metastases
- Radiotherapy for patients with brain metastases
- Treatment approaches to brain metastases: Summary of recommendations
Systemic therapy
- 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?
Management of mucosal melanoma
Management of ocular melanoma
Multidisciplinary care of melanoma patients
Appendices
Working party members and contributors