Melanoma guidelines

In a recent critical appraisal and review of melanoma guidelines, all of the participants drew the same conclusions

Melanoma: management guidelines should consolidate as more data become available (Photograph: Dr P Marazzi/SPL)
Melanoma: management guidelines should consolidate as more data become available (Photograph: Dr P Marazzi/SPL)

In a recent critical appraisal and review of melanoma guidelines from different global organisations, by a number of multidisciplinary teams involved in the care of patients with melanoma, all of the participants drew the same conclusions when data (such as staging excisional margins, sentinel lymph node biopsy) were readily available.

However, differences occurred when there were few studies to support the recommendations.

The recommendations were consistent on a number of diagnosis and management points, such as the lack of evidence to support routine total body melanoma screening, excisional biopsies for lesions <2cm in non-sensitive skin types, excision of melanomas 1-2cm thick with a 1-2cm margin, and use of ipilimumab or vemurafenib in disseminated metastatic disease, depending on BRAF mutation biomarker testing. Recommendations for follow-up and surveillance were varied.

There was little information on the effects of close surveillance on survival, disease control and quality of life. For example, the Australian guidelines endorse a comprehensive examination every three to four months for five years and annually thereafter, whereas the US suggests every three to four months for three years, then annually. The Europeans do not provide strong recommendations on follow-up.

As more data become available, the expectation is that all patients with melanoma will be treated according to the same universal set of scientifically proven guidelines.

Fong ZV, Tanabe KK. Br J Dermatol 2014; 170: 20-30.

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