NICE has published its first guideline on melanoma which aims to reduce the numbers of people dying from the disease, and addresses the wide variations across the country in diagnosis and treatment.
Melanoma is the third most common skin cancer in the UK and accounts for more cancer deaths than all other skin cancers combined. In 2012, there were over 2000 deaths from melanoma, and over the last thirty years, rates of malignant melanoma in Britain have risen faster than any of the current ten most common cancers. Incidence rates have also increased more than five-fold since the mid 1970s.
The new NICE guideline focuses on assessing and managing melanoma, working out how far it has progressed (staging), identifying treatments for each stage of the disease, including when the cancer has spread, and outlines the best follow-up care after treatment.
Recommendations include:
- Improved, preferably nationally standardised information should be made available to all patients with melanoma. Information should be appropriate to the patients’ needs at that point in their diagnosis and treatment, and should be repeated over time. The information given must be specific to the type of lesion, type of treatment, local services and any choice within them, and should cover both physical and psychosocial issues.
- Dermoscopy and other visualisation techniques: assess all pigmented skin lesions that are either referred for further assessment or identified during follow-up in secondary or tertiary care, using dermoscopy carried out by healthcare professionals trained in this technique.
- The guideline also makes recommendations about the use of sentinel lymph node biopsy and subsequent lymph node removal where the biopsy shows evidence that the disease has spread.
- Include the brain as part of imaging for people with suspected stage 4 melanoma. Consider whole-body MRI for children and young people (from birth to 24 years) with stage 3 or stage 4 melanoma.
- Follow-up after treatment for melanoma: perform a full examination of the skin and regional lymph nodes at all follow-up appointments. Consider personalised followup for people who are at increased risk of further primary melanomas (for example people with atypical mole syndrome, previous melanoma, or a history of melanoma in first-degree relatives or other relevant familial cancer syndromes). Consider including the brain for people having imaging as part of follow-up after treatment for melanoma.
Commenting on the new guideline, Professor Mark Baker, Centre for Clinical Practice director at NICE, said: “This new guideline addresses areas where there is uncertainty or variation in practice, and will help clinicians to provide the very best care for people with suspected or diagnosed melanoma, wherever they live.”
