Practice Guidelines

Melanoma: summary of NICE guidance

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h3708 (Published 29 July 2015) Cite this as: BMJ 2015;351:h3708
  1. Fergus Macbeth, associate director1,
  2. Julia Newton-Bishop, professor of dermatology2,
  3. Susan O’Connell, researcher3,
  4. James E Hawkins, health economist3
  5. On behalf of the Guideline Development Group
  1. 1Wales Cancer Trials Unit, Cardiff CF14 4YS, UK
  2. 2University of Leeds, Leeds, UK
  3. 3National Collaborating Centre for Cancer, Cardiff, UK
  1. Correspondence to: F Macbeth fergus.macbeth{at}btinternet.com

The bottom line

  • Use dermoscopy to examine all pigmented lesions referred for assessment and ensure that all staff are adequately trained in its use

  • Consider sentinel node biopsy as a staging tool for patients with stage II melanoma and stage 1B melanoma thicker than 1 mm. Use box 1 or the options grid being developed to discuss the potential advantages and disadvantages of the procedure with patients

  • If a sentinel node biopsy is positive for melanoma, discuss the potential advantages and disadvantages of completion lymphadenectomy with the patient using box 2 or the options grid being developed

  • Consider regular imaging in patients at greater risk of progression to stage IV (metastatic) melanoma. Use box 3 or the options grid being developed to discuss potential advantages and disadvantages of this with the patient

How patients were involved in the creation of this article

Committee members involved in this guideline update included lay members who contributed to the formulation of the recommendations summarised here. Patient and carer organisations were among the stakeholders who commented on the draft guideline.

Melanoma is the fifth most common cancer in the United Kingdom, with more than 13 000 cases diagnosed in 2011 and its incidence is rising rapidly.1 Clinical practice seems to vary in the UK, especially with regard to the use of dermoscopy and photography, access to sentinel lymph node biopsy, vitamin D measurement and advice, follow-up policies, and the use of routine follow-up imaging. Patient groups have reported inadequate information on management options.

This article summarises the most important recent recommendations from the National Institute for Health and Care Excellence (NICE) on the diagnosis and care of people with melanoma.2

Recommendations

NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline development group’s experience and opinion of what …

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