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Melanoma overview

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Melanoma

About

What is covered

This pathway covers suspected or newly diagnosed cutaneous melanoma (including vulval and penile melanoma) in children, young people and adults. However, there was insufficient high-quality evidence on which to make specific recommendations for vulval and penile melanoma. It does not cover primary ocular melanoma or melanoma arising in mucosal sites.
The pathway addresses areas where there is uncertainty or variation in practice. It contains recommendations on:
  • assessing and staging melanoma, including the use of sentinel lymph node biopsy
  • treating stages 0–IV melanoma, including adjuvant chemotherapy and immunotherapy
  • treating in-transit melanoma metastases
  • treating metastatic melanoma
  • follow-up after treatment for melanoma.
It also includes advice on managing vitamin D levels and drug therapy for intercurrent conditions in people diagnosed with melanoma.

Updates

Updates to this pathway

17 February 2016 Nivolumab for treating advanced (unresectable or metastatic) melanoma (NICE technology appraisal guidance 384) added to immunotherapy and targeted therapy.
24 November 2015 Pembrolizumab for advanced melanoma not previously treated with ipilimumab (NICE technology appraisal guidance 366) added to immunotherapy and targeted therapy.
10 November 2015 VivaScope 1500 and 3000 imaging systems for detecting skin cancer lesions (NICE diagnostic guidance 19) added to visualisation, photography and imaging.
06 October 2015 Pembrolizumab for treating advanced melanoma after disease progression with ipilimumab (NICE technology appraisal guidance 357) added to immunotherapy and targeted therapy.

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Patient-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

Assessment and management of melanoma

What is covered

This pathway covers suspected or newly diagnosed cutaneous melanoma (including vulval and penile melanoma) in children, young people and adults. However, there was insufficient high-quality evidence on which to make specific recommendations for vulval and penile melanoma. It does not cover primary ocular melanoma or melanoma arising in mucosal sites.
The pathway addresses areas where there is uncertainty or variation in practice. It contains recommendations on:
  • assessing and staging melanoma, including the use of sentinel lymph node biopsy
  • treating stages 0–IV melanoma, including adjuvant chemotherapy and immunotherapy
  • treating in-transit melanoma metastases
  • treating metastatic melanoma
  • follow-up after treatment for melanoma.
It also includes advice on managing vitamin D levels and drug therapy for intercurrent conditions in people diagnosed with melanoma.

Updates

Updates to this pathway

17 February 2016 Nivolumab for treating advanced (unresectable or metastatic) melanoma (NICE technology appraisal guidance 384) added to immunotherapy and targeted therapy.
24 November 2015 Pembrolizumab for advanced melanoma not previously treated with ipilimumab (NICE technology appraisal guidance 366) added to immunotherapy and targeted therapy.
10 November 2015 VivaScope 1500 and 3000 imaging systems for detecting skin cancer lesions (NICE diagnostic guidance 19) added to visualisation, photography and imaging.
06 October 2015 Pembrolizumab for treating advanced melanoma after disease progression with ipilimumab (NICE technology appraisal guidance 357) added to immunotherapy and targeted therapy.

Sources

NICE guidance and other sources used to create this pathway.
Melanoma (2015) NICE guideline NG14
Nivolumab for treating advanced (unresectable or metastatic) melanoma (2016) NICE technology appraisal guidance 384
Endoscopic radical inguinal lymphadenectomy (2011) NICE interventional procedure guidance 398

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Patient-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Possible advantages of surveillance imaging (having regular scans)
Possible disadvantages of surveillance imaging (having regular scans)
If the melanoma comes back (recurrent melanoma), it is more likely to be detected sooner. It is possible that this could lead to a better outcome by allowing treatment with drugs (such as immunotherapy drugs) to start earlier.
Although early drug treatment of recurrent melanoma might improve survival, there is currently no evidence showing this.
Some people find it reassuring to have regular scans.
Some people find that having regular scans increases their anxiety.
Scans expose the body to radiation, which can increase the risk of cancer in the future.
Scans of the brain and neck increase the risk of developing cataracts.
Scans of the chest cause a very small increase in the risk of thyroid cancer.
Scans may show abnormalities that are later found to be harmless, causing unnecessary investigations and anxiety.

Glossary

Paths in this pathway

Pathway created: July 2015 Last updated: March 2016

© NICE 2016

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