Treatment of Cutaneous Melanoma
The following map shows how the Melanoma Taskforce’s Quality Statements, detailed below, correspond with the appropriate section of the Melanoma Care Pathway (click on the diagram to enlarge it).
QS 1. People are made aware of the symptoms and signs of melanoma through national and local coordinated public awareness campaigns.
QS 2. People with melanoma should have access to a multi-disciplinary team comprising all specialist core members with clinics running simultaneously to facilitate timely clinical discussion and decision making.
QS 3. Patients newly diagnosed with stage 2B or higher melanoma (or stage ≥1B if SLNB is offered) should be referred to a SSMDT in line with current national guidance.
QS 4. People with a suspected melanoma, when being referred by a GP, are done so within the Urgent Suspected Cancer (USC) framework (Two Week Wait), and where possible a photograph of the suspected lesion should be taken, in order to aid triage.
QS 5. People with a suspected melanoma should have the lesion excised completely, as incisional, punch biopsy, or curettage of melanoma may prejudice the measurement of Breslow thickness and may also lead to incorrect histopathological diagnosis as a result of sampling error.
QS 6. People with suspicious lesion(s) have a full history of the lesion(s) taken, followed by a detailed examination of the findings, including: a differential clinical diagnosis; a clinical photograph; and histopathology. All information gathered in the process of diagnosis is available to an LSMDT or to a SSMDT to minimise the risk of error in agreeing upon the final diagnosis.
QS 7. People with melanoma have access to a named “key worker” who will normally be a SCCNS, (but may be an alternative named member of the Skin Cancer MDT), and are offered a holistic needs assessment, including psychological support requirements, at each key stage of care.
QS 8. Although sentinel lymph node biopsy (SLNB) has no established survival value, it is a staging tool for melanoma. People with primary melanoma should be given a clear description of this procedure, its risks and benefits and information on appropriate clinical trials. Those who choose to have a SLNB should be referred promptly to the centre of their choice.
QS 9. People having treatment for melanoma are offered timely and personalised information and support including an appropriately-tailored written follow up care plan.
QS 10. Melanoma patients with good prognosis melanoma (AJCC stage 0 to 1A), who have had a second Out-Patient Department (OPD) appointment and SCCNS consultation following definitive surgery, may be offered Deferred Discharge (discharge allowing subsequent rapid access back to their Skin Cancer Service if they display symptoms that are cause for concern).
QS 11. Patients (AJCC stage 1B to IV) will have regular specialist follow up, 3 monthly for 3 years, thereafter 6 monthly for 2 years, which can include protocol-led clinical nurse specialist follow-up. After the 5 year period of specialist follow-up, Deferred Discharge is discussed with the patient.
QS 12. Melanoma patients with a family history of melanoma or atypical naevus syndrome will require longer term supervision by specialist services which have access to photography using dermoscopy.
QS 13. People with ≥ Stage IIIB melanoma should be offered genotyping of their melanoma to allow subsequent planning of systemic treatment by the multidisciplinary team.
QS 14. Patients with advanced cutaneous melanoma should have equitable access to the full range of available clinically-appropriate therapeutic options.
QS 15. People with melanoma, including Teenagers and Young Adults (16 -24), are offered the opportunity to take part in NCRN approved clinical trials for which they are eligible within the NHS, irrespective of where the trial is taking place. Teams should demonstrate contribution to NCRN trials in the preceding 3 years.
QS 16. Patients with melanoma have access to all appropriate palliative interventions delivered by an expert nominated clinical team.