Introduction

Melanoma is the third most common skin cancer in the UK. It accounts for more cancer deaths than all other skin cancers combined. In 2011 there were 13,348 new cases of melanoma and 2209 deaths from melanoma.

Although melanoma is more often diagnosed in older people, it is increasingly affecting younger people. More than 900 adults aged under 35 are now diagnosed with melanoma annually in the UK, and it is the second most common cancer in adults aged between 25 and 49. Melanoma therefore leads to more years of life lost overall than many more common cancers.

Most melanomas occur in people with pale skin. The risk factors are skin that tends to burn in the sun, having many moles, intermittent sun exposure and sunburn.

This guideline 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.

The guideline also includes advice on managing vitamin D levels and drug therapy for intercurrent conditions in people diagnosed with melanoma.

The guideline 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.

Safeguarding children

Remember that child maltreatment:

  • is common

  • can present anywhere

  • may co‑exist with other health problems, including melanoma.

See the NICE guideline on child maltreatment for clinical features that may be associated with maltreatment.

Medicines

The guideline will assume that prescribers will use a medicine's summary of product characteristics to inform decisions made with individual patients.

This guideline recommends some medicines for indications for which they do not have a UK marketing authorisation at the date of publication, if there is good evidence to support that use. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. The patient (or those with authority to give consent on their behalf) should provide informed consent, which should be documented. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information. Where recommendations have been made for the use of medicines outside their licensed indications ('off‑label use'), these medicines are marked with a footnote in the recommendations.

  • National Institute for Health and Care Excellence (NICE)