Melanoma is a type of skin cancer which can spread to other parts of the body. It is most common in people who have pale skin, or many moles or tend to burn in the sun. It occurs when some cells in the skin begin to develop abnormally and is thought to be caused by exposure to ultraviolet (UV) light from natural or artificial sources. There are currently around 13,500 new cases diagnosed each year in the UK and more than 2,000 people die each year from melanoma – more than all other skin cancers combined – and incidence is predicted to increase by 50% in the next 15 years.

The new guideline focuses on diagnosing 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 for melanoma.

Commenting on the new draft recommendations, Professor Mark Baker, Centre for Clinical Practice director at NICE, said: “The number of people being diagnosed with melanoma is rising at a worrying rate – faster than any other cancer. If it is caught early, the melanoma can be removed by surgery.  If it is not diagnosed until the advanced stages it may have spread, so is harder to treat. However, there are a number of options available to help slow the progress of the disease and improve quality of life.

“The new draft guideline addresses areas where there is uncertainty or variation in practice, and will help clinicians to provide coherent and consistent care for people with suspected or diagnosed melanoma wherever they live.”

Draft recommendations include:

• Dermoscopy[1] and other visualisation techniques: Assess all pigmented skin lesions that are referred for further assessment, and during follow-up, using dermoscopy carried out by healthcare professionals trained in this technique.
• Assessing the progress of the melanoma: Consider sentinel lymph node biopsy as a staging rather than a therapeutic procedure for people with stage 1B-2C melanoma with a Breslow thickness[2] of 1 mm or more, and give them detailed verbal and written information about the possible advantages and disadvantages.
• Completion lymphadenectomy: Consider completion lymphadenectomy for people with a positive sentinel lymph node biopsy (stage 3A melanoma) and give them detailed verbal and written information about the possible advantages and disadvantages
• Follow-up after treatment for melanoma: Consider surveillance imaging as part of follow-up for people who have had stage 2C with no sentinel lymph node biopsy or stage 3 melanoma and who would become eligible for systemic therapy as a result of early detection of metastatic disease in certain circumstance.

Ends

For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors

About the draft guideline

1. The draft guideline will be available at /guidance/indevelopment/GID-CGWAVE0674 from 30 January 2015. Embargoed copies of the draft guidance are available from the NICE press office on request.
2. Related NICE guidance:
• Cancer service guidance on improving outcomes for people with skin tumours including Melanoma - /guidance/CSGSTIM. Cancer Service Guidance is a series of recommendations for the organisation and delivery of care for individuals in specific clinical conditions or circumstances – from prevention and self-care through to primary and secondary care and onto more specialised services
• Public health guidance on skin cancer prevention: information, resources and environmental changes - /guidance/PH32
• The draft public health guideline on sunlight exposure: communicating the benefits and risks to the general public - http://www.nice.org.uk/guidance/gid-phg77/resources/sunlight-exposure-benefits-and-risks-draft-guideline2 (which includes a partial update of PH32) .
3. The stages of melanoma can be described as:

Stage 0 – the melanoma is on the surface of the skin. 
Stage 1A – the melanoma is less than 1mm thick.
Stage 1B – the melanoma is 1-2mm thick, or the melanoma is less than 1mm thick and the surface of the skin is broken (ulcerated) or its cells are dividing faster than usual (mitotic activity).
Stage 2A – the melanoma is 2-4mm thick, or the melanoma is 1-2mm thick and is ulcerated.
Stage 2B – the melanoma is thicker than 4mm, or the melanoma is 2-4mm thick and ulcerated.
Stage 2C – the melanoma is thicker than 4mm and ulcerated.
Stage 3A – the melanoma has spread into one to three nearby lymph nodes, but they are not enlarged; the melanoma is not ulcerated and has not spread further.
Stage 3B – the melanoma is ulcerated and has spread into one to three nearby lymph nodes but they are not enlarged, or the melanoma is not ulcerated and has spread into one to three nearby lymph nodes and they are enlarged, or the melanoma has spread to small areas of skin or lymphatic channels, but not to nearby lymph nodes.
Stage 3C – the melanoma is ulcerated and has spread into one to three nearby lymph nodes and they are enlarged, or the melanoma has spread into four or more lymph nodes nearby.
Stage 4 – the melanoma cells have spread to other areas of the body, such as the lungs, brain or other parts of the skin.