Evidence

2019 surveillance of melanoma: assessment and management (NICE guideline NG14) and improving outcomes for people with skin tumours including melanoma (NICE guideline CSG8)

Surveillance decision

Surveillance decision

In May 2019 we decided to update the following guidelines:

In December 2020, we decided to retain but not update the guideline on improving outcomes for people with skin tumours including melanoma. For information on progress of the melanoma guideline update, see the guideline in development page.

Reasons for the decision

Melanoma: assessment and management

Topic experts, stakeholders and external correspondents highlighted the introduction of a revised 8th edition of the American Joint Committee on Cancer (AJCC) staging system for melanoma. Development of the 8th edition involved an evidence-based revision of stage I-III melanoma, and the introduction of a new category of stage IV disease. Nomenclature for stage III disease also changed, so that microscopic nodal disease should now be termed 'clinically occult' and macroscopic nodal disease should be termed 'clinically detected'. A comparison between the 7th and 8th editions of the AJCC staging systems indicated that stage 0 and stages IIA-IIC melanoma should be unaffected by the introduction of the 8th AJCC edition. All other stages of melanoma are likely to be affected by the revision in staging.

The stages of melanoma referred to in the NICE guideline are from the previous 7th edition of the AJCC staging system. Therefore, this revision has the potential to impact on multiple recommendations in the NICE guideline that refer to specific stages of melanoma that have been redefined under the new system. These include recommendations under the following sections:

  • 1.2 Assessing melanoma (recommendations on genetic testing in early stage melanoma).

  • 1.5 Staging investigations (recommendations on sentinel lymph node biopsy [SLNB] and the use of imaging in staging).

  • 1.6 Managing stages 0-II melanoma (1 recommendation on excision for stage I melanoma).

  • 1.7 Managing stage III melanoma (recommendations on completion lymphadenectomy, lymph node dissection, and adjuvant radiotherapy).

  • 1.8 Managing stage IV melanoma (as a new subcategory has been introduced under stage IV disease to denote central nervous system disease).

  • 1.9 Follow-up after treatment for melanoma (potential impact on several recommendations).

We consulted on a proposal to withdraw recommendations 1.1.1, 1.1.2, 1.1.4 and 1.1.5 on communication and support and replace them with a cross reference to the NICE guideline on patient experience in adult NHS services, and also to retain recommendation 1.1.3 on the provision of advice on skin protection and avoidance of vitamin D depletion, but to move it to section 1.3 on managing suboptimal vitamin D levels. However, comments received at consultation described the value of specific communication, information and support to people with melanoma and so recommendations 1.1.1 to 1.1.5 will be retained.

For further details and a summary of all evidence identified in surveillance, see appendix A1.

Improving outcomes for people with skin tumours including melanoma

Topic expert feedback received during surveillance indicated that this NICE guideline is considered outdated, does not reflect current service structures, and is no longer fit for purpose. Key issues include changes in cancer infrastructure and strategy, and developments in assessment, staging and management of skin cancer since the publication of the guideline.

The 2010 partial update refers to service structures that are no longer in operation, including cancer networks and primary care trusts.

We consulted on the surveillance proposal to withdraw this guideline. Stakeholders emphasised the continuing usefulness of it to clinical practice. However, as service structures have changed since it was published, it is proposed that we update it.

In December 2020, we decided to retain but not update this guideline. For information on progress of the melanoma guideline update, see the guideline in development page.


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