Melanoma: assessment and management

Research recommendations coming out of this guidance

• Monitoring and response biomarkers: Can biomarkers accurately classify recurrence, progression and response to treatment?

• Safety, prognostic and predictive biomarkers: Can biomarkers be used for risk stratification and treatment planning for people with melanoma?

• Effectiveness of localised treatments: What is the effectiveness of localised treatment for people with stages III and IV melanoma?

• Histological margins: What is the optimal histological excision margin in stage 0 melanoma?

• Surveillance strategies: How frequently should surveillance imaging be conducted, and which imaging modality should be used for people with stage IIB to IIIC melanoma?

• Survivorship: What are the experiences of people who are living with, through and beyond a melanoma diagnosis in terms of survivorship and their disease journey?

• Techniques for confirming a diagnosis in people with suspected atypical Spitzoid melanocytic lesions: In people with reported atypical Spitzoid lesions, how effective are fluorescence in situ hybridization (FISH), comparative genomic hybridization (CGH) and tests to detect driver mutations compared with histopathological examination alone in predicting disease specific survival?

  This should be investigated ina prospective diagnostic study. Secondary outcomes should include sensitivity, specificity, accuracy, positive predictive value, disease specific survival and progression free survival.

• Surgical excision for people with lentigo maligna: For people with lentigo maligna (stage 0 in sun damaged skin, usually on the face) how effective is Mohs micrographic surgery, compared with excision with a 0.5 cm clinical margin, in preventing biopsy proven local recurrence at 5 years?

  This should be investigated in a randomised controlled trial. Secondary outcomes should include cosmetic and functional outcomes.

• Vitamin D supplementation: In people with stage I to III melanoma does vitamin D supplementation improve overall survival?

  This should be investigated in a placebo controlled randomised trial. Secondary outcomes should include disease specific survival and toxicity, including the development of renal stones and hypercalcaemia.

• The effect of drug therapy for concurrent conditions on melanoma survival: In people diagnosed with melanoma what is the effect of drug therapy to treat concurrent conditions on disease specific survival?

  This should be investigated in a national prospective cohort study. Secondary outcomes should include overall survival and quality of life.